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Patient
85-year-old man with grade II mitral regurgitation and a history of atrial fibrillation treated with anticoagulants and amiodarone; hospitalization for palpitations and cognitive impairment;
Trace
Supraventricular tachycardia with irregular atrioventricular conduction; ventricular rate of 95 beats/minute; rapid and regular atrial activity corresponding to atrial tachycardia; complete right bundle branch block (QRS duration of 125 ms, rSR' pattern in V1, septal q wave and widened S wave in V6);
Trace
Bradycardia 25 beats/minute; atrial escape rhythm from the coronary sinus region (negative atrial activity in inferior leads, reflecting an activation arising from the inferior aspect of the atrium), narrow QRS (morphological pattern similar to that of a tachycardia QRS but narrower);
Exergue
Sick sinus syndrom reflects the presence of a widespread alteration of the atrium affecting the sinus node (explaining the bradycardia) and atrial myocardium (explaining the supraventricular arrhythmias).
Sick sinus syndrome or tachycardia-bradycardia syndrome is characterized by alternating episodes of supraventricular tachycardia (atrial tachycardia, AF, common flutter) and episodes of bradycardia related to sinus node dysfunction.