Temporary sinus node dysfunction following ablation of atrial fibrillation in patients with aberrancy of the sinus node artery: a case series

OBJECTIVES Our goal was to investigate sinus node dysfunction (SND) as a rare complication following surgical and catheter atrial fibrillation (AF) ablation in patients with an aberrant sinus node artery (SNA).METHODS We used a retrospective analysis of 3 patients with an aberrant SNA who underwent different AF ablation procedures: 1 concomitant to aortic valve replacement, 1 thoracoscopic hybrid AF ablation and 1 catheter AF ablation.RESULTS All patients experienced temporary SND perioperatively. In the first patient, sinus rhythm (SR) recovered by postoperative day 6. In the second patient, SR returned by postoperative day 14. The third patient had a sinus arrest during ablation that restored to SR immediately post-procedure. All patients had normal SR at the 3-month follow-up.CONCLUSIONS Awareness of SNA anatomy can help to prevent iatrogenic SND during AF ablation. If SND occurs, a wait-and-see approach is recommended, given that sinus node function seems to recover. Because SND recovers, the benefits of posterior wall isolation could outweigh the disadvantages of temporary SND. Sinus node dysfunction (SND) is a rare complication of atrial fibrillation (AF) ablation and might be attributed to thermal injury of the sinus node artery (SNA) [1, 2].