Frequent additional tachyarrhythmias in patients with inappropriate sinus tachycardia undergoing sinus node modification: an important cause of symptom recurrence
Abstract
BACKGROUND: Symptom recurrence following sinus node modification (SNM) for inappropriate sinus tachycardia (IST) remains significant despite achieving acute procedural success. The impact of non-IST tachyarrhythmias on symptom recurrence remains poorly characterized. OBJECTIVES: The objective was to determine the prevalence and nature of additional tachyarrhythmias preceding and following SNM for IST. METHODS: Consecutive patients with IST undergoing SNM at the University of Pennsylvania were studied. SNM was initially performed using an anatomic approach targeting the superolateral crista terminalis under intracardiac echocardiographic guidance and later using an electrophysiologic approach, targeting the site of the earliest right atrial activation during maximum heart rate (HR) with isoproterenol infusion. An effort was made to shift the site more caudally until a decrease of >25% in resting HR was achieved, with a blunted response to isoproterenol and flattening of the P-wave axis in leads III and aVF. Patients were followed for arrhythmia recurrence. Tachyarrhythmias were documented with electrocardiographic monitoring and then characterized during EP study. RESULTS: Thirty-three patients underwent SNM and were followed for a mean of 2.0 ± 1.5 years. During follow-up, 27% developed a non-IST tachyarrhythmia and 18% developed recurrent IST. Additionally, 42% of patients had a non-IST tachyarrhythmia prior to SNM. CONCLUSIONS: Non-IST tachyarrhythmias are common in patients with IST before and after SNM. A major reason for symptom recurrence following SNM is development of a non-IST tachyarrhythmia. These tachyarrhythmias should be detected and treated to optimize patient outcomes.
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Ablation can be fruitless because tachycardia might ultimately come from other sinus nodal sites or from the AV junction after complete sinus node obliteration.
“Ablation can be fruitless as tachycardia might ultimately come from other sinus nodal sites or from the AV junction after complete sinus node obliteration. 97”
From Inappropriate sinus tachycardia (2019) · cites this paper as [97]
Patients with IST tend to have frequent other tachycardias even if the sinus node is ablated.
“A more recent report indicated that patients with IST tend to have frequent other tachycardias even if the sinus node is ablated.”
From Inappropriate sinus tachycardia (2019) · cites this paper as [97]
Minimally invasive thoracoscopic surgery with bipolar radiofrequency clamp or cryoablation, isolation of the superior right atrium, and inferior vena cava isolation are alternative approaches.
“Minimally invasive thoracoscopic surgery with use of bipolar radiofrequency clamp or cryoablation, 75,205,215–219, isolation of the superior right atrium from the rest of the atrium217,218,220, and inferior vena cava isolation 205,217 are alternative approaches.”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [219]
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Nhịp nhanh xoang không thích hợp
Nguyễn, D. T., Hiếu, N. L., & Phong, P. Đ. (2021) · Tạp chí Tim Mạch Học Việt Nam · doi:10.58354/jvc.94.95.2021.151
- Authors
- FRANKEL, D. S., LIN, D., ANASTASIO, N., MOUNTANTONAKIS, S. E., DIXIT, S., GERSTENFELD, E. P., HUTCHINSON, M. D., RILEY, M. P., MARCHLINSKI, F. E., & CALLANS, D. J.
- Affiliations
- Hospital of the University of Pennsylvania (US)
- North Shore University Hospital (US)
- Corresponding author
- FRANKEL, DAVID S
- LIN, DAVID
- CALLANS, DAVID J
- ORCID
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2012-04-04
- Volume
- 23
- Issue
- 8
- Pages
- 835-839
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2114856406
- Cited by
- 26
- References
- 16
- Citations by year
- 2024: 1 · 2022: 1 · 2021: 4 · 2020: 1 · 2019: 3 · 2018: 1 · 2017: 1 · 2016: 2 · 2015: 8 · 2013: 2 · 2012: 2
- FWCI
- 2.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- inappropriate sinus tachycardia, symptom recurrence, isoproterenol response, P wave axis
- MeSH terms
- Adrenergic beta-Agonists, Adult, Female, Heart Rate, Hospitals, University, Humans, Isoproterenol, Male, Middle Aged, Pennsylvania, Predictive Value of Tests, Recurrence, Retrospective Studies, Risk Factors, Sinoatrial Node, Tachycardia, Tachycardia, Sinus, Time Factors, Prevalence, Multivariate Analysis, Chi-Square Distribution, Proportional Hazards Models, Treatment Outcome, Catheter Ablation, Risk Assessment, Electrophysiologic Techniques, Cardiac
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