Sinus Node Dysfunction, Atrial Arrhythmias, and the Sinus Node Microcirculation

A patient with sinus node dysfunction (SND) developed atrial arrhythmias that were abolished after avoidance of nonsteroidal anti-inflammatory medication and by the institution of a deliberate, modest increase in blood pressure, suggesting that there was a vascular component to the rhythm disturbance. Published anatomical evidence for a unique sinus node microcirculation substantiates the premise that SND may be sensitive to arterial flow. Because physicians have been unaware of the presence of a unique sinus node microcirculation, recognition of its presence may alter the approach to treatment of patients with SND and atrial arrhythmias, particularly in the elderly and those with diabetes.