Sinus node dysfunction, junctional escape rhythm

Patient

73-year-old woman, hypertensive with concentric left ventricular hypertrophy; control surface ECG; asthenic patient;

Trace

Moderate bradycardia, heart rate of 57 beats/minute, sinus node dysfunction with total absence of sinus P wave, junctional escape rhythm (narrow, regular and moderately slowed QRS complexes), retrograde conduction (negative atrial activity in inferior leads with fixed RP' interval), left ventricular hypertrophy (Sokolow index of 38) with aspecific repolarization disorders;

Exergue

In total absence of sinus activity, a junctional focus most often takes over with a typical QRS complex pattern with little or no modification and a retrograde atrial conduction. As in the case of a long PR, this retrograde conduction can generate symptoms as a result of atrial contraction due to mitral valve closure (pacemaker syndrome without pacemaker).