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KMID : 1011920120130020039
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International Journal of Arrhythmia
2012 Volume.13 No. 2 p.39 ~ p.43
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A case of severe bradycardia secondary to premature atrial beats
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Nam Gi-Byoung
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Abstract
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The standard management of patients with paroxysmal atrial fibrillation (AF) and severe bradycardia (tachycardia-bradycardia syndrome) includes pacemaker implantation and antiarrhythmic medication. Recent progress in interventional electrophysiology has introduced catheter ablation as an important therapeutic option for AF. A 78-year-old woman presented with severe left flank pain and hematuria. She was found to have paroxysmal AF and embolic renal infarction. During hospital admission, symptomatic bradycardia was noted. She was referred to the arrhythmia unit for pacemaker implantation. Careful review of electrocardiograms revealed that closely coupled bigeminy premature atrial beats (PABs) were blocked at the atrioventricular junction, mimicking severe sinus bradycardia. Administration of oral flecainide suppressed PABs and restored the sinus rhythm. This case emphasizes the importance of mechanism-specific approaches in the management of patients with bradycardia.
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KEYWORD
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bradycardia, pacemaker, premature
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