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Acute thrombosis of the sinus node artery: arrhythmological implications
G Ando'1, A Gaspardone, I Proietti
1Cattedra di Cardiochirurgia, Università di Roma Tor Vergata, Rome, Italy. giuseppe.ando@tiscali.it
Insights
Sinus node dysfunction, often attributed to aging, may signal underlying coronary artery disease. This case highlights the importance of considering cardiac ischemia as a cause of bradyarrhythmias.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Sinus node dysfunction (SND) is a common cause of bradyarrhythmias, typically attributed to degenerative fibrosis.
- Coronary artery disease (CAD) is often overlooked as a potential cause of SND, particularly in older patients or those with multiple risk factors.
Observation:
- A 53-year-old woman experienced intermittent sinus arrest and junctional escape rhythm during percutaneous coronary intervention for inferior myocardial infarction.
- The sinus node dysfunction was associated with intermittent occlusion of a coronary side branch supplying the sinus node during stent implantation.
Findings:
- The case suggests that transient ischemia of the sinus node artery can precipitate SND.
- This challenges the conventional view that SND is solely due to intrinsic nodal disease.
Implications:
- Sinus node dysfunction may serve as an unrecognized marker for significant coronary artery disease.
- Clinicians should consider evaluating for CAD in patients presenting with SND, especially when traditional causes are not apparent.
Abstract:
A 53 year old woman was referred for percutaneous coronary intervention because of a recent inferior myocardial infarction. During right coronary artery stent implantation, intermittent occlusion of the coronary side branch for the sinus node occurred, associated with intermittent sinus arrest and junctional escape rhythm. This led to speculation about the potential mechanisms for sinus node dysfunction. Degenerative fibrosis of nodal tissue is actually considered the most common cause of bradyarrhythmias. Yet, in everyday practice, no particular attention is usually paid to other potential pathogenic mechanisms such as coronary artery disease. This may be particularly true for elderly patients or patients with multiple risk factors. Thus, sinus node dysfunction may be an unrecognised marker of coronary artery disease.