scholarly journals Pregnancy related inappropriate sinus tachycardia: a distinct arrhythmia?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Sharp ◽  
C Patient ◽  
J Pickett ◽  
M Belham
Keyword(s):  
Sinus Tachycardia ◽  
Task Force ◽  
Cohort Analysis ◽  
Subsequent Pregnancy ◽  
Autonomic Response ◽  
Inappropriate Sinus Tachycardia ◽  
Background Rate ◽  
Persistent Symptoms ◽  
Coronary Syndrome ◽  
In Pregnancy

Abstract Background The syndrome of inappropriate sinus tachycardia (IST) is well recognized and affects ∼1% of the population. We believe IST in pregnancy is a relatively frequent yet under-recognized phenomenon that may represent a distinct arrhythmia. To date, there are only three case reports in the literature. Purpose To further understand the natural history of IST in pregnancy, and to explore maternal outcomes. Methods A retrospective, observational cohort analysis. Results 19 pregnant women presented to our institute with a definitive diagnosis of IST (as defined by task force criteria) between January 2016 and January 2017. Symptom onset was 4–36 weeks gestation (mean 20 weeks). Of those in their second or subsequent pregnancy (n=8), 50% described symptoms compatible with IST in previous pregnancies. 42% attended the emergency department on ≥1 occasion with symptoms of IST. 32% required hospital admission. 26% required pharmacological therapy (beta-blockers in all). There were no maternal deaths, instances of heart failure or acute coronary syndrome, no thromboembolic or haemorrhagic complications during pregnancy. Rates of Caesarean section were similar to the background rate of our unit; however, rates of induction were notably elevated (58% vs 25%), with 55% of these women being induced purely for symptoms of IST. Following delivery, symptoms resolved within one week for 17 of the women in the cohort, 1 had symptoms resolve after 4 month and 1 had persistent symptoms as she became pregnant again. Conclusion IST in pregnancy likely represents a distinct arrhythmia; the majority of individuals here had symptoms only during pregnancy, which resolved rapidly postpartum. Additionally, half of the women in a second or subsequent pregnancy had suffered IST symptoms during previous pregnancies, with no symptoms in between pregnancies. It is biologically plausible and may represent an exaggerated cardio-autonomic response to the physiological changes of pregnancy such as increased sympathetic tone and change in baroreceptor reflex sensitivity. Recognition of the condition is important given it is associated with significant morbidity, the distressing nature of symptoms leading to high rates of hospitalization and induction of labour. Funding Acknowledgement Type of funding source: None

Pregnancy-related inappropriate sinus tachycardia: A cohort analysis of maternal and fetal outcomes

2021 ◽  
pp. 1753495X2199019
Author(s):  
Alexander Sharp ◽  
Charlotte Patient ◽  
Janet Pickett ◽  
Mark Belham
Keyword(s):  
Sinus Tachycardia ◽  
Cohort Analysis ◽  
Clinical Findings ◽  
Pharmacological Therapy ◽  
Fetal Outcomes ◽  
Inappropriate Sinus Tachycardia ◽  
Background Rate ◽  
Coronary Syndrome ◽  
History Of ◽  
In Pregnancy

Background Little literature exists regarding the syndrome of inappropriate sinus tachycardia during pregnancy. We aimed to further understand the natural history of inappropriate sinus tachycardia in pregnancy, and to explore maternal and fetal outcomes. Methods A retrospective, observational cohort analysis of 19 pregnant women who presented with inappropriate sinus tachycardia. Results 42% attended the emergency department on more than 1 occasion with symptoms of inappropriate sinus tachycardia; 32% required hospital admission and 26% required pharmacological therapy. There were no maternal deaths, instances of heart failure or acute coronary syndrome, and no thromboembolic or haemorrhagic complications during pregnancy. Rates of caesarean section were similar to the background rate of our unit (32% and 27%, respectively). Rates of induction were notably elevated (58% vs 25%). Conclusion Inappropriate sinus tachycardia in pregnancy is associated with high rates of hospitalization and induction of labour, which may not be mandatory given the clinical findings in this group of women.

