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Mayuga KA, Fedorowski A, Ricci F, Gopinathannair R, Dukes JW, Gibbons C, Hanna P, Sorajja D, Chung M, Benditt D, Sheldon R, Ayache MB, AbouAssi H, Shivkumar K, Grubb BP, Hamdan MH, Stavrakis S, Singh T, Goldberger JJ, Muldowney JAS, Belham M, Kem DC, Akin C, Bruce BK, Zahka NE, Fu Q, Van Iterson EH, Raj SR, Fouad-Tarazi F, Goldstein DS, Stewart J, Olshansky B. Sinus Tachycardia: a Multidisciplinary Expert Focused Review. Circ Arrhythm Electrophysiol 2022; 15:e007960. [PMID: 36074973 PMCID: PMC9523592 DOI: 10.1161/circep.121.007960] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sinus tachycardia (ST) is ubiquitous, but its presence outside of normal physiological triggers in otherwise healthy individuals remains a commonly encountered phenomenon in medical practice. In many cases, ST can be readily explained by a current medical condition that precipitates an increase in the sinus rate, but ST at rest without physiological triggers may also represent a spectrum of normal. In other cases, ST may not have an easily explainable cause but may represent serious underlying pathology and can be associated with intolerable symptoms. The classification of ST, consideration of possible etiologies, as well as the decisions of when and how to intervene can be difficult. ST can be classified as secondary to a specific, usually treatable, medical condition (eg, pulmonary embolism, anemia, infection, or hyperthyroidism) or be related to several incompletely defined conditions (eg, inappropriate ST, postural tachycardia syndrome, mast cell disorder, or post-COVID syndrome). While cardiologists and cardiac electrophysiologists often evaluate patients with symptoms associated with persistent or paroxysmal ST, an optimal approach remains uncertain. Due to the many possible conditions associated with ST, and an overlap in medical specialists who see these patients, the inclusion of experts in different fields is essential for a more comprehensive understanding. This article is unique in that it was composed by international experts in Neurology, Psychology, Autonomic Medicine, Allergy and Immunology, Exercise Physiology, Pulmonology and Critical Care Medicine, Endocrinology, Cardiology, and Cardiac Electrophysiology in the hope that it will facilitate a more complete understanding and thereby result in the better care of patients with ST.
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Affiliation(s)
- Kenneth A. Mayuga
- Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Artur Fedorowski
- Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G.d’Annunzio” University of Chieti-Pescara, Chieti Scalo, Italy
| | | | | | | | | | | | - Mina Chung
- Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, Phoenix, AZ
| | - David Benditt
- University of Minnesota Medical School, Minneapolis, MN
| | | | - Mirna B. Ayache
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Hiba AbouAssi
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC
| | | | | | | | | | - Tamanna Singh
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | | | - James A. S. Muldowney
- Vanderbilt University Medical Center &Tennessee Valley Healthcare System, Nashville Campus, Department of Veterans Affairs, Nashville, TN
| | - Mark Belham
- Cambridge University Hospitals NHS FT, Cambridge, UK
| | - David C. Kem
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Cem Akin
- University of Michigan, Ann Arbor, MI
| | | | - Nicole E. Zahka
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Qi Fu
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas & University of Texas Southwestern Medical Center, Dallas, TX
| | - Erik H. Van Iterson
- Section of Preventive Cardiology & Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic Cleveland, OH
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Ahmed A, Pothineni NVK, Charate R, Garg J, Elbey M, de Asmundis C, LaMeir M, Romeya A, Shivamurthy P, Olshansky B, Russo A, Gopinathannair R, Lakkireddy D. Inappropriate Sinus Tachycardia: Etiology, Pathophysiology, and Management: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 79:2450-2462. [PMID: 35710196 DOI: 10.1016/j.jacc.2022.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 12/21/2022]
Abstract
Inappropriate sinus tachycardia (IST) is a clinical syndrome that generally affects young patients and is associated with distressing symptoms. Although the most common symptom is palpitations, it can be accompanied by a myriad of symptoms, including anxiety, dizziness, presyncope, and syncope. The pathogenesis of IST is not well understood and considered multifactorial, with autonomic dysfunction being the central abnormality. IST is a diagnosis of exclusion. Management presents a clinical challenge. The overall efficacy of lifestyle modifications and medical therapy may be limited. Recent advances in catheter and surgical sinus node sparing ablation techniques have led to improvement in outcomes. In addition, increased focus has led to development of multimodality team-based interventions to improve outcomes in this group of patients. In this review, we discuss the mechanistic basis of IST, review current approaches to diagnosis, and outline contemporary therapeutic approaches.
