Resolution of atrial standstill in a child with myocarditis

Atrial standstill is a rare disorder usually seen in adults with extreme myocardial disease. Etiologies described in the literature have included muscular dystrophy, familial amyloidosis, and rarely myocarditis. These etiologies usually lead to permanent atrial standstill and require ventricular pacing. We present a case of an 11-year-old black female who developed atrial standstill secondary to biopsy proven acute necrotizing myocarditis. Absence of atrial function was confirmed by surface electrocardiogram, echocardiogram, and an invasive electrophysiology study. Atrial function returned within 3 days of initiation of methyl-prednisolone. In cases of atrial standstill due to myocarditis, a delay in the placement of a permanent pacemaker with or without a trial of methylprednisolone may prove beneficial.