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Emerg Med J. 2007 September; 24(9): 613.
PMCID: PMC2464655

Prolonged sinus arrest in an asymptomatic woman

A 36‐year‐old woman in the second trimester of pregnancy attended the emergency department complaining of palpitations which were thought to be due to isolated ventricular ectopy. Routine examination, 12 lead electrocardiogram (ECG), transthoracic echocardiogram and ventilation perfusion scan were normal. Ambulatory ECG monitoring showed a 9.3 s pause while sleeping (fig 11)) and the patient was referred urgently for pacing. The patient reported no symptoms attributable to bradycardia and all other investigations were normal. We suspected vagal overactivity and reassured the patient. Repeated Holter ECG monitoring postpartum did not demonstrate any bradyarrhythmias or other evidence of conduction disease. Arrhythmias including sinus arrest are described in healthy individuals during sleep and asymptomatic nocturnal bradycardia does not usually mandate pacing.1

figure em39156.f1
Figure 1 ECG tracing taken from ambulatory Holter monitor showing a 9.3 s sinus pause (while sleeping, asymptomatic).

This young woman was referred for urgent pacing on the basis of a prolonged sinus pause during ambulatory ECG monitoring. Full consideration of her clinical status prompted us to manage her conservatively, and on follow‐up she has remained well without symptoms.


Competing interests: None.


1. Gula L J, Krahn A D, Skanes A C. et al Clinical relevance of arrhythmias during sleep: guidance for clinicians Heart 2004. 90347–352.352 [PMC free article] [PubMed]

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