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Acute and sub-acute sinus node dysfunction following pulmonary vein isolation: a case series
Sérgio Barra1, Deepa Gopalan2,3, Jakub Baran1,4
1Department of Cardiology, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK.
Atrial fibrillation ablation can cause sinus node dysfunction, leading to dangerous pauses and syncope. This study highlights the risk of sinus node artery injury during these procedures, necessitating pacemaker implantation in most patients.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Complications
Background:
- Atrial fibrillation (AF) ablation is a common procedure to treat irregular heart rhythms.
- Sick sinus syndrome (SSS) is a condition affecting the heart's natural pacemaker.
- Sinus node dysfunction (SND) is a recently suggested complication of AF ablation.
Observation:
- Six patients developed significant sinus pauses post-AF ablation, causing syncope.
- Five patients required urgent pacemaker implantation due to bradycardia.
- No patients had prior symptoms of SSS or bradycardia.
Findings:
- The sinus node artery (SNA) coursed near ablation sites in several patients.
- Thermal injury to the SNA is hypothesized to cause acute/sub-acute SND.
- Lack of pre-ablation SSS symptoms and post-ablation pauses support this hypothesis.
Implications:
- Awareness of acute/sub-acute SND as a potential AF ablation complication is crucial.
- Understanding SNA anatomy may help mitigate risks during ablation.
- Further research is needed to confirm the link between SNA injury and SND post-ablation.
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