Management of sinus node dysfunction with junctional escape rhythm in a case of anorexia nervosa

We report on a 17-year-old female patient with anorexia nervosa (AN), who developed electrocardiographic abnormalities consisting of sinus arrest and junctional escape rhythm. She had complaints of general fatigue, lethargy, sweating, and nausea resulting from voluntary weight loss of more than 30 kg during the past six months. Her body weight was 40 kg, heart rate was 44 bpm, and blood pressure was 90/50 mmHg, and she had signs of dehydration. The electrocardiogram showed a junctional rhythm at 44 bpm, no P wave, QRS width of 60 msec, QT of 440 msec, QTc of 400 msec, and QU of 600 msec. Laboratory findings were normal except for hypokalemia. Management consisted of a multidisciplinary team approach with a re-feeding program together with psychiatric and dietary assistance. Due to the absence of atrioventricular node conduction disease and/or structural heart disease, pacemaker implantation was not considered. This management plan resulted in a successful outcome with return to sinus rhythm within 24 hours of admission.