Ablation of Inappropriate Sinus Tachycardia
Open accessAbstract
OBJECTIVES: The goal of this study was to describe short- and long-term outcomes in all patients referred for inappropriate sinus tachycardia ablation, along with the potential complications of the intervention. BACKGROUND: Sinus node (SN) ablation/modification has been proposed for patients refractory to pharmacological therapy. However, available data derive from limited series. METHODS: The electronic databases MEDLINE, Embase, CINAHL, Cochrane, and Scopus were systematically searched (January 1, 1995-December 31, 2015). Studies were screened according to predefined inclusion and exclusion criteria. RESULTS: A total of 153 patients were included. Their mean age was 35.18 ± 10.02 years, and 139 (90.8%) were female. All patients had failed to respond to maximum tolerated doses of pharmacological therapy (3.5 ± 2.4 drugs). Mean baseline heart rates averaged 101.3 ± 16.4 beats/min according to electrocardiography and 104.5 ± 13.5 beats/min according to 24-h Holter monitoring. Two electrophysiological strategies were used, SN ablation and SN modification, with the latter being used more. Procedural acute success (using variably defined pre-determined endpoints) was 88.9%. Consistently, all groups reported high-output pacing from the ablation catheter to confirm absence of phrenic nerve stimulation before radiofrequency delivery. Need of pericardial access varied between 0% and 76.9%. Thirteen patients (8.5%) experienced severe procedural complications, and 15 patients (9.8%) required implantation of a pacemaker. At a mean follow-up interval of 28.1 ± 12.6 months, 86.4% of patients demonstrated successful outcomes. The symptomatic recurrence rate was 19.6%, and 29.8% of patients continued to receive antiarrhythmic drug therapy after procedural intervention. CONCLUSIONS: Inappropriate sinus tachycardia ablation/modification achieves acute success in the vast majority of patients. Complications are fairly common and diverse. However, symptomatic relief decreases substantially over longer follow-up periods, with a corresponding high recurrence rate.
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9.8% of patients in the meta-analysis required pacemaker implantation.
“The acute success was 88.9% but 8.5% experienced severe procedural complications (diaphragmatic paralysis, AV fistula, and retroperitoneal bleed) and 9.8% required pacemaker implantation.”
From Inappropriate sinus tachycardia (2019) · cites this paper as [89]
A meta-analysis of ablation studies (9 studies, 153 patients, mean age 35, 91% female) has been performed.
“A meta-analysis of ablation studies (9 studies, 153 patients, mean age = 35, 91% female) has been performed. 89”
From Inappropriate sinus tachycardia (2019) · cites this paper as [89]
30% of patients in the meta-analysis required continued drug therapy.
“Symptom recurrence rate was 19.6% and 30% required continued drug therapy.”
From Inappropriate sinus tachycardia (2019) · cites this paper as [89]
All patients in the meta-analysis failed to respond to maximal pharmacological therapy.
“All patients failed to respond to a maximal pharmacological therapy.”
From Inappropriate sinus tachycardia (2019) · cites this paper as [89]
Superior vena cava syndrome was apparent in two patients in the meta-analysis.
“Superior vena cava syndrome was apparent in two and some underwent ablation of the AV junction.”
From Inappropriate sinus tachycardia (2019) · cites this paper as [89]
The acute success of ablation in the meta-analysis was 88.9%.
“The acute success was 88.9% but 8.5% experienced severe procedural complications (diaphragmatic paralysis, AV fistula, and retroperitoneal bleed) and 9.8% required pacemaker implantation.”
From Inappropriate sinus tachycardia (2019) · cites this paper as [89]
8.5% of patients in the meta-analysis experienced severe procedural complications (diaphragmatic paralysis, AV fistula, and retroperitoneal bleed).
“The acute success was 88.9% but 8.5% experienced severe procedural complications (diaphragmatic paralysis, AV fistula, and retroperitoneal bleed) and 9.8% required pacemaker implantation.”
From Inappropriate sinus tachycardia (2019) · cites this paper as [89]
Symptom recurrence rate after ablation in the meta-analysis was 19.6%.
“Symptom recurrence rate was 19.6% and 30% required continued drug therapy.”
From Inappropriate sinus tachycardia (2019) · cites this paper as [89]
Tachycardia-mediated cardiomyopathy from IST has been reported in isolated case reports, and these cases were responsive to ivabradine.
“While tachycardia-mediated cardiomyopathy from IST has been reported in isolated case reports, these cases were responsive to ivabradine 203,204, and so invasive management also is not recommended in this group.”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [204]
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Inappropriate sinus tachycardia
Olshansky, B., & Sullivan, R. M. (2019) · EP Europace · doi:10.1093/europace/euy128 · Cited by 80 · see citing works
Sinus Tachycardia: a Multidisciplinary Expert Focused Review
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- Authors
- Rodríguez-Mañero, M., Kreidieh, B., Al Rifai, M., Ibarra-Cortez, S., Schurmann, P., Álvarez, P. A., Fernández-López, X. A., García-Seara, J., Martínez-Sande, L., González-Juanatey, J. R., & Valderrábano, M.
- Affiliations
- Houston Methodist (US)
- Corresponding author
- Valderrábano, Miguel
- Venue
- JACC: Clinical Electrophysiology
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 3
- Issue
- 3
- Pages
- 253-265
- ISSN
- 2405-500X (ISSN-L)
- PMC
- PMC6408216
- OpenAlex
- W2561228512
- Semantic Scholar
- 809ddd8bd427e1cf2f4e93479ff9243c9deef2ed
- Cited by
- 47
- References
- 25
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 6 · 2023: 2 · 2022: 6 · 2021: 14 · 2020: 4 · 2019: 6 · 2018: 2 · 2017: 1 · 2012: 1
- FWCI
- 2.48
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- JACC. Clinical electrophysiology (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American College of Cardiology Foundation
- National Heart, Lung, and Blood Institute (R01HL115003)
- 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, radiofrequency catheter ablation, procedural complications, phrenic nerve stimulation, pacemaker implantation, antiarrhythmic therapy, recurrence, long-term outcomes
- MeSH terms
- Adult, Anti-Arrhythmia Agents, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pacemaker, Artificial, Pericardium, Phrenic Nerve, Recurrence, Sinoatrial Node, Tachycardia, Sinus, Electrocardiography, Ambulatory, Treatment Outcome, Catheter Ablation, Body Surface Potential Mapping, Electrophysiologic Techniques, Cardiac
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