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Affiliation(s)
- Adnan Ahmed
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | | | - Rishi Charate
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Jalaj Garg
- Loma Linda University Hospital, Heart Arrythmia and Electrophysiology, Loma Linda, California, USA
| | - Mehmet Elbey
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Mark LaMeir
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Ahmed Romeya
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | | | | | - Andrea Russo
- Copper University Health Care, Camden, New Jersey, USA
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Sharp A, Patient C, Pickett J, Belham M. Pregnancy-related inappropriate sinus tachycardia: A cohort analysis of maternal and fetal outcomes. Obstet Med 2021; 14:230-234. [PMID: 34880936 DOI: 10.1177/1753495x21990196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/30/2020] [Indexed: 11/15/2022] Open
Abstract
Background Little literature exists regarding the syndrome of inappropriate sinus tachycardia during pregnancy. We aimed to further understand the natural history of inappropriate sinus tachycardia in pregnancy, and to explore maternal and fetal outcomes. Methods A retrospective, observational cohort analysis of 19 pregnant women who presented with inappropriate sinus tachycardia. Results 42% attended the emergency department on more than one occasion with symptoms of inappropriate sinus tachycardia; 32% required hospital admission and 26% required pharmacological therapy. There were no maternal deaths, instances of heart failure or acute coronary syndrome, and no thromboembolic or haemorrhagic complications during pregnancy. Rates of caesarean section were similar to the background rate of our unit (32% and 27%, respectively). Rates of induction were notably elevated (58% vs 25%). Conclusion Inappropriate sinus tachycardia in pregnancy is associated with high rates of hospitalization and induction of labour, which may not be mandatory given the clinical findings in this group of women.
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Affiliation(s)
- Alexander Sharp
- Department of Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Charlotte Patient
- Department of Obstetrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Janet Pickett
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mark Belham
- Department of Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Lakkireddy D, Garg J, DeAsmundis C, LaMeier M, Romeya A, Vanmeetren J, Park P, Tummala R, Koerber S, Vasamreddy C, Shah A, Shivamurthy P, Frazier K, Awasthi Y, Chierchia GB, Atkins D, Bommana S, Di Biase L, Al-Ahmad A, Natale A, Gopinathannair R. Sinus Node Sparing Hybrid Thoracoscopic Ablation Outcomes in Patients with Inappropriate Sinus Tachycardia (SUSRUTA-IST) Registry. Heart Rhythm 2021; 19:30-38. [PMID: 34339847 DOI: 10.1016/j.hrthm.2021.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Medical treatment of inappropriate sinus tachycardia (IST) remains suboptimal. Radiofrequency sinus node (RF-SN) ablation has poor success and higher complication rates. OBJECTIVE We aimed to compare clinical outcomes of the novel SN sparing hybrid ablation technique with those of RF-SN modification for IST management. METHODS This is a multicenter prospective registry comparing the SN sparing hybrid ablation strategy with RF-SN modification. The hybrid procedure was performed using an RF bipolar clamp, isolating superior vena cava/inferior vena cava with the creation of a lateral line across the crista terminalis while sparing the SN region (identified by endocardial 3-dimensional mapping). RF-SN modification was performed by endocardial and/or epicardial mapping and ablation at the site of earliest atrial activation. RESULTS Of the 100 patients (hybrid ablation group, n = 50; RF-SN group, n = 50), 82% were women, and the mean age was 22.8 years. Normal sinus rhythm and rate were restored in all patients in the hybrid group (vs 84% in the RF-SN group; P = .006). Hybrid ablation was associated with significantly better improvement in mean daily heart rate and peak 6-minute walk heart rate compared with RF-SN ablation. The RF-SN group had a significantly higher rate of redo procedures (100% vs 8%; P < .001), phrenic nerve injury (14% vs 0%; P = .012), lower acute pericarditis (48% vs 92%; P < .0001), permanent pacemaker implantation (50% vs 4%; P < .0001) than did the hybrid ablation group. CONCLUSION The novel sinus node sparing hybrid ablation procedure appears to be more efficacious and safer in patients with symptomatic drug-resistant IST with long-term durability than RF-SN ablation.
