Silent atria
The absence of electrical & mechanical activity in the atrium.
ECG findings
•Bradycardia
•No discernable P waves
•Broad complex QRS
EGM findings
•Cannot capture atrial myocardium-even at high output
•Can still maintain atrial fibrillation
Echo findings
•A: Doppler of mitral valve: no visible A wave
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•B: Tissue Doppler imaging – base septal view
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•C: Strain imaging of LA wall (septal side) with no visible atrial contracture
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•D: Strain rate imaging of LA wall with no visible atrial contraction
Transient Causes
•Drug intoxication (e.g., digitalis or quinidine)
•Hyperkalemia
•Acute myocardial infarction
•Post cardiac surgery
Persistent Causes
Secondary to other clinical disorders
•Ebsteins anomaly
•Emery-dreifuss muscular dystrophy
•Kugelberg-Welander syndrome (automsomal)
•Diabetes
•Amyloidosis
Genetic
Links (both of the following genes together)
•SCN5A (cardiac sodium channel)
•Connexin 40 (gap junction structural protein)
Cannot confirm atrial capture?
Silent atria?
Atrial lead dislodgment?
•Change mode to VVI/VVIR
•Order an x-ray to confirm atrial lead position