IMAGES IN EMERGENCY MEDICINE
Prolonged sinus arrest in an asymptomatic woman
Department of Cardiology, James Cook University Hospital, Middlesbrough, UK
Correspondence to:
Correspondence to:
Dr Simon Robinson
James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK; simon.robinson@ed.ac.uk
Accepted 8 June 2006
| The first 150 words of the full text of this article appear below. |
A 36-year-old woman in the second trimester of pregnancy attended the emergency department complaining of palpitations which were thought to be due to isolated ventricular ectopy. Routine examination, 12 lead electrocardiogram (ECG), transthoracic echocardiogram and ventilation perfusion scan were normal. Ambulatory ECG monitoring showed a 9.3 s pause while sleeping (fig 1
) and the patient was referred urgently for pacing. The patient reported no symptoms attributable to bradycardia and all other investigations were normal. We suspected vagal overactivity and reassured the patient. Repeated Holter ECG monitoring postpartum did not demonstrate any bradyarrhythmias or other evidence of conduction disease. Arrhythmias including sinus arrest are described in healthy individuals during sleep and asymptomatic nocturnal bradycardia does not usually mandate pacing.1
Figure 1 ECG tracing taken from ambulatory Holter monitor showing a 9.3 s sinus pause (while sleeping, asymptomatic).
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This young woman was referred for urgent pacing on the basis of a prolonged sinus
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