Sinoatrial arrest
| Sinoatrial arrest |
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Overview
Under certain circumstances, the SA node fails to initiate an impulse at the expected time in the cardiac cycle. In the absence of an impulse from the SA Node neither the atria or the ventricles are stimulated and thus an entire PQRST complex drops out for 1 beat(or more). This is called Sinoatrial(SA) Arrest. In other instances the impulse is initiated normally but is blocked within the SA Node and never reaches the atria and ventricles. Sinus arrest is one variant of sinus node dysfunction.
Differential diagnosis of underlying causes of sinus arrest
- Decreased P wave amplitude occurs when the K is > 7.0 meq/li
- P waves may be absent when the K is > 8.8 meq/li
- The impulses are still being generated in the SA node and are conducted to the ventricles through specialized atrial fibers without depolarizing the atrial muscle
- Moderate or sever hyperkalemia can cause sinus arrest [1]
- Lidocaine
- Percutaneous coronary intervention of the proximal right coronary artery can obstruct the origin of the SA nodal artery in about 17% of patients (14 of 80 in one series). [2] Sinus arrest with junctional escape rhythm went on to develop in 4 of the 14 patients and one patient required a temporary ventricular pacing. There was resolution of the the junctional escape rhythm in all patients within 3 days of the sinus node artery occlusion.
Treatment
- Discontinue the agent that may be causing sinus arrest and treat hyperkalemia.
- Isoproterenol can be used to increase the rate of the escape pacemaker.
- Finally, a temporary pacemaker wire can be placed.
References
- ↑ Bonvini RF, Hendiri T, Anwar A (2006). "Sinus arrest and moderate hyperkalemia". Annales De Cardiologie Et D'angéiologie. 55 (3): 161–3. PMID 16792034. Unknown parameter
|month=ignored (help) - ↑ Munenori Kotoku, Akira Tamura, Shigeru Naono and Junichi Kadota.Sinus arrest caused by occlusion of the sinus node artery during percutaneous coronary intervention for lesions of the proximal right coronary artery. Heart and vessels,2007, p.389-392