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Sinus Node Dysfunction due to Occlusion of the Sinus Node Artery during Percutaneous Coronary Intervention
Ofir Koren1,2, Dante Antonelli1, Ranya Khamaise3
1Heart Institute, Emek Medical Center, Afula, Israel.
Insights
Sinus node artery occlusion (SNO) is a rare complication of percutaneous coronary intervention (PCI), primarily occurring during procedures for acute coronary syndrome. Sinus node dysfunction (SND) is common after SNO, often resolving with treatment, but may require pacemakers in rare cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Sinus node artery occlusion (SNO) is an infrequent complication associated with percutaneous coronary intervention (PCI).
- Understanding the short- and long-term effects of SNO is crucial for patient management.
Purpose of the Study:
- To analyze the short- and long-term consequences of sinus node artery occlusion (SNO) following percutaneous coronary intervention (PCI).
Main Methods:
- Retrospective review of 1379 PCI procedures involving the right coronary artery (RCA) and circumflex arteries from 2016-2019.
- Analysis of periprocedural SNO incidence, patient characteristics, and outcomes, with a median follow-up of 44 months.
Main Results:
- SNO occurred in 5.3% of relevant PCIs (15 patients), predominantly during urgent PCI for acute coronary syndrome (ACS).
- Sinus node dysfunction (SND) developed in 80% of SNO patients, including sinus bradycardia and sinus arrest, mostly responsive to initial medical treatment.
- Temporary pacing was required in 20% of patients, with one permanent pacemaker implantation; sinus node function recovery was observed within one month.
Conclusions:
- SNO is a rare PCI complication, typically seen during RCA angioplasty in ACS patients.
- The incidence of sinus node dysfunction following SNO is high, usually manifesting within 24 hours post-PCI.
- Most SND cases resolve with medical management, necessitating permanent pacemakers only in infrequent instances.
Background:
Sinus node artery occlusion (SNO) is a rare complication of percutaneous coronary intervention (PCI). We analyze both the short- and long-term consequences of SNO.
Methods:
We retrospectively reviewed 1379 consecutive PCI's involving RCA and Cx arteries performed in our heart institute from 2016 to 2019. Median follow-up was 44 ± 5 months.
Results:
Among the 4844 PCIs performed during the study period, 284 involved the RCA and the circumflex's proximal segment. Periprocedural SNO was estimated by angiography observed in 15 patients (5.3%), all originated from RCA. The majority of SNO occurred during urgent and primary PCIs following acute coronary syndrome (ACS). Sinus node dysfunction (SND) appeared in 12 (80%) of patients. Four (26.6%) patients had sinus bradycardia, which resolved spontaneously, and 8 (53.3%) patients had sinus arrest with an escaped nodal rhythm, which mostly responded to medical treatment during the first 24 hours. There was no association between PCI technique and outcome. Three patients (20%) required urgent temporary ventricular pacing. One patient had permanent pacemaker implantation. Pacemaker interrogation during follow-up revealed a recovery of the sinus node function after one month.
Conclusion:
SNO is rare and seen mostly during angioplasty to the proximal segment of the RCA during ACS. The risk of developing sinus node dysfunction following SNO is high. SND usually appears during the first 24 h of PCI. The majority of SND patients responded to medical treatment, and only in rare cases were permanent pacemakers required.
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