BENSALAH SALMA, OUTAHAYOU AMINA, HILAL SAFAE, FELLAT IBTISSAM, CHERTI MOHAMED
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 2
Issue: 11
Date of Publication: 2025/11/17
The coexistence of sinus node dysfunction and an accessory pathway in adults with a structurally normal heart is extremely rare and poses unique diagnostic and therapeutic challenges. We report a 61-year-old woman with a history of a left-sided accessory pathway and several episodes of preexcited atrial fibrillation treated with flecainide, who was admitted for evaluation of near-syncope. Electrocardiogram revealed type I sinoatrial block with QRS widening suggestive of the accessory pathway. Flecainide was withdrawn, and a 24-hour Holter showed significant daytime sinus pauses up to 3.7 seconds. The patient underwent implantation of a dual-chamber pacemaker in AAI mode with an uneventful postoperative course. During device follow-up, an asymptomatic narrow QRS tachycardia was detected, displaying constant, non-decremental VA intervals, consistent with orthodromic atrioventricular reentrant tachycardia. This case highlights the rare coexistence of sinus node dysfunction and a left-sided accessory pathway in a structurally normal heart. Pacemaker implantation effectively addressed the sinus node dysfunction, while device interrogation revealed asymptomatic retrograde tachycardia. Ablation may be considered if recurrent episodes occur, emphasizing the importance of careful follow-up in such uncommon associations.
sinus node dysfunction, accessory pathway, pacemaker, orthodromic atrioventricular reentrant tachycardia.
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