To the Editor: A 9-y-old girl with hemiplegia as the initial symptom, suddenly developed left limb paralysis without obvious inducement and was admitted to our hospital. Cerebral infarction, characterized by significant reduction in the lumen of branches of the right middle cerebral artery, was confirmed through Cranial MRI and MRA. Meanwhile, the patient had recurrent bradycardia (sinus bradycardia/arrest) – tachycardia (atrial tachycardia/flutter) by detected by ECG and Holter monitoring and was positive for atropine test. Transesophageal ultrasound showed patent foramen ovale (PFO), and contrast echocardiography of the right heart indicated right-to-left shunt. Additionally, genetic examination suggested that the patient’s SCN5A gene had a heterozygous mutation (c.719dupT), leading to change in the corresponding amino acids (p. A242Gfs*11).

Based on her clinical manifestations, imaging and genetic examination, the patient was diagnosed as sick sinus syndrome (SSS). A thrombus formed in the right atrium due to abnormal heart rhythm entered the systemic circulation through the small PFO, thereby resulting in cerebral artery embolism and, eventually, hemiplegia of the left limb. To avoid severe damage recurrence, the patient received radiofrequency ablation to cure tricuspid isthmus-dependent atrial flutter, interventional occlusion of the foramen ovale, double chamber pacemaker implantation to correct sinus bradycardia/arrest, after above treatment, and her condition obviously improved through 2 y regular follow-up.

This case is the first report of cerebral infarction caused by SSS in children. SSS caused by ion channel-related gene abnormalities was the pathophysiological basis of cerebral infarction in this case [1, 2]. PFO is a potential pathway capable of causing cerebral infarction; which suggests that relevant examinations should be performed in children with abnormal heart rhythm or nervous system manifestations, Occlusion of the foramen ovale should be recommended as an early intervention to avoid severe complications [3, 4].