Atrial Standstill as a Probable Cause of Stroke in A Young Female Patient; A Case Report

Introduction:
Atrial standstill is a rare cardiac arrhythmia, which may present with different clinical symptoms, including longstanding dyspnea, congestive heart failure, syncope, cerebrovascular accidents, and even sudden cardiac death. According to such various presentations, diagnosis of atrial standstill may be complicated despite a high level of suspicion.
Case Presentation:
The present report demonstrated a case of bilateral idiopathic atrial standstill in a young female patient. The initial presentation of the disorder was the prolonged history of dyspnea and reduced effort tolerance, which was complicated by an episode of ischemic stroke two years ago. The patient was discharged with oral anticoagulants and anti-convulsants, but she had discontinued medication arbitrarily and was diagnosed in an electrophysiological study prior to pacemaker placement because of the junctional rhythm and premature ventricular beats. She was finally diagnosed as a case of biatrial standstill, which was characterized by the absence of electrical and mechanical activity in both atrias. Single-chamber permanent pacemaker was successfully implanted and she was discharged with oral anticoagulants and was recommended for further evaluation for idiopathic or familial cardiomyopathy.
Conclusions:
Atrial standstill could present in a silent manner as longstanding dyspnea and reduced effort tolerance, and remain misdiagnosed even after the development of cerebral ischemia in the absence of a high level of suspicion. These patients are eligible to receive oral anticoagulants life-long, and implanting PPM is almost indicated.