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Tan RBM, Giglia TM, Cecchin F. Time to Move Forward on Pediatric Atrial Standstill. JACC Clin Electrophysiol 2023; 9:70-72. [PMID: 36697202 DOI: 10.1016/j.jacep.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/20/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Reina Bianca M Tan
- Division of Cardiology, Hassenfeld Children's Hospital, NYU Langone Health, New York, New York USA
| | - Therese M Giglia
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Frank Cecchin
- Division of Cardiology, Hassenfeld Children's Hospital, NYU Langone Health, New York, New York USA.
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2
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Ahnfeldt AM, de Knegt VE, Reimers JI, Børresen ML. Atrial standstill presenting as cerebral infarction in a 7-year-old girl. SAGE Open Med Case Rep 2019; 7:2050313X19827735. [PMID: 30783526 PMCID: PMC6366293 DOI: 10.1177/2050313x19827735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 01/10/2019] [Indexed: 11/17/2022] Open
Abstract
Atrial standstill is a rare arrhythmia defined by the absence of mechanical and electrical activity in the atria. Few cases of atrial standstill have been described in children, none of which have presented with cerebral infarction confirmed by imaging. We report a unique case of a 7-year-old girl presenting with expressive aphasia, central facial palsy and irregular pulse with cerebral infarction secondary to atrial standstill. This case illustrates that cardiogenic cerebral embolism in children can be caused by rare conditions like atrial standstill and should be considered in paediatric patients undergoing evaluation for stroke. There are no established treatment guidelines for atrial standstill. We recommend that treatment be directed towards any potential underlying cause. All patients with atrial standstill should receive long-term oral anticoagulation treatment and a permanent cardiac pacemaker implant to reduce the risk of further strokes or other cardiac events.
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Affiliation(s)
- Agnethe May Ahnfeldt
- Department of Pediatrics, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Jesper Irving Reimers
- The Child and Adolescent Clinic, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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3
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Lehmann HI, Meltendorf U, Klein HU. Long-term follow-up of permanent atrial standstill in a German family with mutation in the SCN5A gene. HeartRhythm Case Rep 2018; 4:356-358. [PMID: 30116708 PMCID: PMC6092983 DOI: 10.1016/j.hrcr.2018.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/15/2018] [Accepted: 04/30/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- H Immo Lehmann
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Ulf Meltendorf
- Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Helmut U Klein
- Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.,Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, New York
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4
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5
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Bradiarritmias y bloqueos de la conducción. Rev Esp Cardiol 2012; 65:656-67. [DOI: 10.1016/j.recesp.2012.01.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 01/20/2012] [Indexed: 11/19/2022]
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6
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Varma N, Helms R, Benson DW, Sanagala T. Congenital Sick Sinus Syndrome With Atrial Inexcitability and Coronary Sinus Flutter. Circ Arrhythm Electrophysiol 2011; 4:e52-8. [DOI: 10.1161/circep.111.964213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Niraj Varma
- From the Loyola University Medical Center, Maywood, IL (N.V., R.H., T.S.), and Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH (W.B.)
| | - Ray Helms
- From the Loyola University Medical Center, Maywood, IL (N.V., R.H., T.S.), and Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH (W.B.)
| | - D. Woodrow Benson
- From the Loyola University Medical Center, Maywood, IL (N.V., R.H., T.S.), and Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH (W.B.)
| | - Thriveni Sanagala
- From the Loyola University Medical Center, Maywood, IL (N.V., R.H., T.S.), and Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH (W.B.)
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7
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Abstract
Atrial standstill is a rare form of bradyarrhythmia and consists of a transitory or permanent loss of the electrical and mechanical activity of the atria. It has been described in a few cases of long-standing valvular disease, amyloidosis, myocarditis, and muscular dystrophy. We report on a young female with noncompaction cardiomyopathy that progressed to congestive heart failure. Electrocardiogram showed persistence atrial standstill that was confirmed clinically and by electrocardiomyopathy, Doppler two-dimensional echocardiogram, and tissue Doppler imaging. We assume that worsening of asymptomatic noncompaction and progression to the congestive form of cardiomyopathy could be presaged by the presence of persistent atrial standstill. Thus, persistence of atrial standstill in asymptomatic cardiomyopathy is a sign of poor prognosis.
