Key result
Revascularization of the occluded sinus node artery and catheter ablation successfully treated isolated atrial infarction complicated by sick sinus syndrome and AF, avoiding pacemaker implantation.
Why the study?
Atrial infarction usually complicates ventricular myocardial infarction, but isolated atrial infarction has rarely been reported.
Case Report (n=1)
Revascularization of the sinus node artery combined with catheter ablation for AF can successfully treat isolated atrial infarction complicated by bradycardia-tachycardia syndrome, avoiding the need for a permanent pacemaker.
May avoid permanent pacemaker in atrial infarction with tachy-brady syndrome; hypothesis-generating and requires prospective validation.
Background: Atrial infarction is a complication of myocardial infarction with ventricular infarction; however, isolated atrial infarction (IAI) has rarely been reported. Herein, we report a case of IAI associated with sick sinus syndrome and atrial fibrillation (AF). Case summary: An 83-year-old woman was brought to the emergency department with a complaint of general malaise. An electrocardiogram at the time of her arrival showed a junctional rhythm with sinus arrest (SA) at a heart rate of 30 bpm; therefore, temporary pacing was placed urgently, and coronary angiography (CAG) was performed. Coronary angiography showed a solitary occlusion of the sinus node (SN) artery originating from the proximal portion of the right coronary artery. Therefore, revascularization was performed for the occluded SN artery to recover SN function. Bradycardia persisted for several days after the procedure but returned to normal sinus rhythm on day 10. However, during hospitalization, AF attacks frequently appeared with an SA for up to 10 s at AF termination, which is known as the bradycardia-tachycardia syndrome. Catheter ablation (CA) was performed for AF, and no recurrence of AF or bradycardia occurred thereafter. She was discharged without any symptoms. Discussion: We have experienced a patient who underwent revascularization for the occluded SN artery and CA for paroxysmal AF following IAI, which evaded permanent pacemaker implantation.
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Maeda et al. (2024) conducted a case report in Isolated atrial infarction complicated by sick sinus syndrome and atrial fibrillation (n=1). Revascularization of the occluded sinus node artery and catheter ablation was evaluated on Clinical recovery (resolution of AF and bradycardia). Revascularization of the occluded sinus node artery and catheter ablation successfully treated isolated atrial infarction complicated by sick sinus syndrome and AF, avoiding pacemaker implantation.
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