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

Tatsuo Haraki1, Hiroaki Hirase, Shigeru Hoda

  • 1Department of Cardiology, Takaoka Municipal Hospital, Takara-machi 4-1, Takaoka, 933-8550, Japan, tatsuo_haraki@med-takaoka.jp.

Cardiovascular Intervention and Therapeutics
|September 14, 2013
PubMed

Insights

Percutaneous coronary intervention can cause sinus node artery occlusion, leading to syncope. Promptly wiring the occluded sinus node artery restored sinus rhythm, highlighting the importance of careful PCI strategies.

Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • The sinus node (SN) artery, often originating from the right coronary artery (RCA), is crucial for maintaining normal heart rhythm.
  • Patients with a history of syncope may have underlying cardiac conditions affecting the SN.

Observation:

  • A 67-year-old man with syncope history presented with effort angina.
  • During percutaneous coronary intervention (PCI) with everolimus-eluting stents for RCA, slow-flow and occlusion of the SN artery occurred.
  • This resulted in junctional escape rhythm, a slower, alternative heart rhythm.

Findings:

  • Immediate restoration of sinus rhythm was achieved after wiring the occluded SN artery.
  • The patient maintained continuous sinus rhythm and stable hemodynamics post-intervention.
  • Acute SN ischemia is a potential cause of sinus node dysfunction.

Implications:

  • PCI strategies require careful consideration when the SN artery is the sole blood supply from the RCA, especially in patients with syncope history.
  • This case underscores the risk of SN dysfunction during PCI and the benefit of prompt intervention for occluded SN arteries.
  • Emphasizes the need for anatomical awareness and tailored PCI approaches to prevent cardiac rhythm complications.

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