Pauses in atrial rhythm in a patient with limb-girdle muscular dystrophy: A case report.

A 58-year-old woman with a history of multi-origin atrial tachycardia and limb-girdle muscular dystrophy was treated for presyncope caused by pauses in atrial rhythm. A dual-chamber pacemaker was implanted. The low-voltage area extended broadly, but 10-V pacing could not capture the large right atrium, including the right atrial appendage, except the coronary sinus ostium. The atrial lead was screwed in using a steerable stylet. A ventricular lead was placed in the right ventricular apex. Atrial pacing at the coronary sinus was required to treat the pauses in the atrial rhythm.