Sinoatrial arrest causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Sinus arrest is fairly uncommon. It can be observed in the setting of myocardial disease (myocarditis) and ischemia or infarction (particularly acute inferior or posterior ST segment elevation MI). It can be a manifestation of digitalis or lidocaine toxicity.

Causes

• Acetylcholine
• Carotid sinus hypersensitivity
• Cough related syncope in patients with sick sinus syndrome
• Digitalis including digitalis toxicity
• Endotracheal intubation due to heightened vagal tone
• Hyperkalemia

• 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

• Lidocaine
• Myocarditis
• 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). 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.
• Nasal stimulation as part of a nsaocardiac reflex similar to the oculocardiac reflex during alfentanil - nitrous oxide anesthesia
• Quinidine sulfate
• Sinus node degeneration
• Sleep apnea
• ST elevation myocardial infarction particularly inferior myocardial infarctions and posterior infarctions.
• Vagal tone