Catheter ablation of inappropriate sinus tachycardia
Abstract
Catheter ablation for inappropriate sinus tachycardia (IST) is recommended for patients symptomatic for palpitations and refractory to other treatments. The current approach consists in sinus node modification (SNM), achieved by ablation of the cranial part of the sinus node to eliminate faster sinus rates while trying to preserve chronotropic competence. This approach has a limited efficacy, with a very modest long-term clinical success. To overcome this, proper patient selection is crucial and an epicardial approach should always be considered. This brief review will discuss the current role and limitations of catheter ablation in the management of patients with IST.
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Complications of sinus node modification may occur in up to 14% and include cardiac tamponade, SVC syndrome, diaphragmatic paralysis due to phrenic nerve palsy, and sinus node dysfunction requiring permanent pacing.
“Complications of sinus node modification may occur in up to 14% of cases, and include cardiac tamponade, SVC syndrome, diaphragmatic paralysis due to phrenic nerve palsy, and sinus node dysfunction with the need for permanent pacing.88 -90”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [88]
Typically, faster sinus node rates involve the superior aspect of the sinus node, and ablation is typically targeted here.
“Typically, faster sinus node rates involve the superior aspect of the sinus node, and ablation is typically targeted here.206,207(Appendix 1)”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [206]
The acute success rate of sinus node modification varies from 66-100% depending on the endpoint definition.
“The acute success rate of sinus node modification varies from 66 – 100% depending on the endpoint definition.201,202,206,207,215,225–228”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [206]
Ablation of the entire sinus node is no longer performed, due to the development of junctional rhythm requiring permanent pacemaker.
“Ablation of the entire sinus node is no longer performed, due to the development of junctional rhythm requiring permanent pacemaker206.”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [206]
Complications of sinus node modification vary from 0-14%, but the true occurrence rate is limited by the small studies.
“Complications vary from 0–14% but the true occurrence rate is limited by the small studies.201,202,206,207,215,225–228”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [206]
Right phrenic nerve injury with diaphragmatic paralysis, pericarditis, SVC stenosis, and cardiac tamponade during pericardial balloon placement requiring open-chest repair have all been reported.
“Right phrenic nerve injury with diaphragmatic paralysis206,228, pericarditis205,213,229, SVC stenosis206,226,230 and cardiac tamponade during pericardial balloon placement requiring open-chest repair212 have all been reported.”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [206]
Junctional rhythm is frequent, with 42% of patients having this arrhythmia, usually with recovery of a higher right atrial rhythm within 24 hours.
“Junctional rhythm is also frequent, with 42% of patients having this arrhythmia, usually with recovery of a higher right atrial rhythm within 24 hours.206,208,213”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [206]
Common arrhythmias post-ablation include atrial tachycardias, comprising 71% of all non-IST arrhythmias, which may require catheter ablation.
“Besides sinus node dysfunction including sinus pauses, common arrhythmias post-ablation includes atrial tachycardias, comprising 71% of all non-IST arrhythmias; these may also require catheter ablation206,210,225,228.”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [206]
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- Authors
- Gianni, C., Di Biase, L., Mohanty, S., Gökoğlan, Y., Güneş, M. F., Horton, R., Hranitzky, P. M., Burkhardt, J. D., & Natale, A.
- Affiliations
- University of Milan (IT)
- St David's Medical Center (US)
- Albert Einstein College of Medicine (US)
- Corresponding author
- Natale, Andrea
- ORCID
- Venue
- Journal of Interventional Cardiac Electrophysiology
- Published
- 2015-08-27
- Volume
- 46
- Issue
- 1
- Pages
- 63-69
- ISSN
- 1383-875X (ISSN-L)
- 1572-8595
- OpenAlex
- W2155375226
- Cited by
- 26
- References
- 28
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2022: 3 · 2021: 4 · 2020: 1 · 2019: 4 · 2018: 3 · 2017: 1 · 2016: 4
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Interventional Cardiac Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- inappropriate sinus tachycardia, catheter ablation, epicardial ablation, palpitations, refractory tachycardia, patient selection
- MeSH terms
- Adrenergic beta-Antagonists, Cardiac Surgical Procedures, Humans, Preoperative Care, Prognosis, Sinoatrial Node, Tachycardia, Sinus, Treatment Outcome, Catheter Ablation, Patient Selection, Evidence-Based Medicine, Surgery, Computer-Assisted
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