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Affiliation(s)
- A A El Menyar
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation and Hamad General Hospital, P. O. Box 3050, Doha, State of Qatar.
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8
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Fazelifar AF, Arya A, Haghjoo M, Sadr-Ameli MA. Familial Atrial Standstill in Association with Dilated Cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:1005-8. [PMID: 16176547 DOI: 10.1111/j.1540-8159.2005.00198.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
. Atrial standstill is an extremely uncommon arrhythmia that rarely appears to be familial and genetically determined. Atrial standstill has been associated with several conditions including, but not restricted to, congenital heart disease, valvular heart disease, conduction disturbances, Brugada syndrome, myocardial infarction, and amyloidosis. Only a few cases of familial clustering of atrial standstill have been reported so far. This report represents a family with atrial standstill associated with syncope, dilated cardiomyopathy, and sudden cardiac death.
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Affiliation(s)
- Amir Farjam Fazelifar
- Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical Center, Iran University of Medical Sciences, Mellat Park, Vali-Asr Avenue, Tehran 1996911151, Iran
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9
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Benson DW, Wang DW, Dyment M, Knilans TK, Fish FA, Strieper MJ, Rhodes TH, George AL. Congenital sick sinus syndrome caused by recessive mutations in the cardiac sodium channel gene (SCN5A). J Clin Invest 2003; 112:1019-28. [PMID: 14523039 PMCID: PMC198523 DOI: 10.1172/jci18062] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sick sinus syndrome (SSS) describes an arrhythmia phenotype attributed to sinus node dysfunction and diagnosed by electrocardiographic demonstration of sinus bradycardia or sinus arrest. Although frequently associated with underlying heart disease and seen most often in the elderly, SSS may occur in the fetus, infant, and child without apparent cause. In this setting, SSS is presumed to be congenital. Based on prior associations with disorders of cardiac rhythm and conduction, we screened the alpha subunit of the cardiac sodium channel (SCN5A) as a candidate gene in ten pediatric patients from seven families who were diagnosed with congenital SSS during the first decade of life. Probands from three kindreds exhibited compound heterozygosity for six distinct SCN5A alleles, including two mutations previously associated with dominant disorders of cardiac excitability. Biophysical characterization of the mutants using heterologously expressed recombinant human heart sodium channels demonstrate loss of function or significant impairments in channel gating (inactivation) that predict reduced myocardial excitability. Our findings reveal a molecular basis for some forms of congenital SSS and define a recessive disorder of a human heart voltage-gated sodium channel.
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Affiliation(s)
- D Woodrow Benson
- Department of Pediatrics, Cincinnati Children's Hospital, Ohio, USA.
