Sino-atrial nodal artery occlusion causing acute sinus node dysfunction after percutaneous coronary intervention: Case report and systematic review.
Left main coronary artery
Percutaneous coronary intervention
Sino‐atrial nodal artery
Sino‐atrial node dysfunction
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
23 Jun 2024
23 Jun 2024
Historique:
revised:
07
05
2024
received:
12
09
2023
accepted:
04
06
2024
medline:
26
6
2024
pubmed:
26
6
2024
entrez:
26
6
2024
Statut:
aheadofprint
Résumé
New antithrombotic medications and improved stent designs have reduced branch occlusion, although the sino-atrial nodal artery (SANA) may still be occluded after a percutaneous coronary intervention (PCI), causing sinus node dysfunction (SND). Ischemic sinus nodes are usually asymptomatic but can cause sinus arrest sometimes requiring pacemaker placement. In rare cases, junctional escape rhythms, a manifestation of sinus exit blocks after PCI, can predict cardiogenic shock. We present a case study of a patient who underwent bifurcation PCI to the LMCA to the LCX but subsequently developed cardiogenic shock as a result of SND, a junctional escape rhythm required substantial inotropic support. This case offers an exemplification of a sparsely documented, yet infrequent manifestation of iatrogenic ischemic SND at an unorthodox site, the confluence of the LMCA-LCX. In addition, we conducted a comprehensive analysis of 22 scholarly works pertaining to the subject of sinus node dysfunction (SND) subsequent to PCI resulting from ischemia caused by stenosis or occlusion of the SANA. RCA was responsible for 96.1% of SND cases, whereas LCX was responsible for 3.9%. SND was asymptomatic in 49.3% of cases and junctional escape rhythm in 37.6% of symptomatic cases. 28% needed a temporary transvenous pacemaker, while 7.8% needed a permanent one. Interventional management recanalized the SANA in 5.2% of patients, restoring flow. Transient sino-atrial node ischemia after PCI can cause acute SND. Before stent implantation, doctors should consider SND. Complete plaque evaluation around the SANA is needed before choosing the best PCI procedure.
Sections du résumé
BACKGROUND
BACKGROUND
New antithrombotic medications and improved stent designs have reduced branch occlusion, although the sino-atrial nodal artery (SANA) may still be occluded after a percutaneous coronary intervention (PCI), causing sinus node dysfunction (SND). Ischemic sinus nodes are usually asymptomatic but can cause sinus arrest sometimes requiring pacemaker placement. In rare cases, junctional escape rhythms, a manifestation of sinus exit blocks after PCI, can predict cardiogenic shock.
METHODS
METHODS
We present a case study of a patient who underwent bifurcation PCI to the LMCA to the LCX but subsequently developed cardiogenic shock as a result of SND, a junctional escape rhythm required substantial inotropic support. This case offers an exemplification of a sparsely documented, yet infrequent manifestation of iatrogenic ischemic SND at an unorthodox site, the confluence of the LMCA-LCX. In addition, we conducted a comprehensive analysis of 22 scholarly works pertaining to the subject of sinus node dysfunction (SND) subsequent to PCI resulting from ischemia caused by stenosis or occlusion of the SANA.
RESULTS
RESULTS
RCA was responsible for 96.1% of SND cases, whereas LCX was responsible for 3.9%. SND was asymptomatic in 49.3% of cases and junctional escape rhythm in 37.6% of symptomatic cases. 28% needed a temporary transvenous pacemaker, while 7.8% needed a permanent one. Interventional management recanalized the SANA in 5.2% of patients, restoring flow.
CONCLUSION
CONCLUSIONS
Transient sino-atrial node ischemia after PCI can cause acute SND. Before stent implantation, doctors should consider SND. Complete plaque evaluation around the SANA is needed before choosing the best PCI procedure.
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 Wiley Periodicals LLC.
