{"id":10800,"date":"2026-06-28T06:01:53","date_gmt":"2026-06-28T06:01:53","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10800"},"modified":"2026-07-02T11:47:35","modified_gmt":"2026-07-02T11:47:35","slug":"trace-2-6-differential-diganosis-of-sinus-dysfunction","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-6-differential-diganosis-of-sinus-dysfunction\/","title":{"rendered":"Trace 2.6: Differential diganosis of sinus dysfunction"},"content":{"rendered":"","protected":false},"featured_media":9535,"template":"","ecg_case_type":[251],"language_ecgcase":[258],"class_list":["post-10800","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-sinus-dysfunction","language_ecgcase-english"],"acf":{"ecg_case_title":"Trace 2.6: Differential diganosis of sinus dysfunction","patient_description":"67-year-old man with a history of atrial fibrillation referred to the department due to discovery of irregular bradycardia suggesting the need for implanting a pacemaker;","quiz_question":"Regarding this ECG, which answer(s) is(are) true?","quiz_answer_1":"there is a sinus bradycardia","quiz_answer_2":"there is a second-degree AV block","quiz_answer_3":"there is a sinus node dysfunction","quiz_answer_4":"there are blocked atrial premature complexes","quiz_answer_5":"there is a first-degree AV block","correct_answer":["D"],"ecg_image":9535,"ecg_description":"Sinus activity (positive in leads I, II, V5, V6 and negative in aVR) with significant RR interval variability; in the initial portion of the T wave, there is an ectopic atrial activity corresponding to a blocked atrial extrasystole (not followed by a QRS) with a post-extrasystolic sinus pause explaining the pseudo sinus bradycardia;","ecg_info_box":"An atrial premature complex 1) can be difficult to identify on the electrocardiogram because it may be \u201cconcealed\u201d within the T wave and non-conducted, 2) evokes the differential diagnosis of sinus pause, 3) may originate from a focus located at the ostium of one of the pulmonary veins and represent the trigger for the induction of atrial arrhythmia episodes.","commentary_ecg":"This patient was referred due to irregular heart rate and \u201csinus pauses\u201d. A careful inspection of the tracing allows the highlighting of a notch in the T wave preceding the pause corresponding to a blocked atrial extrasystole explaining the ensuing post-extrasystolic pause. It is therefore not an issue of depressed automaticity (sinus node dysfunction and discussion on the need for a pacemaker implantation) but rather of a hyper-automaticty (atrial extrasystole and discussion on the relevance of an antiarrhythmic therapy). A blocked atrial extrasystole thus constitutes the differential diagnosis of sinus node dysfunction and should be systematically investigated when in the presence of a pause, the therapeutic consequences being drastically opposite.","ecg_info_post_answer":"<img class=\"alignnone wp-image-10811 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/06\/trace-2-6-ecg-en-1024x576.jpg\" alt=\"\" width=\"800\" height=\"450\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trace 2.6: Differential diganosis of sinus dysfunction - Cardiocases<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-6-differential-diganosis-of-sinus-dysfunction\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trace 2.6: Differential diganosis of sinus dysfunction - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-6-differential-diganosis-of-sinus-dysfunction\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-07-02T11:47:35+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-2-6-ecg-scaled-e1782932997476.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"2320\" \/>\n\t<meta property=\"og:image:height\" content=\"1190\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-6-differential-diganosis-of-sinus-dysfunction\\\/\",\"url\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-6-differential-diganosis-of-sinus-dysfunction\\\/\",\"name\":\"Trace 2.6: Differential diganosis of sinus dysfunction - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-6-differential-diganosis-of-sinus-dysfunction\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-6-differential-diganosis-of-sinus-dysfunction\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/cardiocases.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/trace-2-6-ecg-scaled-e1782932997476.jpeg\",\"datePublished\":\"2026-06-28T06:01:53+00:00\",\"dateModified\":\"2026-07-02T11:47:35+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-6-differential-diganosis-of-sinus-dysfunction\\\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-6-differential-diganosis-of-sinus-dysfunction\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-6-differential-diganosis-of-sinus-dysfunction\\\/#primaryimage\",\"url\":\"https:\\\/\\\/cardiocases.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/trace-2-6-ecg-scaled-e1782932997476.jpeg\",\"contentUrl\":\"https:\\\/\\\/cardiocases.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/trace-2-6-ecg-scaled-e1782932997476.jpeg\",\"width\":2320,\"height\":1190},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-6-differential-diganosis-of-sinus-dysfunction\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/cardiocases.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trace 2.6: Differential diganosis of sinus dysfunction\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/#website\",\"url\":\"https:\\\/\\\/cardiocases.com\\\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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