RECURRENT SINUS ARREST DURING LAPAROSCOPIC SACRAL COLPOPEXY IN PATIENTS WITH SICK SINUS SYNDROME : A CASE REPORT

Sick sinus syndrome (SSS) is a disease in which the SA node fails to perform the function of pacemaking. ECG shows various rhythms including sinus arrest. We report recurrent sinus arrest during laparoscopic sacral colpopexy in a 77-year-old female patient with SSS. The patient was diagnosed with SSS, but as there were no symptoms, the operation was performed without pacemaker implantation. After induction of anesthesia, vital signs were stable, but sinus arrest repeatedly appeared due to elevated vagal tone during uterine traction. After operation, the patient underwent pacemaker implantation, and to this day, she is doing well without any symptoms. The anesthesiologist should pay close attention to the progress of the operation through much communication with operator during the surgery. Also, we recommend to considering temporary pacemaker implantation for patients with SSS who undergo surgery that can increase vagal tone.

Implante de marcapasos sin cables. Caso Clínico / Leadless pacemaker implantation. Case report

We report 67-year-old woman with a sinus node dysfunction and diffuse conduction system disease, with a history of recurrent paroxysmal atrial fibrillation. She was admitted to the Hospital due to palpitations, dizziness, and vertigo, attributing the symptoms to the rhythm disorder described, for which the implantation of a pacemaker was indicated. With a history of tracheal cancer treated with radio and chemotherapy, and chronic steroid therapy for rheumatoid arthritis, she had an important limitation in vascular access for a conventional pacemaker, so, added to a high risk of infection, a decision was made to implant a leadless pacemaker. We discuss the electrocardiographic and clinical manifestations of sinus node disease, its relationship with oncological treatment and the indication for a permanent pacemaker, highlighting the characteristics of this new modality of artificial cardiac stimulation, for a special type of patients.

Descripción de los pacientes de 80 o más años intervenidos quirúrgicamente en el laboratorio de electrofisiología en un hospital de tercer nivel / Description of patients aged 80 or older undergoing surgery in the electrophysiology lab of a tertiary care hospital

Resumen Introducción: en una unidad de electrofisiología de un hospital de tercer nivel de Manizales, Caldas, se han atendido pacientes en la cuarta edad; sin embargo, existe poca claridad en la literatura sobre las conductas terapéuticas en este grupo etario. Presentamos nuestra experiencia de atención e intervención en pacientes mayores de 80 años entre el 20 de septiembre de 2017 y 7 de octubre de 2019. Métodos: estudio tipo cohorte longitudinal, se recogió información con base en revisión de historias clínicas. Se realizaron seguimientos telefónicos al tercer y sexto mes del procedimiento. Se incluyeron pacientes mayores de 80 años intervenidos de cualquier procedimiento en la sala de electrofisiología. Se excluyeron los pacientes sin información sobre los datos de seguimiento. Resultados: se recogieron datos de 75 pacientes llevados a procedimiento. El 62.7% de los pacientes fueron hombres, las edades oscilaron entre 80 y 95 años. 32.7%, de pacientes con diagnóstico de disfunción sinusal. La comorbilidad más prevalente fue hipertensión arterial (92%). El procedimiento más realizado fue el implante de marcapaso bicameral. La mediana del tiempo de estancia hospitalaria fue de 1 día. EL 70% de los pacientes tuvieron riesgo medio o bajo según la escala CHA2DS2VASc. En el lapso de seis meses se encontró una incidencia acumulada de complicaciones de 4%, con 8% de reconsultas y una mortalidad de 1.3%. Conclusiones: las complicaciones posquirúrgicas, la necesidad y duración de la hospitalización, la tasa de reconsulta y la mortalidad asociada a los procedimientos en este grupo de edad son similares a las observadas en estudios con población menor de 80 años.

Abstract Introduction: fourth age patients have been cared for in the electrophysiology unit of a tertiary care hospital in Manizales, Caldas; however, there is little clarity in the literature regarding therapeutic conduct in this age group. We present our experience of care and intervention in patients over the age of 80 between September 20, 2017 and October 7, 2019. Methods: a longitudinal cohort study in which data was collected from a chart review. Telephone follow up was performed three and six months after the procedure. Patients over the age of 80 who had undergone any procedure in the electrophysiology lab were included. Patients without follow up information were excluded. Results: data were collected on 75 patients undergoing a procedure: 62.7% of the patients were men, ages ranged from 80 to 95, and 32.7% of the patients had a diagnosis of sinus dysfunction. The most prevalent comorbidity was arterial hypertension (92%). The most frequently performed procedure was dual chamber pacemaker implantation. The median hospital stay was one day. Seventy percent of the patients had a medium or low risk according to the CHA2DS2-VASc scale. Over a six-month period, a 4% cumulative incidence of complications was found, with 8% reconsultation and 1.3% mortality. Conclusions: postsurgical complications, the need for and length of hospitalization, the rate of reconsultation and the mortality associated with procedures in this age group are similar to those seen in studies of populations under 80 years old.