Références
Ferrer MI. The sick sinus syndrome in atrial disease. JAMA. 1968;206:645‐646. doi:10.1001/JAMA.1968.03150030101028
Fadah K, Yohannan S, Cartagena J, Montanez R, Roongsritong C. Resolution of symptomatic intermittent sinoatrial exit block associated with unstable angina following percutaneous coronary intervention. Cardiol Res. 2022;13:172‐176. doi:10.14740/cr1388
Ezeh E, Akhigbe E, Amro M, et al. The jailed sinoatrial node: an interesting case of cardiogenic shock secondary to sinus arrest following percutaneous intervention. J Investig Med High Impact Case Rep. 2022;10:23247096221114524. doi:10.1177/23247096221114524
Seki T, Tokita Y, Shimizu W, Takano H. Cardiogenic cerebral embolism due to sinus arrest associated with coronary intervention for the right coronary artery: a case report. J Cardiol Cases. 2022;25:210‐212. doi:10.1016/j.jccase.2021.09.010
Miyazaki Y, Ueda N, Otsuka F, Miyamoto K, Noguchi T, Kusano K. Rescue percutaneous coronary intervention for sinus node dysfunction following left atrial flutter ablation. HeartRhythm Case Rep. 2021;7:529‐532. doi:10.1016/j.hrcr.2021.04.015
Deeprasertkul P, Thakur RK. Sinus arrest following right coronary artery stent implantation. Int Arch Med. 2012;5:11. doi:10.1186/1755‐7682‐5‐11
Kotoku M, Tamura A, Naono S, Kadota J. Sinus arrest caused by occlusion of the sinus node artery during percutaneous coronary intervention for lesions of the proximal right coronary artery. Heart Vessels. 2007;22:389‐392. doi:10.1007/s00380‐007‐0990‐0
Singh G, Hazergian G. Role of permanent pacing for sinus node dysfunction related to percutaneous coronary intervention of the proximal right coronary artery. J Clin Images Med Case Rep. 2021;2:1516. doi:10.52768/2766‐7820/1516
Jensen PN, Gronroos NN, Chen LY, et al. Incidence of and risk factors for sick sinus syndrome in the general population. J Am Coll Cardiol. 2014;64:531‐538. doi:10.1016/J.JACC.2014.03.056
Nakou ES, Simantirakis EN, Kallergis EM, Skalidis EI, Vardas PE. Long‐standing sinus arrest due to the occlusion of sinus node artery during percutaneous coronary intervention: clinical implications and management. Int J Cardiol. 2016;203:432‐433. doi:10.1016/j.ijcard.2015.10.209
Koren O, Antonelli D, Khamaise R, Ehrenberg S, Rozner E, Turgeman Y. Sinus node dysfunction due to occlusion of the sinus node artery during percutaneous coronary intervention. J Interv Cardiol. 2021;2021:8810484. doi:10.1155/2021/8810484
Yang HB, Guliya Y, Song YN, et al. A benign course of sinus node artery occlusion after stenting at proximal right coronary artery. Chin Med J (Engl). 2021;134:2000‐2002. doi:10.1097/CM9.0000000000001440
Saad Shaukat MH, Tatusov A, Nappi A, Yager N. Transient sinus arrest due to sinus node artery thrombus after revascularisation of the left circumflex artery. BMJ Case Rep. 2019;12:e227878. doi:10.1136/bcr‐2018‐227878
Haraki T, Hirase H, Hoda S, Hashimoto M, Higashi M. Sinus dysfunction after stent implantation in the right coronary artery immediately recovered after reflow in the sinus node artery. Cardiovasc Interv Ther. 2014;29:173‐176. doi:10.1007/s12928‐013‐0208‐6
Antonelli D, Rozner E, Turgeman Y. Long standing sinus arrest following percutaneous coronary intervention of proximal right coronary artery. Isr Med Assoc J. 2022;22:197‐198.
Shin D‐G, Park J‐S, Kim Y‐J, Hong G‐R, Kim H‐J, Shim B‐S. Successful treatment of ischemic dysfunction of the sinus node with thrombolytic therapy: a case report. Korean J Intern Med. 2006;21:283‐286.
