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Hashmath Z, Naniwadekar A. Treatment of inappropriate sinus tachycardia using endocardial sinus node modification with epicardial phrenic nerve deviation. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01697-4. [PMID: 38036766 DOI: 10.1007/s10840-023-01697-4] [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: 07/16/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Zeba Hashmath
- Department of Cardiovascular Sciences, East Carolina University, 115 Heart Drive, Greenville, NC, 27834, USA.
| | - Aditi Naniwadekar
- Department of Cardiovascular Sciences, East Carolina University, 115 Heart Drive, Greenville, NC, 27834, USA
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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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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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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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Shabtaie SA, Witt CM, Asirvatham SJ. Efficacy of medical and ablation therapy for inappropriate sinus tachycardia: A single-center experience. J Cardiovasc Electrophysiol 2021; 32:1053-1061. [PMID: 33566447 DOI: 10.1111/jce.14942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/18/2020] [Accepted: 01/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Effective therapy for inappropriate sinus tachycardia (IST) remains challenging with high rates of treatment failure and symptom recurrence. It is uncertain how effective pharmacotherapy and procedural therapy are long-term, with poor response to medical therapy in general. METHODS We retrospectively reviewed all patients with the diagnosis of IST at a tertiary academic medical center from 1998 to 2018. We extracted data related to prescribing patterns and symptom response to medical therapy and sinus node modification (SNM), assessing efficacy and periprocedural complication rates. RESULTS A total of 305 patients with a formal diagnosis of IST were identified, with 259 (84.9%) receiving at least one prescription medication related to the condition. Beta-blockers were the most commonly used medication (n = 245), with a majority of patients reporting no change or worsening of symptoms, and poor response was seen to other medication classes. Improvement was seen significantly more often with ivabradine than beta blockers, though the sample size was limited (p = .003). Fifty-five patients (18.0% of all IST patients), mean age 32.0 ± 9.1 years, underwent a SNM procedure, with an average of 1.8 ± 0.9 procedures per patient. Acute symptomatic improvement (<6 months) was seen in 58.2% of patients. Long-term complete resolution of symptoms was seen in 5.5% of patients, modest improvement in 29.1%, and no long-term benefit was seen in 65.5% of patients. CONCLUSIONS Among all medical therapies, there were high rates of treatment failure or symptom worsening in over three-quarters of patients in our study. Ivabradine was most beneficial, though the sample size was small. While most patients receiving SNM ablation for IST perceive an acute symptomatic improvement, almost two-thirds of patients have no long-term improvement, and resolution of symptoms is quite rare. AV node ablation with pacemaker implantation following lack of response to SNM offered increased success, though the sample size was limited.
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Affiliation(s)
- Samuel A Shabtaie
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Chance M Witt
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Arai T, Hojo R, Kitamura T, Fukamizu S. A new method of superior vena cava isolation without phrenic nerve injury by longitudinal ablation parallel to the phrenic nerve: a case report. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 33426459 PMCID: PMC7780490 DOI: 10.1093/ehjcr/ytaa312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/14/2020] [Accepted: 08/12/2020] [Indexed: 11/14/2022]
Abstract
Background Superior vena cava (SVC) isolation has improved the outcomes of paroxysmal atrial fibrillation (AF) originating from the SVC. However, right phrenic nerve (PN) injury is a major complication of this procedure. Therefore, in cases where the right atrium (RA)-SVC conduction site is near the PN, tremendous care is required to prevent PN injury. Case summary Repeated SVC isolation was performed due to the recurrence of SVC-triggered AF. The RA-SVC activation map revealed that the partial conduction block line was detected, and the propagation broke through the gap at the course of the PN site from the RA to the SVC. Since the course of the PN identified at high-output pacing was wide, the SVC was isolated by making longitudinal lines on both sides of the PN in a cranial direction, except for where low-output pacing captured, confirming compound muscle action potential to detect PN injury. Eventually, the SVC was successfully isolated without PN injury, and the sinus rhythm was maintained without antiarrhythmic drugs during a 14-month follow-up period. Conclusion Superior vena cava isolation was difficult depending on the course of the PN, and some methods to avoid PN injury were reported. However, this method can facilitate safe and effective SVC isolation with the conventional system, including the cases with AF foci located on the course of the PN.