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Affiliation(s)
| | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Carlo DeAsmundis
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Mark LaMeier
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Ahmed Romeya
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | | | - Peter Park
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | | | - Scott Koerber
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | | | - Alap Shah
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | | | | | | | - Gian Battista Chierchia
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Donita Atkins
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Sudha Bommana
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
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Restrepo AJ, Dickfeld TM. Image Integration Using Intracardiac Echography and Three-dimensional Reconstruction for Mapping and Ablation of Atrial and Ventricular Arrhythmias. Card Electrophysiol Clin 2021; 13:365-380. [PMID: 33990275 DOI: 10.1016/j.ccep.2021.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article reviews the basis for image integration of intracardiac echocardiography (ICE) with three-dimensional electroanatomic mapping systems and preprocedural cardiac imaging modalities to enhance anatomic understanding and improve guidance for atrial and ventricular ablation procedures. It discusses the technical aspects of ICE-based integration and the clinical evidence for its use. In addition, it presents the current technical limitations and future directions for this technology. This article also includes figures and videos of clinical representative arrhythmia cases where the use of ICE is key to a safe and successful outcome.
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Affiliation(s)
- Alejandro Jimenez Restrepo
- Section of Cardiology, Marshfield Clinic Health System, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
| | - Timm Michael Dickfeld
- Section of Cardiac Electrophysiology, Maryland Arrhythmia and Cardiac Imaging Group (MACIG), University of Maryland School of Medicine, 22 South Greene Street, Room N3W77, Baltimore, MD 21201, USA
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Issa ZF. Combined Epicardial and Endocardial Sinus Node Modification Using the Orion™ Mini-basket Mapping Catheter. J Innov Card Rhythm Manag 2021; 12:4452-4455. [PMID: 33777485 PMCID: PMC7987425 DOI: 10.19102/icrm.2021.120305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/30/2020] [Indexed: 11/06/2022] Open
Abstract
In patients with inappropriate sinus tachycardia, conservative medical management targeting the relief of symptoms is the first line of therapy. Sinus node modification can offer a potential benefit in selected patients with severe, refractory inappropriate sinus tachycardia. Extensive endocardial radiofrequency (RF) ablation of the superior aspect of the sinus node complex is typically required but is often limited by the epicardial location of the sinus node and the proximity of the phrenic nerve. More recently, surgical and catheter-based epicardial approaches to the sinus node have been used to facilitate more direct access to the sinus node and mechanical displacement of the phrenic nerve from ablation target sites. In this case report, we describe a combined epicardial-endocardial sinus node modification procedure in a patient with refractory inappropriate sinus tachycardia and previous unsuccessful endocardial ablation. The Orion™ mini-basket catheter (Boston Scientific, Natick, MA, USA) was used both for mapping the sinus node and for mechanically displacing the phrenic nerve from ablation target sites, which facilitated successful ablation.
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Affiliation(s)
- Ziad F Issa
- Prairie Heart Institute, Springfield, IL, USA
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El Gharib K. The sinoatrial node in medication-resistant inappropriate sinus tachycardia: To modify or to ablate? J Cardiovasc Electrophysiol 2020; 32:170-172. [PMID: 33179412 DOI: 10.1111/jce.14808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/01/2022]
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Edward JA, Nguyen DT. Patient Selection for Epicardial Ablation-Part II: The Epicardial Approach and Current Challenges Associated with Epicardial Ablation. J Innov Card Rhythm Manag 2020; 10:3906-3912. [PMID: 32477711 PMCID: PMC7252684 DOI: 10.19102/icrm.2019.101105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/29/2019] [Indexed: 12/03/2022] Open
Abstract
Since their inception, percutaneous epicardial approaches have become increasingly common in clinical practice with the advent of new technology and the growth of catheter ablation for both ventricular and supraventricular arrhythmias. In addition to identifying the arrhythmogenic foci, there remain challenges to successful epicardial ablation such as the choice of energy source, optimizing irrigation during ablation, and anatomic barriers such as epicardial fat and coronary vessels. The performance of continued translational studies to understand how each of these factors contribute to lesion formation will be essential to guide future advances in the field of epicardial ablation.
