Abstract
Myocardial ischemia due to narrowing of the right coronary artery (RCA) may result
in sinus arrhythmias, which usually present as transient sinus bradycardia with no
hemodynamic instability. We report a rare case of sinus arrest with hemodynamic instability,
which lasted for several months, and was caused by the occlusion of the sinus node
(SN) artery following the RCA stenting.
A 78-year-old woman with diabetes mellitus, hypertension, and dyslipidemia was referred
to our hospital because of chest pain during activity. In her coronary angiogram,
severe diffuse stenosis of the RCA was observed and intracoronary imaging using intravascular
ultrasound revealed diffuse atherosclerotic plaque lesions with partial calcification
and vulnerability. RCA was treated by inserting three zotarolimus-eluting stents.
Immediately after these interventions, the SN artery originating from the RCA proximal
to the lesion was occluded, which resulted in SN dysfunction. Significant bradycardia
was observed on electrocardiogram along with low blood pressure, suggesting sinus
arrest. Along with hemodynamic instability, sinus arrest lasted for several months,
and permanent pacemaker implantation was needed.
The plaque burden should be taken into consideration when choosing the appropriate
percutaneous coronary intervention strategy because of the potential complication
of sinus arrest after RCA stenting.
<Learning objective: Clinicians should be aware of the potential for sinus arrest after right coronary
artery stent implantation. In cases with large plaque burden, it might be best to
protect a side branch using a catheter or a small diameter balloon. Acute sinus node
ischemia is a possible cause of sinus dysfunction after percutaneous coronary intervention.
As such the strategy for this intervention should be chosen with care.>
Keywords
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References
- Clinical spectrum of the sick sinus syndrome.Circulation. 1972; 46: 5-13
- Acute thrombosis of the sinus node artery: arrhythmological implications.Heart. 2003; 89: E5
- Sinus node coronary arteries studied with angiography.Am J Cardiol. 1983; 51: 749-750
- Atrial coronary arteries: Anatomy and atrial perfusion territories.J Atr Fibrillation. 2011; 4: 375
- 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
- Sinus arrest following right coronary artery stent implantation.Int Arch Med. 2012; 5: 11
- 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
- Quantification of atrial contribution to left ventricular filling by pulsed Doppler echocardiography and the effect of age in normal and diseased hearts.Am J Cardiol. 1987; 59: 1174-1178
- Effects of aging on asynchronous left ventricular regional function and global ventricular filling in normal human subjects.J Am Coll Cardiol. 1988; 11: 50-58
- Predictors and outcomes of side branch occlusion after main vessel stenting in coronary bifurcation lesions: results from the COBIS II Registry (COronary BIfurcation Stenting).J Am Coll Cardiol. 2013; 62: 1654-1659
Article info
Publication history
Published online: December 30, 2021
Accepted:
November 27,
2021
Received in revised form:
November 15,
2021
Received:
August 16,
2021
Identification
Copyright
© 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