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Affiliation(s)
- Tomoyuki Arai
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan
| | - Rintaro Hojo
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan
| | - Takeshi Kitamura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan
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Reissmann B, Fink T, Schlüter M, Metzner A, Ouyang F, Kuck KH. Catheter ablation for inappropriate sinus tachycardia: Clinical outcomes of sinus node ablation. HeartRhythm Case Rep 2020; 6:81-85. [PMID: 32099795 PMCID: PMC7026537 DOI: 10.1016/j.hrcr.2019.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Bruno Reissmann
- Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Address reprint requests and correspondence: Dr Bruno Reissmann, Dept. of Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
| | - Thomas Fink
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Andreas Metzner
- Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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Wann D, Bhonsale A, Jain S, Saba S, Estes NM, Kancharla K. Novel method of superior vena cava electrical isolation with close proximity to the phrenic nerve. HeartRhythm Case Rep 2019; 5:461-464. [PMID: 31934541 PMCID: PMC6951328 DOI: 10.1016/j.hrcr.2019.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jacobson JT. Appropriate treatment for an inappropriate disease? J Cardiovasc Electrophysiol 2019; 30:1304-1305. [PMID: 31222886 DOI: 10.1111/jce.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Jason T Jacobson
- Section of Cardiology, Department of Medicine, Westchester Medical Center-New York Medical College, Valhalla, New York
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Aalaei-Andabili SH, Miles WM, Burkart TA, Panna ME, Conti JB, McKillop MS, Beaver TM. Minimally invasive thoracoscopic surgery is an effective approach for treating inappropriate sinus tachycardia. J Cardiovasc Electrophysiol 2019; 30:1297-1303. [PMID: 31222889 DOI: 10.1111/jce.13970] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 03/28/2019] [Accepted: 04/11/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Inappropriate sinus tachycardia (IST) is characterized by increased heart rate out of proportion to normal physiologic demand. IST ablation is challenging for the electrophysiology community due to the epicardial location of the sinus node and the risk of phrenic nerve (PN) injury during catheter ablation. In this study, we investigated the safety and efficacy of a minimally invasive thoracoscopic surgery for elimination of IST. METHODS Patients with IST who failed medical therapy or endocardial ablation underwent minimally invasive thoracoscopic epicardial ablation. Epicardial activation mapping was performed to identify the earliest activation site and any possible migration of earliest activation along the lateral right atrium. The PN in each patient was protected by a pericardial retraction suture. RESULTS From 1 January 2000 to 15 June 2018, 10 patients (eight females and two males) underwent minimally invasive thoracoscopic IST ablation. Mean age of the patients was 36.7 ± 12.5 years. Mean baseline sinus rate was 113.8 ± 21.8 beats per minute. After surgery, the mean heart rate significantly decreased to 79.8 ± 8.2 at postoperative day 1 and to 75.8 ± 8.1 at day 30 (both P < .001). No in-hospital death, stroke, or PN injury occurred. One patient required reintubation, one patient developed postoperative pericarditis, and another patient had a pulmonary embolus. Median follow-up was 6 months (range, 1-50). Freedom from reintervention was 88% at 6 months. CONCLUSION Minimally invasive thoracoscopic ablation for IST is a safe and effective approach that preserves the phrenic nerve. Due to the possibility of IST activation site migration, continued follow-up after surgery is required.
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Affiliation(s)
- Seyed Hossein Aalaei-Andabili
- Division of Cardiology, University of Florida, Gainesville, Florida.,Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - William M Miles
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Thomas A Burkart
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Mark E Panna
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Jamie B Conti
- Division of Cardiology, University of Florida, Gainesville, Florida
| | | | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
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Postintervention Dyspnea after Radiofrequency Catheter Ablation: Think of a Phrenic Nerve Injury. Case Rep Cardiol 2017; 2017:6418070. [PMID: 29109869 PMCID: PMC5646315 DOI: 10.1155/2017/6418070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/22/2017] [Accepted: 08/27/2017] [Indexed: 11/21/2022] Open
Abstract
Phrenic nerve injury (PNI) is a rare complication of catheter ablation therapy, most commonly observed in cryoablation of the right side pulmonary veins. We present a case of PNI after radiofrequency catheter ablation that developed acute dyspnea 24 hours after the intervention. Dyspnea is the main symptom of PNI, so the diagnosis should always be suspected if it appears after any type of catheter ablation involving the trajectory of the phrenic nerve. There is no specific treatment for PNI. The only maneuver that has been reported to accelerate the recovery of PNI is early stopping of the ablation therapy.
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Rodríguez-Mañero M, Kreidieh B, Al Rifai M, Ibarra-Cortez S, Schurmann P, Álvarez PA, Fernández-López XA, García-Seara J, Martínez-Sande L, González-Juanatey JR, Valderrábano M. Ablation of Inappropriate Sinus Tachycardia: A Systematic Review of the Literature. JACC Clin Electrophysiol 2016; 3:253-265. [PMID: 29759520 DOI: 10.1016/j.jacep.2016.09.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/25/2016] [Accepted: 09/08/2016] [Indexed: 01/10/2023]
Abstract
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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Affiliation(s)
- Moisés Rodríguez-Mañero
- Division of Cardiac Electrophysiology, Department of Cardiology, Methodist Hospital, Houston, Texas
| | - Bahij Kreidieh
- Division of Cardiac Electrophysiology, Department of Cardiology, Methodist Hospital, Houston, Texas
| | - Mahmoud Al Rifai
- Cardiology Department, Johns Hopkins Cardiology Hospital, Baltimore, Maryland
| | - Sergio Ibarra-Cortez
- Division of Cardiac Electrophysiology, Department of Cardiology, Methodist Hospital, Houston, Texas
| | - Paul Schurmann
- Division of Cardiac Electrophysiology, Department of Cardiology, Methodist Hospital, Houston, Texas
| | - Paulino A Álvarez
- Division of Cardiac Electrophysiology, Department of Cardiology, Methodist Hospital, Houston, Texas
| | | | - Javier García-Seara
- Division of Cardiac Electrophysiology, Department of Cardiology, Methodist Hospital, Houston, Texas
| | - Luis Martínez-Sande
- Cardiology Department, University Hospital Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Miguel Valderrábano
- Division of Cardiac Electrophysiology, Department of Cardiology, Methodist Hospital, Houston, Texas.
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