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10
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Benson DW, Wang DW, Dyment M, Knilans TK, Fish FA, Strieper MJ, Rhodes TH, George AL. Congenital sick sinus syndrome caused by recessive mutations in the cardiac sodium channel gene (SCN5A). J Clin Invest 2003. [DOI: 10.1172/jci200318062] [Citation(s) in RCA: 406] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Groenewegen WA, Firouzi M, Bezzina CR, Vliex S, van Langen IM, Sandkuijl L, Smits JPP, Hulsbeek M, Rook MB, Jongsma HJ, Wilde AAM. A cardiac sodium channel mutation cosegregates with a rare connexin40 genotype in familial atrial standstill. Circ Res 2003; 92:14-22. [PMID: 12522116 DOI: 10.1161/01.res.0000050585.07097.d7] [Citation(s) in RCA: 179] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atrial standstill (AS) is a rare arrhythmia that occasionally appears to be genetically determined. This study investigates the genetic background of this arrhythmogenic disorder in a large family. Forty-four family members were clinically evaluated. One deceased and three living relatives were unambiguously affected by AS. All other relatives appeared unaffected. Candidate gene screening revealed a novel mutation in the cardiac sodium channel gene SCN5A (D1275N) in all three affected living relatives and in five unaffected relatives, and the deceased relative was an obligate carrier. In addition, two closely linked polymorphisms were detected within regulatory regions of the gene for the atrial-specific gap junction protein connexin40 (Cx40) at nucleotides -44 (G-->A) and +71 (A-->G). Eight relatives were homozygous for both polymorphisms, which occurred in only approximately 7% of control subjects, and three of these relatives were affected by AS. The three living AS patients exclusively coinherited both the rare Cx40 genotype and the SCN5A-D1275N mutation. SCN5A-D1275N channels showed a small depolarizing shift in activation compared with wild-type channels. Rare Cx40 genotype reporter gene analysis showed a reduction in reporter gene expression compared with the more common Cx40 genotype. In this study, familial AS was associated with the concurrence of a cardiac sodium channel mutation and rare polymorphisms in the atrial-specific Cx40 gene. We propose that, although the functional effect of each genetic change is relatively benign, the combined effect of genetic changes eventually progresses to total AS.
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Abstract
A child with familial atrial standstill and a ventricular pacemaker had syncope due to atrial flutter that was treated by His-bundle ablation. Bradycardia protection alone may be insufficient in patients with atrial standstill.
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Affiliation(s)
- S Balaji
- Royal Brompton Hospital, London, United Kingdom
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14
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Posada Rodríguez IJ, Gutiérrez-Rivas E, Cabello A. [Cardiac involvement in neuromuscular diseases]. Rev Esp Cardiol 1997; 50:882-901. [PMID: 9470454 DOI: 10.1016/s0300-8932(97)74695-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Many neuromuscular disorders involve the heart, occasionally with overt clinical disease. Muscular dystrophies (dystrophinopathies, limb girdle muscular dystrophy, Emery-Dreifuss muscular dystrophy, Steinert's myotonic dystrophy), congenital myopathies, inflammatory myopathies and metabolic diseases (glycogenosis, periodic paralysis, mitochondrial diseases) may produce dilated or hypertrophic cardiomyopathy and heart rhythm or conduction disturbances. Furthermore the heart is commonly involved in some hereditary and degenerative diseases (Friedreich's ataxia and Kugelberg-Welander syndrome) and acquired (Guillain-Barré syndrome) or inherited (Refsum's disease and Charcot-Marie-Tooth syndrome) polyneuropathies. A cardiologist's high clinical suspicion and a simple but systematic skeletal muscle and peripheral nerve investigation, including muscle enzymes quantification, neurophysiological study and muscle biopsy, are necessary for an accurate diagnosis. In selected patients, more sophisticated biochemical and genetic analysis will be necessary. In most cases, endomyocardial biopsy is not essential for the diagnosis.
