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

Abstract

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.

Sino‐atrial nodal artery occlusion causing acute sinus node dysfunction after percutaneous coronary intervention: Case report and systematic review

“…While the LCX is the source of blood flow to the SAN in 30%−40% of people, as in our case, it usually arises from the proximal segment, the RCA supplies blood to the SAN in nearly 60% of cases Click or tap here to enter text 2,9 . The SAN receives blood from both the RCA and the LCX in about 10%−11% of people 13 . The development of SND secondary to the occlusion of the SANA is uncommon but a major risk factor after PCI of the proximal segments of the RCA and circumflex arteries.…”

“…2,9 The SAN receives blood from both the RCA and the LCX in about 10%−11% of people. 13 The development of SND secondary to the occlusion of the SANA is uncommon but a major risk factor after PCI of the proximal segments of the RCA and circumflex arteries. The likelihood of an atherosclerotic embolus into the SANA is low because the offending lesion was distal from the artery.…”

“…Out of 22 manuscripts, three were case series, including 61 patients, 7,11,12 and the remaining 16 were single-patient case reports, including ours, totaling 77 cases. [2][3][4][5][6][7][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] The data from the case reports is summarized in Table 1, whereas the data from the case series is summarized in Table 2. We included all cases of the SND following PCI relating to the sino-atrial nodal artery occlusion (SANO) documented in the literature.…”

“…Out of 22 manuscripts, three were case series, including 61 patients, 7,11,12 and the remaining 16 were single‐patient case reports, including ours, totaling 77 cases 2–7,10–25 . The data from the case reports is summarized in Table 1, whereas the data from the case series is summarized in Table 2 .…”

Permanent Sinus Node Arrest Complicating Coronary Angioplasty

“…The SNA may be a branch of the RCA in 61%, a branch of the LCx in 37%, and a branch of both the RCA and the LCx in 2% of patients, and occlusion of the SNA during LCx PCI has also been reported ( 5 ). Long-standing sinus node dysfunction may be managed conservatively with close, regular, noninvasive evaluation; restoration of sinus rhythm may happen as late as 6 months post-PCI ( 6 ).…”