Severe Sinus Bradycardia Requiring Cardiac Pacing in a Lupus Patient Who Was Successfully Treated Using Methylprednisolone Pulse Therapy / 대한내과학회지

Symptomatic sinus bradycardia in adults with systemic lupus erythematosus (SLE) is rare. Here, we report a case of severe sinus bradycardia requiring temporary cardiac pacing in a SLE patient successfully treated using methylprednisolone pulse therapy.

Study on Recipients' Experience of Adapting to Permanent Pacemakers / 중환자간호학회지

PURPOSE: This study develops a substantive theory on the recipients' experience of adapting to a permanent pacemaker.METHOD: The study used the grounded theory method developed by Strauss and Corbin (1998). The participants of the study were 13 adults who had received a permanent pacemaker during the previous year. The study addressed the research question “what is the experience of adaptation in people who had received permanent pacemakers?” From October 2016 to March 2017, data were collected from the participants through in-depth interviews.RESULTS: The core category indicating the essence of the adaptation experience was shown to be “accepting the pacemaker as part of my body and living in line with it.”CONCLUSION: In nursing practice, the results of this study will assist nurses in improving their communications with and developing guidelines or interventions for their clients who have received permanent pacemakers. In the field of nursing education, this study is expected to provide a framework to understand the experiences of future nurses and other healthcare workers working with permanent pacemaker recipients.

Assessment of relationship between atrial synchrony and paroxysmal atrial fibrillation by two-dimensional speckle tracking imaging in patients with sick sinus syndrome / 中华医学超声杂志（电子版）

Objective To evaluate the relationship between atrial synchrony and paroxysmal atrial fibrillation (PAF) in patients with sick sinus syndrome (SSS) by two-dimensional speckle tracking imaging. Methods Forty-four SSS patients who underwent echocardiographic examination at Department of Ultrasound, No. 2 Hospital of Yinzhou in Ningbo City of Zhejiang Province from January 2015 to August 2016 were enrolled, including 25 without PAF and 19 with PAF. Twenty-eight normal adults who underwent echocardiographic examination at this department at the same time were included as a normal control group. The structural and functional parameters of the left ventricle of all enrolled subjects were evaluated by echocardiographic examination. After two-dimensional speckle tracking images of the right atrium free wall, atrial septum, and left atrium free wall were obtained, the time interval from the initial point of P wave on electrocardiograph to the second negative wave of the diastolic phase in two-dimensional speckle tracking images were measured to calculate the electrical-mechanical time of the right atrium free wall (P-RA), the electrical-mechanical time of the atrial septum (P-IAS), and the electrical-mechanical time (P-LA) of the left atrium free wall. Subsequently, the parameters of atrial synchrony were calculated. Conventional echocardiographic parameters, P-RA, P-IAS, P-LA, and the parameters of atrial synchrony were compared among the three groups by one-way ANOVA, and further comparisons between any two groups were performed by the SNK-q test. The relationship between the parameters of electrical-mechanical time, parameters of atrial synchrony, and PAF were analyzed by Spearman correlation analysis. Receiver operating characteristic curve (ROC) analysis was then performed to evaluate the value of the parameters of electrical-mechanical time and parameters of atrial synchrony in predicting PAF. Results The left atrial size was significantly larger in the SSS without PAF group and SSS with PAF group than in the normal control group (q=4.18, 5.37, both P＜0.05), although there was no significant difference between the SSS without PAF group and SSS with PAF group. The P-RA and P-IAS were significantly larger in the SSS without PAF group and SSS with PAF group than in the normal control group (q=4.03, 4.10; q=4.16, 4.31, all P＜0.05), but there was no significant difference between the SSS without PAF group and SSS with PAF group. The P-LA, right atrial intra-atrial synchrony, left atrial intra-atrial synchrony, and inter-atrial synchrony showed a gradually rising trend from the normal control group to the SSS without PAF group and SSS with PAF group, and the difference between any two groups was statistically significant (q=5.18, 11.23, 4.43; q=5.25, 11.74, 4.63; q=7.38, 14.67, 4.73; q=8.01, 16.37, 6.39, all P＜0.05). Spearman correlation analysis showed that P-LA, right atrial intra-atrial synchrony, left atrial intra-atrial synchrony, and inter-atrial synchrony were significantly positively correlated with PAF in patients with SSS (r=0.61, 0.55, 0.75, 0.78, all P ＜ 0.01), and the correlation between inter-atrial synchrony and PAF was the highest. ROC analysis demonstrated the optimal threshold of P-LA for prediction of PAF was 94 ms [sensitivity: 68.42%; specificity: 76.00%; the area under the ROC curve (AUC): 0.764 (95% CI: 0.612-0.879)]; the optimal threshold of right atrial intra-atrial synchrony was 19 ms [sensitivity: 57.89%; specificity: 76.00%; AUC: 0.714 (95% CI: 0.558-0.840)];the optimal threshold of left atrial intra-atrial synchrony was 42 ms [sensitivity: 78.95%; specificity: 76.00%;AUC: 0.860 (95% CI : 0.722-0.946)]; and the optimal threshold of inter-atrial synchrony was 68 ms [sensitivity:84.21%; specificity: 84.00%; AUC: 0.859 (95% CI: 0.721-0.945)]. These results suggest that left atrial intra-atrial synchrony and inter-atrial synchronization are superior to right atrial intra-atrial synchrony in predicting PAF in patients with SSS. Conclusion Atrial electro-mechanical motion time parameters and synchrony parameters are closely related to PAF in patients with SSS, and left atrial intra-atrial synchrony and inter-atrial synchronization are the most effective parameters in predicting PAF in patients with SSS.

