Electrocardiographic and Arrhythmic Manifestations of End-Stage Atrial Myopathy in Patients With Longstanding Persistent or Permanent Atrial Fibrillation: A 3-Patient Case Series.
Frans Serpa, Nimesh Patel, Jose A Joglar
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Case in brief
This case series describes three patients with end-stage atrial myopathy and longstanding persistent or permanent atrial fibrillation (AF). One patient experienced recurrent low-amplitude atrial tachycardias post-AF ablation, while two others progressed to atrial standstill with junctional rhythms, evidenced by serial ECGs showing loss of fibrillatory activity and absent atrial sensing. One patient required pacemaker implantation without an atrial lead due to these findings.
Diagnostic / clinical pearl
Clinicians should be aware that advanced atrial myopathy in patients with longstanding AF can present with unique electrocardiographic changes, including loss of fibrillatory waves and junctional rhythms, which may complicate management.
Why it matters
Understanding these manifestations can enhance the recognition of advanced atrial remodeling, potentially guiding more effective AF ablation and pacing strategies.