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

2009 ◽  
Vol 32 (1) ◽  
pp. 131-133 ◽  
Author(s):  
SITARA KHAN ◽  
SHOAIB HAMID ◽  
CHRISTOPHER RINALDI
Keyword(s):  
Sinus Tachycardia ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Dual Chamber ◽  
Inappropriate Sinus Tachycardia ◽  
Dual Chamber Pacemaker

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.

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 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.

scholarly journals Clinical and Laboratory Improvement in Hyperadrenergic Postural Orthostatic Tachycardia Syndrome (POTS) after COVID-19 Infection

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Rebecca A. Ocher ◽  
Erika Padilla ◽  
Jonathan C. Hsu ◽  
Pam R. Taub
Keyword(s):  
Heart Rate ◽  
Sinus Tachycardia ◽  
Symptomatic Improvement ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Av Block ◽  
Event Monitoring ◽  
Inappropriate Sinus Tachycardia ◽  
History Of ◽  
The Impact ◽  
Catecholamine Levels

A 32-year-old woman with a history of symptomatic supraventricular tachycardia, inappropriate sinus tachycardia, and hyperadrenergic POTS was treated with ivabradine and metoprolol. She then presented with bradycardia and Mobitz II second-degree AV block on event monitoring six weeks after COVID-19 infection. Her post-viral workup revealed normalization of catecholamine levels and significant symptomatic improvement in heart rate. To the authors’ knowledge, this is the first reported case of improvement in POTS after COVID-19 infection. As our understanding of COVID-19 continues to improve, it will be vital to better understand the impact of COVID-19 dysautonomia on cardiac patients.

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