Imagen de Flúter Atrial en una Paciente con Marcapasos Bicameral: ¿Cuál es el Mecanismo? / Atrial Flutter in a Patient with a Two-chamber Pacemaker. What is the mechanism?

Se presenta el caso de una paciente portadora de un marcapasos bicameral implantado por enfermedad del nodo sinusal. En su primer control postoperatorio presentó un electrocardiograma sugestivo de flúter atrial. Se discuten los mecanismos posibles que resultan de la interacción entre el ritmo propio del paciente y la función del marcapasos y sus manifes taciones electrocardiográficas.

Atrial Flutter in a Patient with a Two-chamber Pacemaker. What is the mechanism? We present the case of a female patient patient in whom a dual-chamber pacemaker was implanted due to sick sinus syndrome. During her first postoperative follow-up visit, her electrocardiogram showed an atrial flutter pattern. The mechanisms of interaction between the patient´s intrinsic rhythm and the pacemaker functions as well as the main electrocardiographic findings are discussed.

Effects of different right ventricular pacing sites on left ventricular systolic function in elderly patients with sick sinus syndrome / 重庆医学

Objective To compare the effects of different right ventricular pacing sites on left ventricle systolic function in elderly patients with sick sinus syndrome (SSS).Methods A total of 78 elderly patients with SSS were selected in our hospital from 2014 to 2016,and were divided into the right ventricular apical group (RVA group,40 cases) and right ventricular outflow tract group (RVOT group,38 cases) according to sites of right ventrieular pacing.The QRS duration,accumulative total right ventricular pacing percentage and left ventricle function indicators were compared between the two groups before operation and 3,9 months after operation.Results There was no statistically significant difference in QRS duration and left ventricle function indicators before operation between the two groups (P＞0.05).The QRS durations in the RVA group at 3,9 months after operation were longer than those in the RVOT group,there were statistically significant differences (P＜0.05).No statistically significant difference was found in accumulative total right ventricular pacing percentage at 9 months after operation between the two groups (P＞ 0.05).At 9 months after operation,the left ventricular ejection fraction in the RVOT group was higher than that in the RVA group,and the left ventricular end diastolic diameter was lower than that in the RVA group,there were statistically significant differences (P＜0.05).Conclusion The effects of RVOT pacing on left ventricle systolic function in elderly patients with SSS is superior to the RVA pacing.

