Ablation therapy of postural orthostatic tachycardia syndrome, inappropriate sinus tachycardia and primary electrical diseases: new insights in invasive treatment options in severely symptomatic patients

Sinus rhythm is diagnosed based on 12-lead ecg recording. Diagnostic criteria are as follows: positive P waves in limb lead I and II and negative in aVR; PR interval of at least 120 ms; the difference of consecutive P-P interval should be less than 120 ms. A sinus rate limit is between 50-100/min. Numerous factors: physiologic, pathologic, medications, drugs and stimulants could increase sinus rate. Sinus tachycardia is also observed in inappropriate sinus tachycardia and postural orthostatic tachycardia syndrome. ESC guidelines related to latter two syndrome are summarized.

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Use of Saline Injection to Create Large Thermal Lesions During Radio Frequency Ablation Therapy: 2. Experimental Results

10.1115/imece2001/htd-24427 ◽

2001 ◽

Author(s):

Lissa P. Silver ◽

Patrick S. Hamilton ◽

Angela C. Ni ◽

Roberto M. Aimi ◽

Michael G. Curley

Keyword(s):

Heat Transfer ◽

Radio Frequency ◽

Liver Tumors ◽

Treatment Options ◽

Left Ventricular ◽

Electrode Site ◽

Experimental Results ◽

Interface Temperature ◽

Invasive Treatment ◽

Ablation Therapy

Abstract Tissue charring during radio frequency (RF) therapy causes an impedance rise and prevents further tissue heating from occurring, thereby limiting the size of lesions that can be created. The ability to create very large lesions would provide minimally invasive treatment options for deep tissue left ventricular arrythmias and otherwise-untreatable large liver tumors. Adding convection as a method of heat transfer by injecting saline at the RF electrode site acts to both clamp the electrode/tissue interface temperature and carry energy deeper into the tissue. We have developed a RF system that uses both conduction and convection simultaneously to both enhance the amount of heat transfer and prevent or greatly delay the onset of charring. Here we confirm the heat transfer augmentation of convection with experimental results in skeletal muscle, liver, and myocardium.

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Treatment of Inappropriate Sinus Tachycardia with Ivabradine in a Patient with Postural Orthostatic Tachycardia Syndrome and a Dual Chamber Pacemaker

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2009.02186.x ◽

2009 ◽

Vol 32 (1) ◽

pp. 131-133 ◽

Cited By ~ 25

Author(s):

SITARA KHAN ◽

SHOAIB HAMID ◽

CHRISTOPHER RINALDI

Keyword(s):

Sinus Tachycardia ◽

Postural Orthostatic Tachycardia Syndrome ◽

Dual Chamber ◽

Inappropriate Sinus Tachycardia ◽

Dual Chamber Pacemaker

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Sinus node-related tachycardias: physiological sinus tachycardia, inappropriate sinus tachycardia, sinus node reentrant tachycardia, and postural orthostatic tachycardia syndrome

ESC CardioMed ◽

10.1093/med/9780198784906.003.0483 ◽

2018 ◽

pp. 2066-2069

Author(s):

Brian Olshansky

Keyword(s):

Sinus Tachycardia ◽

Clinical Presentation ◽

Sinus Node ◽

Postural Orthostatic Tachycardia Syndrome ◽

Reentrant Tachycardia ◽

Inappropriate Sinus Tachycardia ◽

Different Types

This chapter describes the different types of sinus tachycardias and an approach to evaluate and treat these sinus tachycardias based on the clinical presentation and on recent guidelines and consensus documents.

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Sinus node sparing novel hybrid approach for treatment of inappropriate sinus tachycardia/postural sinus tachycardia: multicenter experience

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-021-01044-5 ◽

2021 ◽

Author(s):

Carlo de Asmundis ◽

Gian-Battista Chierchia ◽

Dhanunjaya Lakkireddy ◽

Ahmed Romeya ◽

Eric Okum ◽

...

Keyword(s):

Complete Resolution ◽

Sinus Tachycardia ◽

Sinus Node ◽

Postural Orthostatic Tachycardia Syndrome ◽

Drug Resistant ◽

3D Mapping ◽

Inappropriate Sinus Tachycardia ◽

Invasive Approach ◽

Chronotropic Response

Abstract Background The ideal treatment of inappropriate sinus tachycardia (IST) and postural orthostatic tachycardia syndrome (POTS) still needs to be defined. Medical treatments yield suboptimal results. Endocardial catheter ablation of the sinus node (SN) may risk phrenic nerve damage and open-heart surgery may be accompanied by unjustified invasive risks. Methods We describe our first multicenter experience of 255 consecutive patients (235 females, 25.94 ± 3.84 years) having undergone a novel SN sparing hybrid thoracoscopic ablation for drug-resistant IST (n = 204, 80%) or POTS (n = 51, 20%). As previously described, the SN was identified with 3D mapping. Surgery was performed through three 5-mm ports from the right side. A minimally invasive approach with a bipolar radiofrequency clamp was used to ablate targeted areas while sparing the SN region. The targeted areas included isolation of the superior and the inferior caval veins, and a crista terminalis line was made. All lines were interconnected. Results Normal sinus rhythm (SR) was restored in all patients at the end of the procedure. All patients discontinued medication during the follow-up. After a blanking period of 6 months, all patients presented stable SR. At a mean of 4.07 ± 1.8 years, normal SN reduction and chronotropic response to exercise were present. In the 51 patients initially diagnosed with POTS, no syncope occurred. During follow-up, pericarditis was the most common complication (121 patients: 47%), with complete resolution in all cases. Pneumothorax was observed in 5 patients (1.9%), only 3 (1.1%) required surgical drainage. Five patients (1.9%) required a dual-chamber pacemaker due to sinus arrest > 5 s. Conclusions Preliminary results of this multicenter experience with a novel SN sparing hybrid ablation of IST/POTS, using surgical thoracoscopic video-assisted epicardial ablation combined with simultaneous endocardial 3D mapping may prove to be an efficient and safe therapeutic option in patients with symptomatic drug-resistant IST and POTS. Importantly, in our study, all patients had a complete resolution of the symptoms and restored normal SN activity.

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