Persistent Inappropriate Sinus Tachycardia After Radiofrequency Ablation of Left Lateral Accessory Pathway

Moreira, José Marcos; Curimbaba, Jefferson; Filho, Halim Cury; Pimenta, João

doi:10.1111/j.1540-8167.2006.00376.x

Cited by 12 publications

(7 citation statements)

References 14 publications

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“…Every patient underwent 12-lead electrocardiogram to confirm normal P-wave morphology. Additional evaluations included: baseline blood testing (complete metabolic panel, thyroid function, blood count, renal function, electrolytes, drug testing and serum and urine catecholamines), 3, 12-14 and autonomic testing (tilt table testing, in order to rule out postural orthostatic tachycardia syndrome [POTS]). Patients who proved refractory to, or intolerant of, pharmacologic therapy were offered ablative treatment.…”

Section: Methodsmentioning

confidence: 99%

Strategies for phrenic nerve preservation during ablation of inappropriate sinus tachycardia

et al. 2016

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Background Radiofrequency (RF) ablation can alleviate drug-refractory inappropriate sinus tachycardia (IST). However, phrenic nerve (PN) injury and other complications limit its use. Objective We sought to characterize the maneuvers utilized to avoid PN injury and the long-term clinical outcomes. Methods Retrospective analysis of consecutive patients who underwent ablation for IST. Results RF ablation was carried out on 13 consecutive female patients with drug-refractory IST. Eleven patients exhibited PN capture at desired ablation sites. In one patient, PN capture was not continuous throughout the respiratory cycle and ventilation holding sufficed to avoid PN injury. In 10 patients, pericardial access (PA) and balloon (PB) insertion was required. Initially (n=4) a posterior PA was utilized, which was replaced by an anterior PA in the subsequent 6 cases. PA to optimal balloon positioning time was significantly lower in anterior vs. posterior PA (16.3±6 min vs. 58±21.3 min p=0.01), as was fluoroscopy time (15.66±16.72 min vs. 35.9±1.8 min, p=0.03). RF ablation successfully reduced sinus rate to less than 90 bpm in 13/13 patients. Procedure times and total radiofrequency times were not significantly different in anterior vs posterior PA. Major complications occurred in 2 patients, including unremitting pericardial bleeding requiring open-chested repair in one patient and sinus pauses mandating pacemaker implantation in another. Long-term symptom control after a follow-up of 811±42 days was successful in 84.6%. Conclusion Ventilation holding and/or pericardial balloon insertion are frequently warranted in IST ablation. Anterior PA appears to facilitate the procedure over posterior PA.

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Section: Methodsmentioning

confidence: 99%

Strategies for phrenic nerve preservation during ablation of inappropriate sinus tachycardia

et al. 2016

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“…IST has been reported as a complication of supraventricular tachycardias RF ablation, 33–36 but its mechanism remains poorly understood. After ganglionated plexi ablation, IST was observed in 23.5% of the patients, 37 and cardiac denervation has been suggested to be one of the mechanisms leading to IST.…”

Section: Pnpmentioning

confidence: 99%

Collateral Nervous Damages After Cryoballoon Pulmonary Vein Isolation

Guiot

Savouré

Godin

et al. 2011

Cardiovasc electrophysiol

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“…Anxiety, pain, cocaine abuse, amphetamine ingestion, catecholamine infusions, anticholinergic drugs, tobacco, caffeine, alcohol, β‐blocker withdrawal, hyperthyroidism, and hypoglycemia are other explanations. Sinus tachycardia after catheter ablation of supraventricular tachycardia, 1–6 with diabetes, 7,8 or in the postural orthostatic tachycardia syndrome 9,10 is explainable and may be appropriate.…”

Section: Editorial Commentmentioning

confidence: 99%

What's So Inappropriate About Sinus Tachycardia?

Olshansky¹

2008

Cardiovasc electrophysiol

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Sinus tachycardia is a physiological response to sympathetic activation and/or parasympathetic withdrawal. Exercise, anemia, dehydration, pulmonary embolus, fever, pericarditis, cardiac rupture, aortic insufficiency, acute mitral regurgitation, myocardial infarction, pulmonary edema, and pneumothorax are some autonomic triggers. Anxiety, pain, cocaine abuse, amphetamine ingestion, catecholamine infusions, anticholinergic drugs, tobacco, caffeine, alcohol, β-blocker withdrawal, hyperthyroidism, and hypoglycemia are other explanations. Sinus tachycardia after catheter ablation of supraventricular tachycardia, 1-6 with diabetes, 7,8 or in the postural orthostatic tachycardia syndrome 9,10 is explainable and may be appropriate.So how can sinus tachycardia be inappropriate? It is inappropriate when it is not understood. Then, it is termed inappropriate sinus tachycardia (IST). Extracardiac and intracardiac mechanisms have been postulated. Similar to appropriate sinus tachycardia, excess sympathetic activity, impaired parasympathetic activity or increased sinus node automaticity can explain IST. The exact pathways for sinus tachycardia, inappropriate or not, remain largely unresolved. Perhaps the present view of autonomic innervation of the sinus node is, at best, naïve. Additionally, there is no reason to suspect only one responsible mechanism.For IST, an autonomic neuropathy, excessive venous pooling, β-receptor hypersensitivity, α-receptor hyposensitivity, altered sympathovagal balance, and brainstem dysregulation have been considered but then disputed. β-adrenergic receptor autoantibodies, β-adrenergic receptor supersensitivity, M2 receptor abnormalities, an intrinsic problem with sinus node, a depressed efferent cardiovagal reflex, or impaired baroreflex control are likely explanations, 7,11-15 but the underlying mechanisms are likely multifactorial and complex. They remain understood poorly. 15 What is known is that IST patients can be highly symptomatic and generally do not respond well to any medical therapy including β-adrenergic blockers even at high doses. 16 Ivabradine, an If blocker, is showing promise. 17,18 Radiofrequency catheter ablation has been advocated, but it is unclear exactly what it does. Does it shave off superior portions of the sinus node that are under greater sympathetic control or does it eliminate select sympathetic inputs? 19,14,20 Zhou and colleagues believe they have arrived at an animal model of IST. 21,22 Their group showed that cardiac fat pad stimulation slows and that isoproterenol or epinephrine injections increase sinus rate. 21 Sinus tachycardia originated from the sinus node or crista terminalis region. Ablation of the innervating autonomic ganglia stopped sinus tachycardia but did not impair the sinus node response to an adrenergic challenge. This response was not surprising. It was sinus tachycardia plain and simple, not IST.In this issue of the Journal, 22 Zhou and colleagues define the course of the interganglionic nerve from the right stellate ganglion along the superior...

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Persistent Inappropriate Sinus Tachycardia After Radiofrequency Ablation of Left Lateral Accessory Pathway

Cited by 12 publications

References 14 publications

Strategies for phrenic nerve preservation during ablation of inappropriate sinus tachycardia

Strategies for phrenic nerve preservation during ablation of inappropriate sinus tachycardia

Collateral Nervous Damages After Cryoballoon Pulmonary Vein Isolation

What's So Inappropriate About Sinus Tachycardia?

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