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Vol. 71. Issue 5.
Pages 394 (May 2018)
ECG Contest
DOI: 10.1016/j.rec.2017.11.031
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ECG, May 2018
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Ignacio Gil-Ortegaa,
Corresponding author
ignaciogilortega@gmail.com

Corresponding author:
, Beatriz Garrido-Corrob, Juan Antonio Castillo-Morenoc
a Unidad de Arritmias, Hospital Universitario Santa Lucía, Cartagena, Murcia, Spain
b Farmacia Hospitalaria, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
c Servicio de Cardiología, Hospital Universitario Santa Lucía, Cartagena, Murcia, Spain
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Rev Esp Cardiol. 2018;71:48910.1016/j.rec.2017.11.033
Ignacio Gil-Ortega, Beatriz Garrido-Corro, Juan Antonio Castillo-Moreno
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A 51-year-old man was seen for symptomatic bradycardia and suspected sinus rhythm dysfunction. He had a history of atrial fibrillation immediately after a mitral valve repair procedure. The event was treated with amiodarone and β-blockers. Holter monitoring showed a symptoms-activated event (Figure 1) and an asymptomatic period (Figure 2).

Figure 1
(0.21MB).
Figure 2
(0.11MB).

What do you think was the diagnosis?

  • 1.

    Figure 1 shows sinus dysfunction; Figure 2 shows alternating structural branch block. A definitive pacemaker should be implanted.

  • 2.

    Figure 1 shows sinus dysfunction; Figure 2 shows alternating structural branch block. The drugs should be withdrawn and the outcome of withdrawal assessed.

  • 3.

    Figure 1 shows a sinoatrial block due to atrial disease; Figure 2 shows the pharmacological effect of amiodarone on the conduction system and refractory periods.

  • 4.

    Figure 1 shows a high-density atrial extrasystole, with resetting of sinus rhythm and atrioventricular block, leading to a symptomatic heart rate of 40 bpm. Figure 2 shows alternating aberrantly conducted extrasystoles in both branches.

To submit your diagnosis, go to http://www.revespcardiol.org/en/electroreto/71/05. The diagnosis will be published in the next issue (June 2018). #RetoECG.

Copyright © 2017. Sociedad Española de Cardiología
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