Partial atrial electrical standstill: report of three cases and review of clinical and electrophysiological features

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Abstract
Three patients with partial atrial electrical standstill are described. Serial electrocardiograms and electrophysiological studies were performed after a clinical follow-up ranging from four to ten years. Two patients had valvular heart disease and one patient had a sick sinus syndrome. Case I presented, on the admission electrocardiogram, an atrioventricular (AV) junctional rhythm whereas paroxysmal atrial fibrillation had been previously documented. Case 2, who had had long-standing atrial fibrillation presented on admission absence of fibrillation waves and simulated AV junctional rhythm. In case 3 with known sino-atrial block, electrocardiographic monitoring showed sinus rhythm with episodes of slow AV junctional rhythm. Atrial endocardial mapping showed an electrically silent area ranging from a small region near the sinus node (case 1) to the entire right atrium except for a discrete area near the tricuspid valve (case 2). AV dissociation between the electrical activity recorded in the remaining atrium and the junctional escape rhythm was present in every patient. The clinical and electrophysiological features of this entity are reviewed. This study emphasizes the limitations of the electrocardiogram in making the diagnosis of atrial standstill. However, partial atrial electrical standstill should be suspected in patients with AV junctional rhythm or atrial fibrillation with fine waves. This diagnosis may have important therapeutic implications.

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