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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:394 - Vol. 71 Num.05 DOI: 10.1016/j.rec.2017.11.031

ECG, May 2018

Ignacio Gil-Ortega a,, Beatriz Garrido-Corro b, Juan Antonio Castillo-Moreno c

a Unidad de Arritmias, Hospital Universitario Santa Lucía, Cartagena, Murcia, Spain
b Farmacia Hospitalaria, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
c Servicio de Cardiología, Hospital Universitario Santa Lucía, Cartagena, Murcia, Spain
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Article

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).

Figure 1.

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 The drugs should be withdrawn and the outcome of withdrawal assessed.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.

Corresponding author: ignaciogilortega@gmail.com

1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved