Atrial Standstill

Atrial standstill is a rare but serious condition, characterised by the absence of atrial electrical and mechanical activity. It potentially leads to syncope, congestive heart failure, stroke and sudden death. It can affect the atria partially or totally and in a transient or permanent way. There are three forms: idiopathic, inherited or secondary. It should be suspected if the ECG shows absence of P waves and a regular supraventricular bradycardic rhythm. The diagnosis can be confirmed through an echocardiogram revealing the absence of atrial contraction. The treatment of this condition is focused on its consequences and potential complications, and includes pacemaker implantation, heart failure management and anticoagulation therapy. We report a case of total atrial standstill, possibly idiopathic, in a young patient with a longstanding history of dizziness and reduced effort tolerance, and we review the literature about the subject.