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Tachy-brady Syndrome in an 85-Year-Old Woman

Tachy-brady Syndrome in an 85-Year-Old Woman

Case review: Mrs Robertson is 85-years-old and has a long-standing history of paroxysmal atrial fibrillation (AF). After recurrent episodes of palpitations and lightheadedness, you order 48h Holter monitoring and the results lead to a diagnosis of tachy-brady syndrome, a variant of sick sinus syndrome (SSS). (Note: Holter monitor results showed multiple bursts of AF with rapid ventricular response [RVR] followed by episodes of conversion back to sinus rhythm with post-conversion pauses [longest 3.2 seconds]). There are also some AF episodes with slow ventricular response (heart rate in the 40s) and pauses in AF of as long as 5.1 seconds.

She had no improvement in her tachy- or bradyarrhythmias after discontinuation of her metoprolol and you have referred her to an electrophysiologist for a pacemaker based on:

 → Lightheadedness associated with post-conversion pauses (Class I)

 → Bradyarrhythmias that preclude taking nodal agents for RVR (Class II)

 → Sinus pause/arrest of >3 sec and pause of >5 sec while in AF

1. The electrophysiologist is most likely to recommend placement of which of the following for Mrs Robertson:

A. Atrial pacemaker

B. Right ventricular pacemaker

C. Dual chamber pacemaker

D. Dual chamber with left ventricular lead

E. Dual chamber with implantable cardiac defibrillator (ICD)

Answer, discussion, next question>>>

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