Breeding and genotyping of a miR-5572transgenic mouse model of sick sinus syndrome / 中国实验动物学报

Objective This study aimed to explore the possibility of establishing a model of sick sinus syndrome by using miR-5572 transgenic mice. Methods F1 and F2 miR-5572 transgenic mice were bred and genotyped, and then observed the phenotype levels of miR-5572 transgenic mice by morphology, electrocardiogram record ( ECG ) and the Cav1. 2 and Cav1. 3 expressions levels of mRNA and protein in sinoatrial node tissue of homozygous, heterozygote and wild type mice. Results Compared with the wild type and heterozygous mice,the miR-5572 homozygous mice showed a devel-opment delay and smaller body shape,and had slower average heart rate. The mRNA and protein levels of Cav1. 2 and Cav1. 3 in the sinoatrial node tissues were significantly lower. Conclusions The results of this study indicate that miR-5572 homozygous mice may be an efficient approach to establish the model of sick sinus syndrome

Effects of different right ventricular pacing sites on left ventricular systolic function in elderly patients with sick sinus syndrome / 重庆医学

Objective To compare the effects of different right ventricular pacing sites on left ventricle systolic function in elderly patients with sick sinus syndrome (SSS).Methods A total of 78 elderly patients with SSS were selected in our hospital from 2014 to 2016,and were divided into the right ventricular apical group (RVA group,40 cases) and right ventricular outflow tract group (RVOT group,38 cases) according to sites of right ventrieular pacing.The QRS duration,accumulative total right ventricular pacing percentage and left ventricle function indicators were compared between the two groups before operation and 3,9 months after operation.Results There was no statistically significant difference in QRS duration and left ventricle function indicators before operation between the two groups (P＞0.05).The QRS durations in the RVA group at 3,9 months after operation were longer than those in the RVOT group,there were statistically significant differences (P＜0.05).No statistically significant difference was found in accumulative total right ventricular pacing percentage at 9 months after operation between the two groups (P＞ 0.05).At 9 months after operation,the left ventricular ejection fraction in the RVOT group was higher than that in the RVA group,and the left ventricular end diastolic diameter was lower than that in the RVA group,there were statistically significant differences (P＜0.05).Conclusion The effects of RVOT pacing on left ventricle systolic function in elderly patients with SSS is superior to the RVA pacing.

Progresses of ultrasound in evaluation of myocardial function for sick sinus syndrome / 中国介入影像与治疗学

Sick sinus syndrome (SSS) is a disease of multiple arrhythmias and symptoms.It has great impact on patients in the quality of life for the symptoms of high incidence.The asynchrony of myocardial electromechanical movement caused by the SSS electrophysiological changes are focused.The ultrasound can not only observe the electrical physiological activity,but also measure the mechanical movement caused by electrophysiological delay.The research progresses of ultrasound in quantitative evaluation of myocardial function in SSS patients was reviewed in this article.

Clinical features and outcomes of radiofrequency catheter ablation of atrial flutter in children / 中华儿科杂志

Objective@#To explore the clinical features of atrial flutter (AFL) and evaluate the efficacy of radiofrequency catheter ablation (RFCA) for AFL in children.@*Method@#Data were collected and analyzed on 50 consecutive pediatric AFL patients (male 37/female 13) who underwent electrophysiology study and RFCA from February 2009 to November 2016 in a case observational study. The average age was (6.2±3.5) years and body weight was (23.7±13.5) kg. Heart structure was normal in 26 patients. Twenty-four patients had congenital heart disease (CHD) and among them 22 patients underwent repaired surgery before. Patients were followed-up for 1 month to 7 years after RFCA. Clinical features and the outcomes of RFCA in AFL patients were analyzed.@*Result@#The average onset age was (4.2±3.3) years. Of these patients, 84% had persistent AFL and 16% paroxysmal AFL. AFL with sick sinus syndrome (SSS) occurred in 36% patients without statistically significant difference between the groups with and without CHD (38.9%(7/18) vs. 61.1%(11/18), respectively, P=0.239 5); 49 patients underwent RFCA except one case with atrial standstill during the procedure. The total acute success rate was 96%. The follow-up recurrence rate was 8%.No complication of the procedures was observed. The cavotricuspid isthmus-dependent AFL occurred in all patients without CHD. However, in the children with CHD after the repair surgery 10 (45%) cases were with cavotricuspid isthmus-dependent AFL, 4 (8%) with atrial scars-dependent AFL, and 8(16%) with both cavotricuspid isthmus and atrial scars-dependent AFL.@*Conclusion@#RFCA was effective and safe for pediatric AFL. There is no difference on the acute success rate, the follow-up AFL recurrence rate, as well as occurrence of SSS between the groups with and without CHD. AFL patients with CHD included the cavotricuspid isthmus-dependent AFL, atrial scars-dependent AFL or both.

