A 51-year-old man was seen for symptomatic bradycardia and suspected sinus rhythm dysfunction. He had a history of atrial fibrillation immediately after a mitral valve repair procedure. The event was treated with amiodarone and β-blockers. Holter monitoring showed a symptoms-activated event (Figure 1) and an asymptomatic period (Figure 2).
What do you think was the diagnosis?
- 1.
Figure 1 shows sinus dysfunction; Figure 2 shows alternating structural branch block. A definitive pacemaker should be implanted.
- 2.
Figure 1 shows sinus dysfunction; Figure 2 shows alternating structural branch block. The drugs should be withdrawn and the outcome of withdrawal assessed.
- 3.
Figure 1 shows a sinoatrial block due to atrial disease; Figure 2 shows the pharmacological effect of amiodarone on the conduction system and refractory periods.
- 4.
Figure 1 shows a high-density atrial extrasystole, with resetting of sinus rhythm and atrioventricular block, leading to a symptomatic heart rate of 40 bpm. Figure 2 shows alternating aberrantly conducted extrasystoles in both branches.
To submit your diagnosis, go to http://www.revespcardiol.org/en/electroreto/71/05. The diagnosis will be published in the next issue (June 2018). #RetoECG.