Six seconds to P wave! Recovered without permanent pacemaker – An enlightening story

Abstract

Severe symptomatic sinus node dysfunction in obstructive jaundice is known but rarely encountered. Sinus bradycardia in these patients has been attributed to the effect of bile salts on sino-atrial node. We report a case of 49-year-old cachectic and icteric lady, with obstructive jaundice due to peri-ampullary mass, who was a surgical turn-down owing to symptomatic sinus node dysfunction associated with 6 s sinus pause and was referred for permanent pacemaker. The patient was managed with temporary pacemaker implantation followed by a successful Whipple’s procedure. Sinus rhythm was restored after 72 hours with decline of serum bilirubin level and an unnecessary permanent pacemaker implantation was avoided.

Keywords

• Obstructive jaundice
• Sinus node dysfunction
• Reversible sinus pause