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Affiliation(s)
- Justin A Edward
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado Denver, Aurora, CO, USA
| | - Duy T Nguyen
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado Denver, Aurora, CO, USA
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9
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Edward JA, Nguyen DT. Patient Selection for Epicardial Ablation-Part I: The Role of Epicardial Ablation in Various Cardiac Disease States. J Innov Card Rhythm Manag 2020; 10:3897-3905. [PMID: 32477710 PMCID: PMC7252769 DOI: 10.19102/icrm.2019.101104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/29/2019] [Indexed: 11/30/2022] Open
Abstract
Epicardial catheter ablation is most commonly performed following unsuccessful endocardial ablation. Given the frequency of epicardial substrates in certain cardiomyopathic disease states, however, a combined endocardial–epicardial approach should be considered as a primary treatment strategy. Although epicardial ablation is primarily deployed in patients with ventricular arrhythmias, the role of epicardial approaches in supraventricular tachycardias (eg, atrial fibrillation, inappropriate sinus tachycardia, and—rarely—accessory pathways) is growing, with continued advances being made.
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Affiliation(s)
- Justin A Edward
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado Denver, Aurora, CO, USA
| | - Duy T Nguyen
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado Denver, Aurora, CO, USA
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10
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Khiabani AJ, Greenberg JW, Hansalia VH, Schuessler RB, Melby SJ, Damiano RJ. Late Outcomes of Surgical Ablation for Inappropriate Sinus Tachycardia. Ann Thorac Surg 2019; 108:1162-1168. [PMID: 31077661 DOI: 10.1016/j.athoracsur.2019.03.103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 02/09/2019] [Accepted: 03/25/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inappropriate sinus tachycardia (IST) is a rare clinical disorder characterized by an elevated resting heart rate and an exaggerated rate response to exercise or autonomic stress. Pharmacologic therapy and catheter ablation are considered first-line treatments for IST but can yield suboptimal relief of symptoms. The results of surgical ablation at our center were reviewed for patients with refractory IST. METHODS Between 1987 and 2018, 18 patients underwent surgical sinoatrial (SA) node isolation for treatment-refractory IST. All 18 patients had previously failed pharmacologic therapy, and 15 patients had failed catheter ablation of the SA node. RESULTS Ten patients underwent a median sternotomy, and 8 patients underwent a minimally invasive right thoracotomy. The SA node was isolated with the use of surgical incisions, cryoablation, or bipolar radiofrequency ablations. Sinus tachycardia was eliminated in 100% of patients in the immediate postoperative period. Long-term follow-up data were available for 17 patients, with a mean follow-up of 11.4 ± 7.9 years. At last follow-up, 100% of patients were free from recurrent symptomatic IST. More than 80% of patients were completely asymptomatic, whereas 3 patients reported occasional palpitations. Four patients were on β-blockers, and 5 patients required subsequent pacemaker implantation. All 8 patients who underwent minimally invasive isolation were in normal sinus rhythm at last follow-up, and only 1 patient complained of palpitations. CONCLUSIONS Surgical isolation of the SA node is a feasible treatment for IST refractory to pharmacologic therapy and catheter ablation. A minimally invasive surgical approach offers a less morbid alternative to traditional median sternotomy.
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Affiliation(s)
- Ali J Khiabani
- Division of Cardiothoracic Surgery, Department of Surgery, Washinton University School of Medicine in St Louis, St Louis, Missouri
| | - Jason W Greenberg
- Division of Cardiothoracic Surgery, Department of Surgery, Washinton University School of Medicine in St Louis, St Louis, Missouri
| | - Vivek H Hansalia
- Division of Cardiothoracic Surgery, Department of Surgery, Washinton University School of Medicine in St Louis, St Louis, Missouri
| | - Richard B Schuessler
- Division of Cardiothoracic Surgery, Department of Surgery, Washinton University School of Medicine in St Louis, St Louis, Missouri
| | - Spencer J Melby
- Division of Cardiothoracic Surgery, Department of Surgery, Washinton University School of Medicine in St Louis, St Louis, Missouri
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washinton University School of Medicine in St Louis, St Louis, Missouri.
