Heart Institute, Emek Medical Center, Afula, Israel.
Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
J Interv Cardiol. 2021 Mar 30;2021:8810484. doi: 10.1155/2021/8810484. eCollection 2021.
Sinus node artery occlusion (SNO) is a rare complication of percutaneous coronary intervention (PCI). We analyze both the short- and long-term consequences of SNO.
We retrospectively reviewed 1379 consecutive PCI's involving RCA and Cx arteries performed in our heart institute from 2016 to 2019. Median follow-up was 44 ± 5 months.
Among the 4844 PCIs performed during the study period, 284 involved the RCA and the circumflex's proximal segment. Periprocedural SNO was estimated by angiography observed in 15 patients (5.3%), all originated from RCA. The majority of SNO occurred during urgent and primary PCIs following acute coronary syndrome (ACS). Sinus node dysfunction (SND) appeared in 12 (80%) of patients. Four (26.6%) patients had sinus bradycardia, which resolved spontaneously, and 8 (53.3%) patients had sinus arrest with an escaped nodal rhythm, which mostly responded to medical treatment during the first 24 hours. There was no association between PCI technique and outcome. Three patients (20%) required urgent temporary ventricular pacing. One patient had permanent pacemaker implantation. Pacemaker interrogation during follow-up revealed a recovery of the sinus node function after one month.
SNO is rare and seen mostly during angioplasty to the proximal segment of the RCA during ACS. The risk of developing sinus node dysfunction following SNO is high. SND usually appears during the first 24 h of PCI. The majority of SND patients responded to medical treatment, and only in rare cases were permanent pacemakers required.
窦房结动脉闭塞（SNO）是经皮冠状动脉介入治疗（PCI）的罕见并发症。我们分析了 SNO 的短期和长期后果。
我们回顾性分析了 2016 年至 2019 年期间在我们心脏研究所进行的涉及 RCA 和 Cx 动脉的 1379 例连续 PCI。中位随访时间为 44±5 个月。
在研究期间进行的 4844 例 PCI 中，有 284 例涉及 RCA 和回旋支的近端节段。15 例（5.3%）患者经血管造影术估计存在围手术期 SNO，均源自 RCA。大多数 SNO 发生在急性冠状动脉综合征（ACS）后紧急和直接 PCI 期间。12 例（80%）患者出现窦房结功能障碍（SND）。4 例（26.6%）患者窦性心动过缓，可自行缓解，8 例（53.3%）患者窦性停搏伴结性逸搏节律，大多数在 24 小时内对药物治疗有反应。PCI 技术与结局之间无相关性。3 例（20%）患者需要紧急临时心室起搏。1 例患者植入永久性起搏器。随访期间起搏器询问显示窦性节点功能在 1 个月后恢复。
SNO 罕见，多见于 ACS 时 RCA 近端节段的血管成形术。SNO 后发生窦房结功能障碍的风险较高。SND 通常在 PCI 后 24 小时内出现。大多数 SND 患者对药物治疗有反应，只有极少数情况下需要永久性起搏器。
