An isolated case of left ventricular non-compaction with sick sinus syndrome/Izole sol ventrikuler "non-compaction" ile hasta sinus sendromu olgusu.

A 21-year-old male patient referred to our hospital because of his abnormal electrocardiogram (ECG). His past history revealed the presence of exertional dizziness since childhood period. Low heart rate (40 bpm) with apical 1-2/6 grade systolic murmur radiating to left subcostal area were detected at physical examination. We determined nodal rhythm on ECG. Transthoracic echocardiography showed hypertrabeculation of left ventricular apex and mid-segments of inferior and lateral walls (Fig. 1). There was a direct flow in the spaces between the trabeculations detected by color Doppler analysis. Left ventricular ejection fraction was 50% and mitral inflow Doppler interrogation revealed type 1 diastolic dysfunction. Mild mitral regurgitation was also detected on echocardiographic examination. The diagnosis of left ventricular non-compaction was made according to echocardiographic criteria as recently reviewed by Sura et al (1). A 24-hour Holter recording revealed alternating sinus and nodal rhythm with frequent sinus pauses (up to 7 seconds) (Fig. 2). Therefore, we concluded that the patient also has concomitant sick sinus syndrome and we decided to implant a pacemaker. After pacemaker implantation his symptoms disappeared and warfarin was started on 5th day.

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

The left ventricular non-compaction is an unclassified cardiomyopathy, which can be a part of other syndromes or can be found as an isolated disorder. Clinical problems in noncompaction are usually related to heart failure, arrhythmias and systemic embolic events that led us to begin warfarin treatment. To the best of our knowledge this is the third case representing the association of sick sinus syndrome-left ventricular noncompaction. In our opinion, our case may provide further supportfor the possibility that sick sinus syndrome is nota coincidental finding in left ventricular noncompaction.

Reference

(1.) Sura AC, Prasad R, Saripalli YV, Plotnick GD. Isolated left ventricular non compaction: echocardiographic diagnosis. Echocardiography 2006; 23:350-1.

Oben Baysan, Cem Koz, Mehmet Uzun, Mehmet Yokusoglu, Celal Genc

Department of Cardiology, Faculty of Medicine, Gulhane Military Medical Academy, Etlik-Ankara, Turkey

Address for Correspondence/Yazisma Adresi: Dr. Mehmet Yokusoglu, Gulhane Askeri Tip Akademisi, Kardiyoloji Anabilim Dali 06018, Etlik, Ankara, Turkey Phone: [phone] Fax: [phone] E-mail: [e-mail]