Key result
Percutaneous coronary intervention of the right coronary artery and distal left circumflex successfully restored flow to the sinus nodal artery, resulting in complete resolution of symptomatic sinoatrial exit block.
Why the study?
Ischemic disease is a rare etiology of bradyarrhythmia, with limited cases demonstrating direct evidence of ischemia to the sinus node vessels.
Does percutaneous coronary intervention resolve symptomatic sinoatrial exit block in a patient with unstable angina and severe right coronary artery stenosis?
Case Report (n=1)
Does percutaneous coronary intervention resolve symptomatic sinoatrial exit block in a patient with unstable angina and severe right coronary artery stenosis?
Coronary angiography and percutaneous coronary intervention should be considered before permanent pacemaker placement in patients with symptomatic bradyarrhythmia and high cardiovascular risk, as ischemia-induced sinus node dysfunction may be reversible.
Suggests reversible ischemia-induced sinoatrial exit block with PCI; hypothesis-generating and leaves open angiography before pacing.
Bradyarrhythmia commonly occurs because of degenerative fibrosis in the conductive system. Ischemic disease is a rare etiology and limited cases have demonstrated direct evidence of ischemia to the sinus node vessels. We report a 62-year-old Hispanic male with a significant medical history of diabetes mellitus type II (DM II), hypertension, and dyslipidemia who was admitted to our hospital for symptomatic sinoatrial (SA) exit block. Patient had no electrolyte abnormalities and our differential included ischemic vs. fibrotic or infiltrative pathologies, giving symptomatic bradycardia, cardiac chest pain, and high-risk factors for coronary artery disease. We decided to take him for cardiac catheterization which revealed sluggish, pulsatile flow into the SA nodal artery due to severe stenosis of the ostial right coronary along with sever distal left circumflex (LCX) lesion. The flow into the sinus nodal artery (SNA) markedly improved post percutaneous coronary intervention (PCI) of the right coronary artery (RCA) and distal LCX and restoration of flow into SNA. Resolution of his bradyarrhythmia and symptoms post intervention confirmed our suspicious for reversible ischemic sinus node dysfunctions. Therefore, ischemic pathologies should be thought of when other common etiologies are less likely. Coronary angiogram should be considered prior to pacemaker evaluation in these setting to avoid missing reversible causes of bradyarrhythmia.
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Fadah et al. (2022) conducted a case report in Symptomatic intermittent sinoatrial exit block associated with unstable angina (n=1). Percutaneous coronary intervention (PCI) was evaluated on Resolution of bradyarrhythmia and symptoms. Percutaneous coronary intervention of the right coronary artery and distal left circumflex successfully restored flow to the sinus nodal artery, resulting in complete resolution of symptomatic sinoatrial exit block.
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