An unusual complication of coil embolization of a large coronary-pulmonary fistula

A 58-year-old man with hemoptysis was found to have a large fistula from his circumflex artery to the pulmonary system. Coil embolization was performed. This resulted in occlusion of the fistula, including a small branch likely supplying the sinus node. Following the procedure he developed junctional bradycardia but remained hemodynamically stable. He had a brief period of atrial fibrillation which, after 48 hours, reverted to a rhythm from an ectopic focus in the low right atrium. This case highlights an unusual complication of fistula embolization and emphasizes the need for caution when occluding vessels which may supply the sinus node.