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MESH Headings
- Adolescent
- Adult
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/etiology
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/etiology
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/etiology
- Charcot-Marie-Tooth Disease/complications
- Child
- Child, Preschool
- Echocardiography
- Electrocardiography
- Glycogen Storage Disease/complications
- Glycogen Storage Disease/diagnosis
- Heart Diseases/diagnosis
- Heart Diseases/etiology
- Humans
- Infant
- Infant, Newborn
- Male
- Middle Aged
- Mitochondrial Myopathies/complications
- Mitochondrial Myopathies/diagnosis
- Muscular Atrophy/complications
- Muscular Atrophy/diagnosis
- Muscular Dystrophies/complications
- Muscular Dystrophies/diagnosis
- Myopathies, Nemaline/complications
- Myopathies, Nemaline/diagnosis
- Neuromuscular Diseases/complications
- Neuromuscular Diseases/diagnosis
- Neuromuscular Diseases/metabolism
- Paralyses, Familial Periodic/complications
- Paralyses, Familial Periodic/diagnosis
- Polyradiculoneuropathy/complications
- Polyradiculoneuropathy/diagnosis
- Refsum Disease/complications
- Refsum Disease/diagnosis
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15
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Ho SY. Sinus node dysfunction, atrioventricular block, and bundle branch and fascicular blocks: Morphologic aspects. PROGRESS IN PEDIATRIC CARDIOLOGY 1994. [DOI: 10.1016/s1058-9813(05)80010-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Simpson IA, Jones S, Camm AJ. Total atrial paralysis after permanent dual chamber cardiac pacing. BRITISH HEART JOURNAL 1993; 69:191-2. [PMID: 8435248 PMCID: PMC1024951 DOI: 10.1136/hrt.69.2.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A 73 year old woman with known ischaemic heart disease and ischaemic ventricular tachycardia underwent temporary dual chamber pacing as part of the treatment to suppress tachycardia. Insertion of a permanent dual chamber system seven days later was uncomplicated. Total atrial paralysis, with inability to pace the atrium or obtain an atrial electrocardiogram from four atrial sites, developed within 24 hours of the permanent system being implanted. Atrial electrical and mechanical function recovered over several weeks.
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Affiliation(s)
- I A Simpson
- Department of Cardiological Sciences, St George's Hospital Medical School, London
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17
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Affiliation(s)
- M K Shah
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Talwar KK, Dev V, Chopra P, Dave TH, Radhakrishnan S. Persistent atrial standstill--clinical, electrophysiological, and morphological study. Pacing Clin Electrophysiol 1991; 14:1274-80. [PMID: 1719505 DOI: 10.1111/j.1540-8159.1991.tb02867.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Persistent atrial standstill (PAS) is a rare disorder characterized by absence of atrial activity on the surface and intracavity electrograms, absence of atrial mechanical activity, and inability to electrically stimulate the atria. Four patients (ages 18-60 years) with PAS were evaluated. One of these (no. 3) only had right atrial (RA) standstill, whereas left atrium (LA) showed spontaneous activity and could be stimulated electrically. As RA biopsy is not possible, right ventricular (RV) endomyocardial biopsy (EMB) was obtained to identify possible atrial pathology that revealed inflammatory myocarditis, 2; amyloidosis, 1; and myocardial hypertrophy with fibrosis, 1. Three patients were given permanent pacemakers. One of these with amyloidosis died suddenly. One is lost to follow-up. The others cases are persisting with PAS.
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Affiliation(s)
- K K Talwar
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi
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Abstract
There are many genetic disorders associated with an increased risk for stroke that may easily be overlooked in the evaluation of both adult and pediatric acute stroke victims. The recognition of a genetic disorder as the cause of a stroke has important implications not only for the immediate care of the stroke victim, but often also for others in the patient's family who may be at risk for the same disease and for whom preventive measures sometimes can be taken. We present here a comprehensive review of genetic disorders associated with stroke in the nongeriatric age groups for which a causative role in the evolution of stroke has been recognized or is likely. For each disorder, the major clinical and biochemical characteristics as well as the probable pathogenetic mechanisms of stroke are discussed, together with the appropriate testing required to screen for and confirm the diagnosis. The great variety of genetic disorders and mechanisms causing stroke underscores the increasing importance of understanding genetic disease for appropriate diagnosis and treatment of a common clinical problem affecting both children and adults.
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Affiliation(s)
- M Natowicz
- Division of Genetics, Children's Hospital of Philadelphia, PA 19104
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Abstract
Emery-Dreifuss muscular dystrophy is sometimes referred to as benign X-linked muscular dystrophy. We present two young patients with this disorder who had severe cardiovascular complications including: conduction disease, major thromboembolic events, valvular dysfunction with congestive cardiac failure, ventricular tachyarrhythmias, and sudden cardiac death. Of these cardiac problems, only conduction disease has been previously emphasized. This form of muscular dystrophy is not benign--it has malignant cardiac manifestations.
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