Sinus Node Dysfunction and Atrial Fibrillation Associated with Isolated Sinoatrial Node Artery Ectasia

Abstract

A 74 year-old female patient was admitted to emergency service with a complaints of dizziness and shortness of breath. Complete atrioventricular block was observed and patient was followed up two days with transient transvenous cardiac pacemaker. Afterthat, atrial fibrillation (AF) was progressed and then, coronary angiography was scheduled. Although all three main coronary arteries was free of the stenotic lesion and coronary ectasia, there was a local ectatic segment with prominent slow flow in the sinoatrial node artery that originated from proximal right coronary artery. Patient was treated with dual anti-agregants and enoxaparine in the hospitalization period. Bradiarrhtymias did not recur and AF was reverted to sinusal rhythm with medical therapy. Classical risk factors for AF progression was absent in the patient. We thought that, ectasia and slow flow in the sinoatrial node artery could trigger the bradiarrhtymia and AF by the mechanism of ischemic sinus node dysfunction.

Keywords

• Coronary ectasia, sinoatrial node artery, atrial fibrillation

Sinus Node Dysfunction and Atrial Fibrillation Associated with Isolated Sinoatrial Node Artery Ectasia

Abstract

Yetmişdört yaşında kadın hasta baş dönmesi, nefes darlığı şikayetleriyle acil polikliniğe başvurdu. Atrioventriküler tam blok saptanan hasta iki gün geçici transvenöz kalp pili ile takip edildi. Sonrasında atriyal fibrillasyon gelişen hastaya, koroner anjiyografide uygulandı. Her üç ana koroner arterlerde kritik darlık ve koroner ektazi olmamasına karşın; proksimal sağ koroner arterden köken alan sinoatrial nod arterinde izole lokal ektazi ve ektazik segmentte belirgin yavaş akım izlendi. Medikal takip kararı alınan hastaya ikili antiagregan tedavi ve enoksaparin tedavisi uygulandı. Takipte bradiaritmi izlenmedi; atriyal fibrilasyon sinüs ritmine döndü. Hastada AF gelişimi için klasik etiyolojik faktörler yoktu. Sinoatriyal nod arterinde saptanan ektazi ve yavaş akımın, iskemik sinüs nod disfonksiyona yol açtığını ve buna bağlı olarak bradiaritmi ve AF geliştiğini düşünüyoruz

Keywords

• Koroner ektazi, sinoatriyal nod arteri, atriyal fibrillasyon

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