Abstract
Inappropriate sinus tachycardia (IST) is relatively uncommon and poorly understood. Proposed mechanisms include sympathovagal imbalance or a primary sinus node (SAN) abnormality. We report a case of IST in a transplanted heart refractory to pharmacological therapy and causing severe allograft dysfunction. Secondary causes of sinus tachycardia were excluded. Cardiomyopathy resolved with heart rate (HR) control by SAN modification and -blocker therapy. The occurrence of IST in a completely denervated heart excluded a sympathovagal mechanism and implicated a primary defect in the donor SAN.
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