Sinus Arrest
Often intermittent and interspersed with a normal rhythm, sinus arrest is characterised by the absence of P waves and pauses of 3 seconds or more. It is the result of either sinus node disease or carotid sinus hypersensitivity (see trace, below).
Management
Exacerbating drugs such as beta blockers or calcium channel antagonists should be stopped. Rarely, a permanent pacemaker is required.