Sustained Atrial Fibrillation by Acetylcholine Infusion into the Sinus Node Artery

Abstract Background Circumferential pulmonary vein isolation is an established therapy for selected patients with atrial fibrillation (AF). Three-dimensional imaging modalities can be useful to establish the mechanism of a procedure-related complication. Purpose The purpose of this study was to investigate the course of the sinus node artery (SNA) and the coronary arterial injury during catheter ablation of AF. Methods In the 254 consecutive patients, the courses of the SNA were recorded using multislice computed tomography. Results The visualization rate was 96.9% (246/254). Of 246 patients, 287 SNAs were detected among which 114 (44.9%) originated from the right coronary artery, 91 (35.9%) from the left circumflex (Cx) artery, and 41 (16.1%) from both the right and Cx artery. Only SNAs originated from the Cx artery coursed along the left atrium. Only in 2 patients, SNAs coursed endocardial surface of the left atrium. In one of these 2 patients, sinus node dysfunction developed just after the ablation of the right superior pulmonary vein ostium, requiring a permanent pacemaker implantation. The SNA originated from the distal Cx artery, and precisely coursed endocardial surface at the radiofrequency application site. Coronary angiography revealed the occlusion of the SNA at that site, and the SNA occlusion was presumed the cause of the sinus node dysfunction in this patient. Conclusion The recognition of the course of the SNA is important in minimizing the risk of sinus node dysfunction during catheter ablation of AF.

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The course of the sinus node artery and its impact on achieving linear block at the left atrial roof in patients with persistent atrial fibrillation

Heart Rhythm ◽

10.1016/j.hrthm.2012.04.016 ◽

2012 ◽

Vol 9 (9) ◽

pp. 1395-1402 ◽

Cited By ~ 11

Author(s):

Miki Yokokawa ◽

Baskaran Sundaram ◽

Hakan Oral ◽

Fred Morady ◽

Aman Chugh

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Sinus Node ◽

Persistent Atrial Fibrillation ◽

Sinus Node Artery ◽

Linear Block

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Evaluation of β-Adrenerglc Blocking Agents in Presence of Adrenergic Tone

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y72-059 ◽

1972 ◽

Vol 50 (5) ◽

pp. 381-388

Author(s):

Victor Elharrar ◽

Reginald A. Nadeau

Keyword(s):

Dose Response ◽

Sinus Node ◽

Stellate Ganglion ◽

Sodium Pentobarbital ◽

Response Curves ◽

Chronotropic Response ◽

Blocking Agents ◽

Sinus Node Artery ◽

Anesthetized Dogs ◽

The Right

The importance of the level of adrenergic tone in the determination of the dose–response curve to noradrenaline (NA) and in the evaluation of β-adrenergic blocking agents was studied in open-chest sodium pentobarbital anesthetized dogs by injecting drugs directly into the sinus node artery. Changes in the level of adrenergic tone by stimulating the right stellate ganglion resulted in variation of the observed chronotropic response to NA and of its ED50. The chronotropic responses were corrected by taking into account the underlying adrenergic tone. The negative chronotropic effect of dl-propranolol (1 and 10 μg) appeared to be related to its β-blocking properties and not to its quinidine-like effects as shown by the lack of effect of d-propranolol injected at the same doses. The magnitude of the negative chronotropic effects of 10 μg of propranolol and 100 μg of practolol, oxprenolol, and sotalol was shown to be related to the initial heart rate and consequently to the level of adrenergic tone. The comparison of these four β-blocking agents was carried out on corrected dose-response curves to NA. Their relative potencies were found to be: propranolol > oxprenolol > practolol > sotalol, corresponding to ratios of 1, [Formula: see text], [Formula: see text], and [Formula: see text]

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