Ablation of Inappropriate Sinus Tachycardia

Abstract

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.

Combined Epicardial and Endocardial Sinus Node Modification Using the Orion™ Mini-basket Mapping Catheter

“…Various endocardial ablation techniques have been developed; however, given the predominantly epicardial location of the sinus node and its close proximity to the PN that can prohibit adequate ablation, procedural success has been limited. 4 More recently, surgical and catheter-based epicardial approaches to the sinus node have been used to achieve more direct access to the sinus node and facilitate the use of additional techniques for mechanical displacement of the PN from ablation target sites. 5 , 6 …”

A young female patient with recurrent paroxysms of inappropriate sinus tachycardia

“…The goal is to modify the sinus node without ablating it completely to avoid the need for permanent pacemaker implantation. [10] Finally, IST is a diagnosis of exclusion and is difficult to characterize symptomatic condition that represents a spectrum of disorders related to increased sinus node automaticity, disordered autonomic activation, or both.…”

Inappropriate Sinus Tachycardia: Current Challenges and Future Directions

“…6,7 Treatment approaches to IST center on reducing the sinus rate using lifestyle modifications, pharmacotherapy, or catheter ablation. 7,8,[15][16][17][18][19][20][21][22][23][24][25][26][27] Recent data support the role of exercise therapy in patients with IST. 15 Pharmacotherapy for IST aims to reduce the heart rate by targeting the hyperpolarization-activated cyclic nucleotide-gated channel, β-adrenergic receptors, or calcium channels.…”

“…21 Several nonrandomized studies assessed the efficacy of radiofrequency ablation with variable degrees of success. 7,22 Initially, complete sinus node ablation resulted in a high requirement for pacemaker implantation; thus, a subsequent less-aggressive approach of "sinus node modification" was considered, aimed at achieving a 25% reduction in the heart rate and a change in the P-wave morphology. [23][24][25] Technical approaches included mapping and ablating the earliest site of atrial activation and/or ablating the SVCright atrial appendage-crista terminalis confluence as visualized on intracardiac echocardiography.…”