Park JS, Shin DG, Kim YJ, Hong GR, Kim HJ, Shim BS. Successful treatment of ischemic dysfunction of the sinus node with thrombolytic therapy: a case report. Korean J Intern Med. 2006;21:283‐286. doi:10.3904/kjim.2006.21.4.283
Osborn LA, Icenogle M. Resolution of exercise intolerance secondary to ischemic sinus node dysfunction following percutaneous transluminal angioplasty. Cathet Cardiovasc Diagn. 1997;42:44‐47. doi:10.1002/(SICI)1097‐0304(199709)42 :1<44::AID‐CCD13>3.0.CO;2‐M
Shimizu R, Aoyama R, Ishikawa J, Harada K. Prolonged sinus arrest due to the obstruction of a sinus node branch after percutaneous coronary intervention of the right coronary artery. J Cardiol Cases. 2022;25:319‐322. doi:10.1016/j.jccase.2021.11.014
Ando’ G. Acute thrombosis of the sinus node artery: arrhythmological implications. Heart. 2003;89:e5. doi:10.1136/heart.89.2.e5
Abe Y, Tamura A, Kadota J. Prolonged sinus node dysfunction caused by obstruction of the sinus node artery occurring during coronary stenting. J Electrocardiol. 2008;41:656‐658. doi:10.1016/j.jelectrocard.2008.07.003
Stratinaki M, Sbarouni E. Permanent sinus node arrest complicating coronary angioplasty. JACC Case Rep. 2021;3:407‐411. doi:10.1016/j.jaccas.2020.12.030
Nakamura T, Sasaki W, Matsumoto M. Cardiogenic shock caused by sinus node artery occlusion following stent implantation. IHJ Cardiovascular Case Reports (CVCR). 2019;3:91‐94. doi:10.1016/j.ihjccr.2019.12.005
Singh G, Hazergian G. Role of permanent pacing for sinus node dysfunction related to percutaneous coronary intervention of the proximal right coronary artery. J Clin Images Med Case Rep. 2021;2:1516. doi:10.52768/2766‐7820/1516
Seow S‐C, Soo W‐M, Tolentino CS. Sinus arrest following stenting of the right coronary artery images in cardiovascular medicine. Heart Asia. 2011;3:35‐36. doi:10.1136/ha.2011.003988
Morakhia J, Ramachandran P, Sanjeeva NCG, Damodaran H, Kothari S, Thakkar A. Sinus node ischemia—a unique presentation. Int J Clin Med. 2015;06:50‐54. doi:10.4236/ijcm.2015.61007
Kumar D, Pawar A, Sabnis G, et al. Reversible SA nodal dysfunction. Interv Cardiol (Lond). 2018;10:37‐38. doi:10.4172/Interventional‐Cardiology.1000603
Pejković B, Krajnc I, Anderhuber F, Košutić D. Anatomical aspects of the arterial blood supply to the sinoatrial and atrioventricular nodes of the human heart. J Int Med Res. 2008;36:691‐698. doi:10.1177/147323000803600410
Dobrzynski H, Anderson RH, Atkinson A, et al. Structure, function and clinical relevance of the cardiac conduction system, including the atrioventricular ring and outflow tract tissues. Pharmacol Ther. 2013;139:260‐288. doi:10.1016/j.pharmthera.2013.04.010
Romhilt DW, Doyle M, Sagar KB, et al. Prevalence and significance of arrhythmias in long‐term survivors of cardiac transplantation. Circulation. 1982;66:1219‐1222.
Misumi I, Yamakawa M, Harada M, et al. Severe hypotension during junctional rhythm in a patient with multiple cerebral infarcts. J Cardiol Cases. 2023;27:84‐87. doi:10.1016/j.jccase.2022.10.010
Hildick‐Smith DJR, Lowe MD, Walsh JT, et al. Coronary angiography from the radial artery—experience, complications and limitations. Int J Cardiol. 1998;64:231‐239. doi:10.1016/S0167‐5273(98)00074‐6
Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2019;140:e382‐e482. doi:10.1161/CIR.0000000000000628
Cossú SF, Rothman SA, Chmielewski IL, et al. The effects of isoproterenol on the cardiac conduction system. J Cardiovasc Electrophysiol. 1997;8:847‐853. doi:10.1111/j.1540‐8167.1997.tb00845.x
Cooper BE. Review and update on inotropes and vasopressors. AACN Adv Crit Care. 2008;19:5‐13. doi:10.1097/01.AACN.0000310743.32298.1d
López Ayerbe J, Villuendas Sabaté R, García García C, et al. Temporary pacemakers: current use and complications. Rev Esp Cardiol (English Edition). 2004;57:1045‐1052. doi:10.1016/S1885‐5857(06)60190‐4