title: Ebstein anomaly associated with unusual conduction delay and sick sinus syndrome.
abstract: A 64-year-old man was admitted to our hospital because of palpitation, dyspnea on effort, and facial edema. The echocardiographic diagnosis was Ebstein anomaly. Although the 12-lead electrocardiogram showed an atrial rate of 150 beats/min and no typical flutter wave, the electrophysiological study showed counterclockwise rotation of excitation along the tricuspid annulus. Because of sinus arrest and syncope, a permanent pacemaker was implanted, but the right atrium was not captured by electrical stimulation at 5 V/0.4 ms, except for the orifice of coronary sinus, and the intracardiac P wave was only 0.2 mV or less. This is a rare case of Ebstein anomaly characterized by unusually prolonged conduction in the atrium, the basis of which was global myocardial damage, including the ventricles.
authors.affiliation: Second Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan. mani@koto.kpu-m.ac.jp
authors.forename: Hiroki
authors.initials: H
authors.lastname: Mani
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shirayama
authors.forename: Midori
authors.initials: M
authors.lastname: Yamamura
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Akiko
authors.initials: A
authors.lastname: Yoshida
authors.forename: Masao
authors.initials: M
authors.lastname: Nakagawa
mesh_terms: D004437:Ebstein Anomaly / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D004452:Echocardiography; D004562:Electrocardiography; D006329:Heart Conduction System / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012804:Sick Sinus Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology