Sinus arrest during right pulmonary vein isolation related to right sinus node artery injury: a case report

Abstract

A 50-year-old man with long-standing persistent atrial fibrillation received radiofrequency catheter ablation after electrical cardioversion. The second radiofrequency application on anterior antrum of the right superior pulmonary vein induced sinus arrest following a sinus cycle length prolongation. Sinus arrest persisted. Right ventricular pacing was required for 3 min until a sinus rhythm was restored. Preprocedural contrast-enhanced computed tomography revealed that the ablation site was near the right sinus node artery (SNA). Retrospective analysis during catheter ablation confirmed a direct anatomical relationship between the ablation site and the right SNA. In the present case, rapid recovery without coronary intervention suggests a transient and reversible mechanism, such as SNA spasm. This case highlights the importance of preprocedural anatomical assessment of the SNA and performing ablation under sinus rhythm, which may facilitate early recognition of sinus node dysfunction and help prevent irreversible injury.

Learning objective

A right sinus node artery might be close to the right superior pulmonary vein and can be affected by right pulmonary vein isolation. In cases of persistent atrial fibrillation, performing ablation under sinus rhythm allows immediate recognition of sinus node dysfunction and may help prevent irreversible sinus node injury.