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Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jaïs P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C, Gorenek B, Dagres N, Dan GA, Vos MA, Kudaiberdieva G, Crijns H, Roberts-Thomson K, Lin YJ, Vanegas D, Caorsi WR, Cronin E, Rickard J. 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 Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace 2018; 19:465-511. [PMID: 27856540 DOI: 10.1093/europace/euw301] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pierre Jaïs
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Roberto Keegan
- Hospital Privado del Sur y Hospital Español, Bahia Blanca, Argentina
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Deirdre A Lane
- Asklepios Hospital St Georg, Hamburg, Germany.,University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | | | - Bulent Gorenek
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gheorge-Andrei Dan
- Colentina University Hospital, 'Carol Davila' University of Medicine, Bucharest, Romania
| | - Marc A Vos
- Department of Medical Physiology, Division Heart and Lungs, Umc Utrecht, The Netherlands
| | | | - Harry Crijns
- Mastricht University Medical Centre, Cardiology & CARIM, The Netherlands
| | | | | | - Diego Vanegas
- Hospital Militar Central - Unidad de Electrofisiologìa - FUNDARRITMIA, Bogotà, Colombia
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Oliveira P, Arnott H, Mavropoulou A. Inappropriate sinus tachycardia in a dog. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2018-000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Pedro Oliveira
- Department of CardiologyDavies Veterinary SpecialistsHitchinUK
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13
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Yasin OZ, Vaidya VR, Chacko SR, Asirvatham SJ. Inappropriate Sinus Tachycardia: Current Challenges and Future Directions. J Innov Card Rhythm Manag 2018; 9:3239-3243. [PMID: 32479576 PMCID: PMC7252682 DOI: 10.19102/icrm.2018.090706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Omar Z. Yasin
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | | | | | - Samuel J. Asirvatham
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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14
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Ruzieh M, Moustafa A, Sabbagh E, Karim MM, Karim S. Challenges in Treatment of Inappropriate Sinus Tachycardia. Curr Cardiol Rev 2018; 14:42-44. [PMID: 29189171 PMCID: PMC5872261 DOI: 10.2174/1573403x13666171129183826] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 11/16/2017] [Accepted: 11/23/2017] [Indexed: 11/29/2022] Open
Abstract
Background: Inappropriate Sinus Tachycardia (IST) is a clinical syndrome characterized by a sinus heart rate inexplicably higher than one hundred beats per minute at rest that is associated with symptoms like palpitations, dyspnea or dizziness in the absence of primary causes of tachycar-dia. The diagnosis requires exclusion of other causes of tachycardia including medications/substances (such as anti-cholinergic, beta-blocker withdrawal, caffeine, and alcohol) or medical conditions (such as panic attacks, pulmonary embolism, fever, hyperthyroidism, hypovolemia, anemia, and pain). Methods: Work up should include an EKG to differentiate other causes of tachycardia, 24 hour-Holter monitor if indicated, serum thyroid levels, hemoglobin levels and toxicology screen. Electro-physiological studies are not routinely recommended, but should be considered in certain patients in whom concurrent supraventricular tachycardia is suspected. Conclusion: The underlying pathology in IST is yet to be completely understood. However, it is thought that the causes of IST can be broadly classified into two groups; either as an intrinsic increase in sinus node automaticity or an extrinsic cause. Among extrinsic causes, there is evolving evidence that IgG anti-β receptor antibodies are found in IST causing tachycardia. Managing patients with IST includes lifestyle modification, non-pharmacological and pharmacologi-cal interventions. Ivabradine has recently emerged as an effective treatment of IST and was shown to be superior to beta-blockers.