Evaluation of left and right atrial synchrony in patients with sick sinus syndrome before and after pacemaker implantation by tissue Doppler ultrasonography / 中华超声影像学杂志

Objective To evaluate the intra- and interatrial synchronization before and after pacemaker implantation in patients with sick sinus syndrome ( SSS) by tissue Doppler imaging ( TDI) . Methods Thirty-eight patients with SSS ( SSS group ) underwent pacemaker implantation . Echocardiography was performed before and after operation . Twenty-five volunteers were chosen as control group . Routine measurement of left and right atrial diameter by echocardiography . In apical four chamber view ,the sample volume of TDI was located at right atrial lateral wall at tricuspid annulus ,interatrial septum and left atrial lateral wall at mitral annulus . The interval time between the early diastolic wave ( E wave) and the late diastolic wave (A wave) (E-AR ,E-AI ,E-AL ) ,and the duration of A wave (AR ,AI ,AL ) were measured . At the same time ,the electromechanical coupling time was measured ,namely the initiation of the P wave of the synchronous electrocardiogram to the starting point of A wave ( P-A0R ,P-A0I ,P-A0L ) , and the starting point of the P wave to the peak point of the A wave ( P-AR ,P-AI ,P-AL ) . And the right atrial electromechanical delay time ,P-A0I and P-A0R value ( T0IR ) ,P-AI value and P-AR value ( TIR ) were recorded .Other parameters include left atrial electromechanical delay time:P-A0L and P-A0I value ( T0LI ) , and P-AL and P-AI value ( TLI ) ;interatrial electromechanical delay time:P-A0L and P-A0R value ( T0LR ) ,P-AL and P-AR ( TLR ) were recorded . Results Compared with the control group ,left atrium and right atrium in SSS group enlarged before operation , E-AR ,E-AI ,E-AL ,P-A0R ,P-A0I ,P-AR ,P-AL prolonged ,while T0LR and T0LI were shortened ( all P < 0 .05 ) . Postoperative changes in SSS group patients included shortened E-AR ,E-AI and E-AL ,and prolonged T0LI and T0LR ( all P <0 .05) . Compared with the control group ,the size of left atriums and right atriums in SSS group still increased postoperation ,and the P-A0I 、P-AR and P-AL remained longer (all P <0 .05) . The same as the control group ,the postoperative AR ,AI and AL in SSS group were decreased successively ( all P < 0 .05 ) . Conclusions In SSS patients , electromechanical asynchrony exists in different part of atrium and between left atrium and right atrium . Pacemaker therapy can improve atrial electromechanical synchronicity .

Breeding and genotyping of a miR-5572transgenic mouse model of sick sinus syndrome / 中国实验动物学报

Objective This study aimed to explore the possibility of establishing a model of sick sinus syndrome by using miR-5572 transgenic mice. Methods F1 and F2 miR-5572 transgenic mice were bred and genotyped, and then observed the phenotype levels of miR-5572 transgenic mice by morphology, electrocardiogram record ( ECG ) and the Cav1. 2 and Cav1. 3 expressions levels of mRNA and protein in sinoatrial node tissue of homozygous, heterozygote and wild type mice. Results Compared with the wild type and heterozygous mice,the miR-5572 homozygous mice showed a devel-opment delay and smaller body shape,and had slower average heart rate. The mRNA and protein levels of Cav1. 2 and Cav1. 3 in the sinoatrial node tissues were significantly lower. Conclusions The results of this study indicate that miR-5572 homozygous mice may be an efficient approach to establish the model of sick sinus syndrome

Pharmaceutical Care for a Patient with Sick Sinus Syndrome Complicated with Essential Thrombocythemia / 中国药师

Objective:To explore the main points of pharmaceutical care performed by clinical pharmacists for patients with sick sinus syndrome ( SSS) and essential thrombocythemia ( ET) . Methods:Clinical pharmacists participated in the whole process of drug treatment for a case of SSS and ET,and focused on the rational use of hydroxyurea ( Hu) and aspirin, the intervention in the medication and the positive follow-up. Results:Serious ADR such as bone marrow suppression was avoided by pharmaceutical care, and bleeding increase including pocket hematoma during the operation didn’ t come up. Conclusion: Timely medical intervention, pharmaceutical care for the key drugs and strengthened follow-up are the breakthrough points for pharmaceutical service of clinical pharmacists.

