PubMed · 9047450
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M Sumida, E Isawa. 1996. [Wandering atrial pacemaker].. https://pubmed.ncbi.nlm.nih.gov/9047450/
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A case of intermittent Wolff-Parkinson-White syndrome is reported, which is the first report of an apparent bradycardia-dependent block in the accessory pathway. When the P-P interval gradually lengthened to a critical value of 0.89 second or more, preexcitation failed to occur, but thereafter, when the P-P interval gradually shortened to 0.89 second or less, preexcitation again occurred. These findings seem to suggest that bradycardia-dependent block occurred in the accessory pathway. In the electrocardiogram taken on another day, however, when a ventricular extrasystole was followed by a compensatory pause, the ensuing QRS complex showed preexcitation, although the pause was markedly longer than the critical period of 0.89 second. This indicates that this case is not one of true bradycardia-dependent block in the accessory pathway. Rather, the effect occurred because increased vagal tone depressed conductivity in the accessory pathway to a greater degree than automaticity in the sinus node.
A 60-years old patient with symptomatic sick sinus disease was implanted a dual-chamber pacemaker that did well during the following 13 years. Thereafter, the pacemaker had to be explanted because of a systemic infection, with the patient in constant chronic atrial fibrillation in the meantime. After another asymptomatic year, 6 arrhythmogenic syncopes occurred, apparently due to pre-automatic pauses prior to spontaneous conversions to sinus rhythm. Subsequently, the patient was implanted a VVI pacemaker, whereupon he did well henceforth. This case demonstrates the possibility of recurrence of sinus rhythm even after long-standing chronic atrial fibrillation.
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