INTRINSIC SINUS NODE DYSFUNCTION IN ADOLE SCENCE DURING ANOREXIA-NERVOSA

A seventeen year-old girl with anorexia nervosa (32 kg; 165 cm) was ad mitted as an emergency after syncope with severe bradycardia resistent to atropine monitored over a one week period. Autonomic blockade conf irmed the intrinsic character of the sinus node dysfunction with chron otropic incompetence on exercise. Secondarily, a Mobitz I second degre e AVB was observed. A DDDR pacemaker was implanted with an excellent f unctional result. With a one year follow-up, the bradycardia persists but body weight has increased. The authors discuss the physiopathology of this case : in the literature, the classical bradycardia of anorex ia nervosa is sensitive to vagolytic drugs and only exceptionally as i ntense as in this patient. Sinus node dysfunction is very rare in the young in the absence of congenital heart disease. It is possible that the bradycardia had become chronic in this case.