Study of left ventricular function in patients with DDD pacemaker implantation during atrioventricular conduction and right ventricular apex pacing mode / 中华超声影像学杂志

Objective To compare the left ventricular function parameters of patients with sick sinus syndrome ( SSS ) and DDD pacemaker implantation during atrioventricular conduction ( AVC ) and right ventricular apex pacing ( RVAP ) mode . Methods Forty‐six consecutive patients with SSS who had undergone DDD pacemaker implantation were studied . Fifty volunteers were included as control group . Changing from AVC to RVAP mode ,the acute effect on echocardiographic parameters ,including LVEF , parameters of aortic/pulmonary artery pulse wave Doppler ,and parameters of left ventricular twist by speckle tracking imaging were measured respectively . Pacemaker implantation duration and cumulative ventricular pacing proportion ( Cum% VP) were recorded . The relationships of pacemaker parameter and above left ventricular function parameters were analyzed . Results Compared with control group ,values of peak rotation in LV apex and LV twist were significantly lower during AVC and RVAP mode . The value of peak rotation in LV base showed no significant difference between three groups .Apical‐basal rotation delay during RVAP was significantly longer than those during AVC and in control group respectively ( P <0 .05) . LVEF during RVAP decreased statistically ( P< 0 .05 ) ,but showed no difference during AVC , compared with the control group . The peak LV twist related positively with LVEF ,and negatively with Cum% VP . Conclusions RVA pacing decreases left ventricular function , which is independent of asynchrony contraction patterns caused by pacing . LVEF ,apical rotation and LV twist are more sensitive to demonstrate the LV dysfunction in patients with pacemaker implantation . LV twist related negatively with Cum% VP .

Genetic Variation of SCN5A in Korean Patients with Sick Sinus Syndrome

BACKGROUND AND OBJECTIVES: Due to recent studies that have shown an association between the genetic variation of SCN5A and sick sinus syndrome (SSS), we sought to determine if a similar correlation existed in Korean patients with SSS. SUBJECTS AND METHODS: We enrolled 30 patients with SSS who showed a sinus pause (longer than 3.0 s) in Holter monitoring, in addition to 80 controls. All exons including the putative splicing sites of the SCN5A gene were amplified by polymerase chain reaction and sequenced either directly or following subcloning. Wild-type and single nucleotide polymorphisms were expressed in human embryonic kidney cells, and the peak sodium current (I(Na)) was analyzed using the whole-cell patch-clamp technique. RESULTS: A total of 9 genetic variations were identified: 7 variations (G87A-A29A, IVS9-3C>A, A1673G-H558R, G3823A-D1275N, T5457C-D1819D, T5963G-L1988R, and C5129T-S1710L) had been previously reported, and 2 variants (A3075T-E1025D and T4847A-F1616Y) were novel; the potential structural effects of F1616Y were analyzed in a three-dimensional model of the SCN5A domain. Patch-clamp studies at room temperature demonstrated that the peak I(Na) was significantly increased by 140% in HEK cells transfected with F1616Y compared with wild-type (-335.13 pA/pF+/-24.04, n=8 vs. -139.95 pA/pF+/-23.76, n=7, respectively). Furthermore, the voltage dependency of the activation and steady-state inactivation of F1616Y were leftward-shifted compared with wild-type (V(h) activation=-55.36 mv+/-0.22, n=8 vs. V(h) activation=-44.21 mV+/-0.17, n=7; respectively; V(h) inactivation=-104.47 mV+/-0.21, n=7 vs. V(h) inactivation=-84.89 mV+/-0.09, n=12, respectively). CONCLUSION: F1616Y may be associated with SSS.

Reversible Pulmonary Hypertension due to Sick Sinus Syndrome / 대한내과학회지

A 60-year-old man visited the hospital after experiencing dyspnea after exertion for 2 weeks. An electrocardiogram showed sinus arrest with junctional escape rhythm at 40 beats/min. Transthoracic echocardiography showed that the right ventricular systolic pressure (RVSP) was approximately 71 mmHg and that the left ventricular ejection fraction was preserved. The ratio of peak early diastolic transmitral inflow velocity to early diastolic peak mitral annular velocity (E/E') was 29. Cardiac catheterization revealed a systolic pulmonary artery pressure (SPAP) of 63 mmHg, a mean pulmonary artery pressure of 27 mmHg, and a pulmonary capillary wedge pressure of 22 mmHg with a rhythm of 40 beats/min. The patient was diagnosed with pulmonary hypertension (group 2) due to sick sinus syndrome. SPAP decreased to 48 mmHg during atrial pacing at 60 beats/min. After permanent pacemaker insertion, RVSP decreased from 71 mmHg to 44 mmHg. In this case, passive group 2 pulmonary hypertension occurred due to sick sinus syndrome.