Coexistence of sick sinus rhythm and atrial flutter-fibrillation.

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Abstract
A 58 yr old man with hypertensive cardiovascular disease and atrial flutter underwent electrophysiologic studies, including multiple intra-atrial recordings and atrial stimulation. Although the surface ECG suggested the presence of atrial flutter, intra-atrial recordings demonstrated the presence of sinus-like rhythm localized to an area of .apprx. 5 mm in and around the region of the sinus node, which was pretected by entrance block; flutter and/or fibrillation of the remaining parts of the right atrium; fibrillation of the left atrium; and transient degeneration of flutter into fibrillation at right atrial sites with predominant flutter activity. Although a major part of the right atrium was in flutter and/or fibrillation sinus node function was assessed by overdrive stimulation of the area of sinus node activity. Sinus node function studies revealed an underlying sick sinus syndrome.

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