Sinus arrest following right coronary artery stent implantation

The Jailed Sinoatrial Node: An Interesting Case of Cardiogenic Shock Secondary to Sinus Arrest Following Percutaneous Intervention

Complete occlusion of the sinoatrial node artery can be a complication of percutaneous intervention (PCI) to the right coronary artery (RCA). When this happens, dysfunction of the sinus node may follow resulting in sinus arrest. When this occurs, it is usually transient and as such, is typically not accompanied by hemodynamic instability. Permanent sinus arrest and shock state may, however, occur on rare occasions. The presence of junctional rhythms on the electrocardiogram (ECG) may predict the occurrence of these permanent arrhythmias and cardiogenic shock. In this case report, we present a 78-year-old woman who developed cardiogenic shock secondary to sinus arrest following PCI to RCA. Her ECG showed junctional rhythm, and she went on to require permanent ventricular pacing. This illustrates a known but rare complication of PCI to RCA.

Sinus Node Dysfunction due to Occlusion of the Sinus Node Artery during Percutaneous Coronary Intervention

Background

Sinus node artery occlusion (SNO) is a rare complication of percutaneous coronary intervention (PCI). We analyze both the short- and long-term consequences of SNO.

Methods

We retrospectively reviewed 1379 consecutive PCI's involving RCA and Cx arteries performed in our heart institute from 2016 to 2019. Median follow-up was 44 ± 5 months.

Results

Among the 4844 PCIs performed during the study period, 284 involved the RCA and the circumflex's proximal segment. Periprocedural SNO was estimated by angiography observed in 15 patients (5.3%), all originated from RCA. The majority of SNO occurred during urgent and primary PCIs following acute coronary syndrome (ACS). Sinus node dysfunction (SND) appeared in 12 (80%) of patients. Four (26.6%) patients had sinus bradycardia, which resolved spontaneously, and 8 (53.3%) patients had sinus arrest with an escaped nodal rhythm, which mostly responded to medical treatment during the first 24 hours. There was no association between PCI technique and outcome. Three patients (20%) required urgent temporary ventricular pacing. One patient had permanent pacemaker implantation. Pacemaker interrogation during follow-up revealed a recovery of the sinus node function after one month.

Conclusion

SNO is rare and seen mostly during angioplasty to the proximal segment of the RCA during ACS. The risk of developing sinus node dysfunction following SNO is high. SND usually appears during the first 24 h of PCI. The majority of SND patients responded to medical treatment, and only in rare cases were permanent pacemakers required.

Permanent Sinus Node Arrest Complicating Coronary Angioplasty

Sinus node artery (SNA) occlusion is a rare complication of percutaneous coronary intervention and usually has a benign prognosis; sinus arrest may occur but frequently resolves. We report a case of unresolved SNA obstruction following percutaneous coronary intervention of the mid-right coronary artery, for which permanent pacemaker implantation was required. (Level of Difficulty: Beginner.)

Transient sinus arrest due to sinus node artery thrombus after revascularisation of the left circumflex artery

We present a case of sinus arrest and junctional escape rhythm from sinus node artery (SNA) thrombus in a 55-year-old man after revascularisation of right coronary and proximal circumflex arteries for infero-posterior wall ST-segement elevation myocardial infarction (STEMI). Sinus arrest from occlusion of the SNA is uncommon. The ensuing bradycardia may have haemodynamic consequences requiring temporary pacing but is almost always self-limited.

Sinus dysfunction after stent implantation in the right coronary artery immediately recovered after reflow in the sinus node artery

A 67-year-old man who had a history of syncope was admitted because of effort angina. The sinus node (SN) was the single blood supply from the right coronary artery (RCA). After we implanted 2 everolimus-eluting stents for RCA, slow-flow occurred and the SN artery was occluded, and junctional escape rhythm was sustained. After the wiring to the occluded SN artery, junctional escape rhythm immediately recovered to sinus rhythm, and the patient achieved continuous sinus rhythm and stable hemodynamics. Given that acute SN ischemia is a possible cause of sinus dysfunction, careful choice of a percutaneous coronary intervention strategy should be taken into consideration if the SN artery is the single blood supply from the RCA and if syncopal history is present.