[A case of atrial standstill associated with combined valvular disease]

A 62-year-old man was admitted to our hospital because of general malaise. The chest X-ray film showed severe cardiomegaly (CTR = 81%). The electrocardiogram demonstrated absence of P wave in 12-leads and regular junctional rhythm with incomplete right bundle branch block. Echocardiogram and color Doppler led to the diagnosis of mitral stenosis and regurgitation, tricuspid regurgitation with enlarged left and right atrium. Cardiac catheterization study revealed elevation of the pulmonary artery wedge pressure and the right atrial pressure without A wave. In the electrophysiologic study, no atrial electrical activity was recorded in the right atrium and the coronary sinus. However, when atrial pacing was attempted at multiple sites with stimulum strength of 10 V, there was no atrial activity at various sites. We considered that the atrial overload due to combined valvular disease for seventeen years had resulted in total and persistent atrial standstill. In this report, we discussed atrial standstill in 67 cases recorded in the medical literatures in our country.