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Affiliation(s)
- Mohammed Ruzieh
- Penn State Heart and Vascular Institute, 500 University Drive, Hershey, PA 17033, United States
| | - Abdelmoniem Moustafa
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43614, United States
| | - Ebrahim Sabbagh
- Division of Cardiovascular Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43614, United States
| | - Mohammad M Karim
- Penn State Heart and Vascular Institute, 500 University Drive, Hershey, PA 17033, United States
| | - Saima Karim
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43614, United States
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Belham M, Patient C, Pickett J. Inappropriate sinus tachycardia in pregnancy: a benign phenomena? BMJ Case Rep 2017; 2017:bcr-2016-217026. [PMID: 28275013 DOI: 10.1136/bcr-2016-217026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The syndrome of inappropriate sinus tachycardia (IST) is a well-described and generally benign condition outside pregnancy. There is, however, little information in the literature about IST during pregnancy and nothing about the likely mechanism in such cases. Equally there is a paucity of information about the effects on maternal and fetal well-being in patients who develop IST during pregnancy. Here, we describe the case of a woman who developed IST for the first time during pregnancy. We have first given a brief clinical summary of events and then follow this with the patient's personal account which she has written herself specifically for this case report. We believe that this case highlights some of the important issues associated with the condition when it occurs during pregnancy. We hope that the publication of this case report will increase the awareness of IST during pregnancy. This is important as we believe that the correct diagnosis and understanding of the condition and its consequences will allow clinicians to manage women afflicted by the condition empathetically and appropriately.
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Affiliation(s)
- Mark Belham
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Janet Pickett
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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16
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Baruscotti M, Bianco E, Bucchi A, DiFrancesco D. Current understanding of the pathophysiological mechanisms responsible for inappropriate sinus tachycardia: role of the If "funny" current. J Interv Card Electrophysiol 2016; 46:19-28. [PMID: 26781742 DOI: 10.1007/s10840-015-0097-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/28/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Together with the afferent branches of the autonomic nervous system, the sinoatrial node (SAN) forms a functional unit whose function is to fire rhythmic action potentials at a rate optimal for coping with the metabolic needs of the body. Dysfunctional behavior of this complex unit may thus result in SAN rhythm disorders. Among these disorders, there is the inappropriate sinus tachycardia (IST) which occurs when an unjustified fast SAN rate is present. METHODS We here present a critical review of the role of pacemaker f/HCN channels in cardiac rhythm generation and modulation and their involvement in IST. RESULTS Recent evidence demonstrates that a familial form of IST is associated with a gain-of-function mutation in the HCN4 pacemaker channel (R524Q) which confers an increased sensitivity to the second messenger cAMP, a key mediator in sympathetic modulation. CONCLUSIONS This finding is consistent with the general view that hypersympathetic tone is one of the causes of IST and introduces the novel concept of defective funny channel-dependent tachyarrhythmias.
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Affiliation(s)
- Mirko Baruscotti
- Department of Biosciences, Centro Interuniversitario di Medicina Molecolare e Biofisica Applicata, University of Milano, via Celoria 26, 20133, Milano, Italy.
| | - Elisabetta Bianco
- Cardiovascular Department, "Ospedali Riuniti di Trieste", University Hospital, Trieste, Italy
| | - Annalisa Bucchi
- Department of Biosciences, Centro Interuniversitario di Medicina Molecolare e Biofisica Applicata, University of Milano, via Celoria 26, 20133, Milano, Italy
| | - Dario DiFrancesco
- Department of Biosciences, Centro Interuniversitario di Medicina Molecolare e Biofisica Applicata, University of Milano, via Celoria 26, 20133, Milano, Italy.
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17
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Katritsis DG, Boriani G, Cosio FG, Jais P, Hindricks G, Josephson ME, Keegan R, Knight BP, Kuck KH, Lane DA, Lip GY, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Young-Hoon K, Lundqvist CB. Executive Summary: European Heart Rhythm Association Consensus Document on the Management of Supraventricular Arrhythmias: Endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Arrhythm Electrophysiol Rev 2016; 5:210-224. [PMID: 28116087 PMCID: PMC5248663 DOI: 10.15420/aer.2016:5.3.gl1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 10/20/2016] [Indexed: 12/26/2022] Open
Abstract
This paper is an executive summary of the full European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, published in Europace. It summarises developments in the field and provides recommendations for patient management, with particular emphasis on new advances since the previous European Society of Cardiology guidelines. The EHRA consensus document is available to read in full at http://europace.oxfordjournals.org.
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Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Pierre Jais
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Mark E Josephson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Roberto Keegan
- Hospital Privado del Sur y Hospital Espanol, Bahia Blanca, Argentina
| | | | | | - Deirdre A Lane
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Yh Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | - Kim Young-Hoon
- Korea University Medical Center, Seoul, Republic of Korea
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