scholarly journals Inappropriate sinus tachycardia in post-covid-19 Syndrome

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Arano Llach ◽  
VBG Victor Bazan ◽  
GLL Gemma Llados ◽  
RA Raquel Adelino ◽  
MJ Maria Jesus Dominguez ◽  
...  
Keyword(s):  
Heart Rate ◽  
Acute Phase ◽  
Sinus Tachycardia ◽  
Exercise Intolerance ◽  
Inappropriate Sinus Tachycardia ◽  
Persistent Symptoms ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Background Persistent symptoms after the acute phase of SARS-CoV-2 infection are referred to as "post-COVID-19 syndrome" (PCS), with a reported incidence ranging between 35% and 87%. Fatigue, palpitations and exercise intolerance are common complains among PCS patients in whom unexplained sinus tachycardia, occasionally exacerbated by postural changes, is a frequent observation that remains poorly characterized. Purpose We sought to characterize the prevalence of inappropriate sinus tachycardia (IST) and postural orthostatic tachycardia (POTS) in a consecutive and prospective population of patients with PCS. Methods Consecutive patients with persistent symptoms 3 months after an acute SARS-CoV-2 infection were prospectively evaluated at a multi-disciplinary PCS unit. All patients were screened for IST or POTS and those with confirmed criteria underwent comprehensive cardiovascular examination including echocardiography, 24-hour Holter, Minnesota Living with Heart Failure Questionnaire (MLHFQ), six-minute walking test (6MWT) and inflammation and myocardial biomarkers. Two control patients, matched by age and gender, were assigned to each case: one with previous SARS-CoV-2 infection without PCS (group 2) and one without prior SARS-CoV-2 infection (group 3). Results IST or POTS criteria were met in 34 out of the 200 PCS patients (17%). The mean age was 39 ± 10 years, with 29 women (91%). The interval from the index COVID-19 disease to the PCS diagnosis was 71 ± 17 days, with a majority of patients (n = 29,85%) not requiring hospital admission during the acute phase. At physical examination, the mean heart rate was 96 ± 3bpm at supine and 112 ± 17bpm at the upright position, with 8 patients fulfilling diagnostic criteria of POTS. No underlying structural heart disease, pro-inflammatory state, myocyte injury or hypoxia were identified among our patient population. The 6MWT showed a significantly diminished exercise capacity with a 59% of the estimated distance after adjustment by age, sex and body mass index; an impaired quality of life was also identified, as suggested by a median MLFHQ total score of 67 out of 105 points. The 24-hour Holter showed an increase in HR predominantly during daytime in group 1 (mean daytime HR of 94 ± 3bpm), an altered heart rate variability with a decrease in time domain parameters [PNN50 4 ± 4 in group 1 (vs. 11 ± 9 in group 2 and 18 ± 9 in group 3; p < 0.002)respectively; SD 100 ± 20 (vs. 127 ± 38 and 136 ± 13; p = 0.009) and a decrease in frequency domain parameters [LF 751 ± 450 (vs. 1721 ± 1009 and 2199 ± 920; p = 0.01), HF 336 ± 280 (vs. 823 ± 1200 and 1229 ± 630; p = 0.01)]. Conclusions IST and its POTS variant are a prevalent condition among PCS patients and may at least partially explain the common symptoms of fatigue, impaired exercise and palpitations that characterize the PCS. Cardiac autonomic nervous system imbalance may account as a plausible pathophysiological mechanism of IST in PCS patients.

scholarly journals Inappropriate sinus tachycardia in pregnancy: a benign phenomena?

2017 ◽  
pp. bcr2016217026
Author(s):  
Mark Belham ◽  
Charlotte Patient ◽  
Janet Pickett
Keyword(s):  
Sinus Tachycardia ◽  
Inappropriate Sinus Tachycardia ◽  
In Pregnancy

Abstract 15694: Atrial Tachycardia Masquerading as Sinus Tachycardia - Electrophysiological Characteristics and Ablation Outcomes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rakesh Gopinathannair ◽  
Krishna Akella ◽  
Ghulam Murtaza ◽  
Luigi Di Biase ◽  
Andrea Natale ◽  
...  
Keyword(s):  
Atrial Tachycardia ◽  
Sinus Tachycardia ◽  
Sinus Node ◽  
Outcome Data ◽  
P Wave ◽  
Autonomic Response ◽  
Inappropriate Sinus Tachycardia ◽  
P Waves ◽  
Wave Morphology ◽  
Activation Mapping

Background: Focal atrial tachycardia (AT) is typically distinguished by P wave morphology and autonomic response. AT arising close to the sinus node can be easily misdiagnosed as Inappropriate sinus tachycardia (IST). Objective: This multicenter study sought to describe the electrophysiological (EP) features and ablation outcomes of perisinus node atrial tachycardia (PNAT). Methods: Baseline as well as procedural characteristics and outcome data of 7 patients with PNAT are described. Results: Mean age of the cohort was 38±17 years (100% female). Time from symptom onset to diagnosis was12.2± 9 months with an average of 1.7 prior hospitalizations. Mean baseline HR was127.8 bpm and all patients carried a diagnosis of IST. Baseline ECG in all patients was identical to sinus tachycardia, with exception of taller P waves in lead II in 5 patients and deeper negative component of P wave in V1. At EP study, mean AT cycle length was 420 msec and significant acceleration was seen with isoproterenol, mimicking IST. Activation mapping was done using Ensite TM Balloon Array (5), Precision TM (1) and Carto TM (1). Site of origin was slightly anterolateral to sinus node in 3 and anterior, inferior and medial to sinus node in 4 (Figure). AT was successfully ablated in all patients without any phrenic injury or sinus node dysfunction. Over 2.9 years of follow-up, only 1 patient had recurrence that was successfully re-ablated. Conclusion: PNAT has similar ECG and EP characteristics and is often misdiagnosed as IST. A high index of suspicion is needed for diagnosis. Evaluation of P wave morphology during tachycardia and careful activation mapping can enable successful ablation with excellent long-term outcomes.

scholarly journals Recommendations of the AGG (Task Force for Obstetrics, Section Maternal Diseases) on the Management of Maternal Hepatitis B, C and D Infection in Pregnancy

2021 ◽  
Vol 81 (04) ◽  
pp. 390-397
Author(s):  
Maritta Kühnert ◽  
Sven Kehl ◽  
Ulrich Pecks ◽  
Ute Margaretha Schäfer-Graf ◽  
Tanja Groten ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatitis B ◽  
Task Force ◽  
Clinical Care ◽  
Diagnostic Procedures ◽  
Routine Clinical Care ◽  
Prenatal Counselling ◽  
Hepatitis Infection ◽  
Birth Planning ◽  
In Pregnancy

AbstractThese statements and recommendations should provide appropriate information about maternal and fetal routes of infection, screening, detection of risk factors, diagnostic procedures, treatment, birth planning and peripartum and postpartum management of maternal hepatitis infection and offer pointers for prenatal counselling and routine clinical care on delivery wards.

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