Reversible sinus node dysfunction after multiple ablations along the course of sinus nodal artery in patient with paroxysmal atrial fibrillation

摘要

A 60-year-old man who had medically refractory paroxysmal atrial fibrillation (PAF) had undergone catheter ablation. Despite the amiodarone usage, there was no sinus pause lasting more than 2 s aftertermination of PAF. Amiodarone was discontinued for 4 weeks before ablation. After successful isolation of bilateral pulmonary vein antrum and posterior roof line, sustained atrial tachycardia (AT) was induced by programmed electrical stimulation. Atrial tachycardia was originated from the high ridge between the left superior pulmonary vein (LSPV) and the left atrial appendage. Therefore, we performed additional ablation at this area near left atrial (LA) roof to mitral annulus (panel A), but did not terminated AT. After direct current cardioversion (200 J, biphasic), long sinus arrest (9.7 s) was observed. Junctional escaped rhythm with marked sinus bradycardia was lasted for 2 days afterthe procedure. From 3 days after ablation, junctional rhythm changed to sinus bradycardia with no more sinus pause. Computed tomography (CT) angi-ography showed that sinus nodal artery (SNA) was originated from left circumflex artery, and crossed the anterior roof area between LA appendage and LSPV, where multiple ablations were performed (panel 8).