Arterial supply of the sinoatrial node: a CT coronary angiographic study

Öztürk, Ersin; Sağlam, Muzaffer; Bozlar, Uğur; Sivrioğlu, Ali Kemal; Karaman, Bülent; Onat, Levent; Başekim, C. Çınar

doi:10.1007/s10554-010-9705-1

Cited by 25 publications

(27 citation statements)

References 20 publications

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“…Most of these studies (7-18, 21-23) reported that the SAN artery predominantly originates from the RCA (50-85%), followed by the LCX (10-45%) and tour results agree with these reports. Only one study (24) reported that the SAN artery predominantly originates from the LCX (49.1%), followed by the RCA (48.1%).…”

Section: Discussionsupporting

confidence: 71%

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Anatomy of the Sinoatrial Nodal Branch in Korean Population: Imaging with MDCT

et al. 2012

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ObjectiveTo evaluate, on a retrospective basis, the anatomic characteristics of the arterial supply to the sinoatrial node (SAN) in the Korean population using an ECG-gated multi-detector CT (MDCT).Materials and MethodsThe electrocardiographic-gated MDCTs of 500 patients (258 men and 242 women; age range, 17-83 years; mean age, 58.6 ± 12.04 years) were analyzed retrospectively. In each case, the SAN artery (arteries) was named according to a special nomenclature with regard to origin, course, and termination.ResultsA total of 516 SAN arteries were visualized in 496 patients. The SAN was supplied by a single artery in 476 (96.4%) cases and by 2 arteries in 18 (3.6%) cases. The SAN originated from the right coronary artery in 265 (53.4%) cases and from the left circumflex in 213 (43%) cases.ConclusionThis study can provide basic data on variations of the SAN artery in the Korean population.

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Section: Discussionsupporting

confidence: 71%

“…However, the extent of the variations differs in frequency between studies. Ethnic differences between the study groups were suggested as a cause of these differences (8, 15-17, 23, 24). Thus, results of previous studies performed in specific ethnic groups may not be simply applied to another ethnic population.…”

Section: Introductionmentioning

confidence: 99%

Anatomy of the Sinoatrial Nodal Branch in Korean Population: Imaging with MDCT

et al. 2012

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“…15 In the present study, we could observe a wide variation in the distance between the site of origin of SANA and ostium of RCA. The mean distance of origin from RCA measured was 1.68 cm and the longest distance measured was 4.4 cm.…”

Section: Arterysupporting

confidence: 43%

A Study on Anatomy and Variations of Sinoatrial Nodal Artery

Sukumaran¹,

Kuruppath²

2017

jemds

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BACKGROUNDThe sinoatrial nodal artery is anatomically significant because it is the landmark for the identification of the sinoatrial node (SA node), which is the natural pacemaker of heart. Origin of the SA nodal artery is highly variable. Its close relation with the atrium may lead to iatrogenic injury and ischaemia to SA node causing arrhythmias.The aim of the present study is to assess the normal anatomy and variations of SA nodal artery by studying the number, origin, course, length and distance of its origin from the ostium of parent artery. MATERIALS AND METHODSThis descriptive study was done on 75 embalmed hearts stored in the Department of Anatomy at Government Medical College, Kottayam, during the period 2016 -2017. Any heart with clearly visible abnormalities was excluded from the study. Dissection was carried out as follows-The pericardium was stripped off. RCA, LCA and their branches to SA node were dissected from their origin to termination. The number, point of origin and course of SA nodal artery were studied. The length and distance of origin from the ostium of parent artery were measured with the help of a measuring scale. RESULTSIn the study, the artery to SA node was single in 70 hearts (93.33%). Double SA nodal artery was noted in 5 hearts (6.67%). In 60 hearts, it originated from RCA (80%), in 9 hearts from circumflex branch of LCA (12%). In one heart SA nodal artery took origin from left coronary artery, where the artery trifurcated into circumflex, left anterior descending and SA nodal. Precaval course was the most common (60%). CONCLUSIONA thorough knowledge of anatomy and variations of the artery would help cardiologists to take necessary precautions to prevent ischaemia of the SA node, atrial walls and atrial septum.

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“…The courses of left-sided SN artery were variable, with more than half of them running along the high anterior left atrium and the remainder either passing behind the LA appendage before overlying the roof or rarely running along the posterior left atrium to reach the right atrium. 3,4 The recognition of the course of SN artery can lead us to either avoid ablating at this location or limit energy delivery to prevent this complication. …”

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confidence: 99%

Sinus Nodal Dysfunction After Left Atrial Flutter Ablation

Hai

Mulpuru

Williamson

et al. 2014

Circ: Arrhythmia and Electrophysiology

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A 74-year-old man who had drug-refractory paroxysmal atrial flutter 2 years after circumferential pulmonary venous isolation was referred to our hospital. During repeated ablation, clinical arrhythmia was induced. Mapping of the left atrium revealed the entire tachycardia cycle length. Capturing fractionated bipolar electrograms at anterolateral left atrial (LA) wall demonstrated concealed entrainment with postpacing interval comparable with tachycardia cycle length. During linear ablation from mitral annulus along fractionated electrograms to the scar near left superior pulmonary vein using an irrigated tip catheter (power, 35 W; temperature, 40 o C), atrial flutter terminated, which was followed by sinus nodal (SN) arrest requiring urgent temporary pacing ( Figure 1). There was no recovery of SN function after 3 days, and a permanent pacemaker was implanted. A review of cardiac computed tomography (CT) before ablation revealed a small blood vessel originating from the left circumflex artery, running along the anterior LA wall to reach the cavoatrial junction of the right atrium, which was not seen in postablation CT (Figure 2). A 3-dimensional reconstruction image showed that this was a left-sided SN artery (Figures 3 and 4). DiscussionPersistent SN dysfunction has been reported in 7% of patients after ablation of atrial fibrillation and is thought to be the result of atrial remodeling and associated sinoatrial conduction abnormality.1 However, our patient had normal SN function before ablation as evidenced by excellent exercise tolerance and absence of bradycardia or long pause in Holter monitoring. Although vagal response during ablation near leftsided pulmonary vein is not uncommon, 2 and an unusually prolonged SN recovery time remained possible, taking persistent SN arrest and CT findings together, the mechanism was likely direct thermal injury to the SN artery. Although not well recognized, this is a potential complication during ablation at the left atrium because the prevalence of exclusively left-sided SN artery is up to 30% to 40%. The courses of left-sided SN artery were variable, with more than half of them running along the high anterior left atrium and the remainder either passing behind the LA appendage before overlying the roof or rarely running along the posterior left atrium to reach the right atrium. 3,4 The recognition of the course of SN artery can lead us to either avoid ablating at this location or limit energy delivery to prevent this complication. DisclosuresNone.

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Arterial supply of the sinoatrial node: a CT coronary angiographic study

Cited by 25 publications

References 20 publications

Anatomy of the Sinoatrial Nodal Branch in Korean Population: Imaging with MDCT

Anatomy of the Sinoatrial Nodal Branch in Korean Population: Imaging with MDCT

A Study on Anatomy and Variations of Sinoatrial Nodal Artery

Sinus Nodal Dysfunction After Left Atrial Flutter Ablation

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