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

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.

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

ESC CardioMed ◽  
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.

scholarly journals Sinus node modification with an ultra high-density electroanatomical mapping system in inappropriate sinus tachycardia

EP Europace ◽  
2017 ◽  
Vol 19 (10) ◽  
pp. 1656-1656 ◽  
Author(s):  
Susanne Löbe ◽  
Jedrzej Kosiuk ◽  
Silke John ◽  
Sebastian Hilbert ◽  
Gerhard Hindricks ◽  
...  
Keyword(s):  
Sinus Tachycardia ◽  
Sinus Node ◽  
High Density ◽  
Electroanatomical Mapping ◽  
Inappropriate Sinus Tachycardia ◽  
Mapping System ◽  
Electroanatomical Mapping System ◽  
Sinus Node Modification

scholarly journals Sinus Node Sparing Hybrid Thoracoscopic Ablation Outcomes in Patients with Inappropriate Sinus Tachycardia (SUSRUTA-IST Registry)

Heart Rhythm ◽  
2021 ◽  
Author(s):  
Dhanunjaya Lakkireddy ◽  
Jalaj Garg ◽  
Carlo DeAsmundis ◽  
Mark LaMeier ◽  
Ahmed Romeya ◽  
...  
Keyword(s):  
Sinus Tachycardia ◽  
Sinus Node ◽  
Inappropriate Sinus Tachycardia

NORMOCARDIA – CORRECT HEART RHYTHM

2020 ◽  
Vol 2 (55) ◽  
pp. 34-38
Author(s):  
Przemysław Mitkowski
Keyword(s):  
Sinus Tachycardia ◽  
Heart Rhythm ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Inappropriate Sinus Tachycardia ◽  
P Waves ◽  
Sinus Rate ◽  
Pr Interval ◽  
Esc Guidelines ◽  
The Difference ◽  
Rate Limit

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.

scholarly journals P433Case series of radiofrequency ablation for drug resistant inappropriate sinus tachycardia

EP Europace ◽  
2018 ◽  
Vol 20 (suppl_1) ◽  
pp. i82-i82
Author(s):  
M Emami ◽  
R S Mishima ◽  
K Kadhim ◽  
A Thiyagarajah ◽  
D A Munawar ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Sinus Tachycardia ◽  
Drug Resistant ◽  
Inappropriate Sinus Tachycardia

scholarly journals 502 Secondary cardiac lymphoma complicated with tamponade

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P H Lee
Keyword(s):  
Pericardial Effusion ◽  
Malignant Lymphoma ◽  
Cardiac Tamponade ◽  
Complete Resolution ◽  
Sinus Tachycardia ◽  
Left Ventricular ◽  
Pulmonary Congestion ◽  
Shortness Of Breath ◽  
Pericardial Mass

Abstract Introduction A 72-year-old lady presented with one-week history of palpitation and shortness of breath. She had pyrexia of unknown origin for 4 weeks associated with weight loss. Initial clinical examination revealed sinus tachycardia of 110 beats/min and saturations of 96% on 2L/min oxygen. Neck exam revealed a 2 x 3 cm firm mass at left supraclavicular fossa. Electrocardiogram showed sinus tachycardia at 106 beats/min. There was fixed T wave inversions over anterolateral chest leads and inferior limb leads. Chest radiograph showed enlarged cardiac silhouette and evidence of pulmonary congestion Procedure Transthoracic echocardiogram revealed a moderate pericardial effusion with an 8 x 4 cm pericardial mass compressing at the right atrioventricular groove (Figure B & C). Respiratory variation of Doppler mitral and tricuspid inflow velocities suggested cardiac tamponade (Figure A). Inferior vena cava was engorged with impaired inspiratory collapse. Left ventricular size and function were otherwise normal. Urgent pericardiocentesis was performed which yielded 1 litre of light blood stained fluid. Her had subjective improvement of symptoms. There was also resolution of sinus tachycardia and pulmonary congestion. PET/CT scan showed multiple enlarged hypermetabolic lymph nodes in multiple regions above and below the diaphragm, worrisome for malignant lymphoma. Cytological assessment of pericardial fluid showed scattered large lymphoid cells which are immunoreactive to B cell marker CD 20 (Figure E & F). Bone marrow exam showed normal marrow. First cycle of R-CEOP and intrathecal methotrexate was given. Follow-up echocardiogram in one week after chemotherapy showed complete resolution of pericardial effusion. Prior pericardial mass also showed marked reduction in size (Figure D). No tamponade physiology was present. She tolerated the chemotherapy well with complete resolution of palpitation and shortness of breath. She was discharged from hospital with outpatient follow up and continuation of chemotherapy course. Discussion Cardiac tumors are rare and secondary tumors remain the most common etiology. Most of these metastatic tumors arise from solid organs such as lung, breast, kidney, melanoma as well as lymphoma. Echocardiography is a valuable tool both in diagnosis and assessment of hemodynamic significance of cardiac masses. It also aids in diagnosis of associated condition such as pericardial effusion. In this case, the cardiac tamponade is both contributed by mechanical compression of cardiac mass coupled with moderate pericardial effusion. Successful pericardiocentesis achieved temporary normalization of tamponade physiology and aided in early histological diagnosis of malignant lymphoma with pericardial metastasis. Timely initiation of intensive systemic chemotherapy was the key to rapid tumor size reduction, complete resolution of tamponade physiology and control of recurrent pericardial effusion. Abstract 502 Figure. Echo & histology

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