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

Common 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

Causes by Organ System

Cardiovascular	Cough related syncope in patients with sick sinus syndrome, Myocarditis, Obstruction of artery to SA node during PCI, Sinus node degenration, ST elevation myocardial infarction
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Acetylcholine, Digitalis, Lidocaine, Quinidine
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	Hyperkalemia
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Sleep apnea
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Carotid sinus hypersensitivity, Vagal reaction