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

Andrea Natale,Scott Koerber,Alap Shah,Sudha Bommana,Justin Vanmeetren,Gian Battista Chierchia,Jalaj Garg,Ken S. Frazier ,Rangarao V. Tummala ,Rakesh Gopinathannair,Amin Al‐Ahmad ,Chandra Vasamreddy,Donita Atkins,Ahmed Romeya,Dhanunjaya Lakkireddy,Yashi Awasthi,Peter J. Park ,Carlo DeAsmundis,Poojita Shivamurthy,Mark LaMeier,Luigi Di Biase

doi:10.1016/j.hrthm.2021.07.010

Abstract

Medical treatment of inappropriate sinus tachycardia (IST) remains suboptimal. Radiofrequency sinus node (RF-SN) ablation has poor success and higher complication rates. We aimed to compare clinical outcomes of the novel SN sparing hybrid ablation technique with those of RF-SN modification for IST management. This is a multicenter prospective registry comparing the SN sparing hybrid ablation strategy with RF-SN modification. The hybrid procedure was performed using an RF bipolar clamp, isolating superior vena cava/inferior vena cava with the creation of a lateral line across the crista terminalis while sparing the SN region (identified by endocardial 3-dimensional mapping). RF-SN modification was performed by endocardial and/or epicardial mapping and ablation at the site of earliest atrial activation. Of the 100 patients (hybrid ablation group, n = 50; RF-SN group, n = 50), 82% were women, and the mean age was 22.8 years. Normal sinus rhythm and rate were restored in all patients in the hybrid group (vs 84% in the RF-SN group; P = .006). Hybrid ablation was associated with significantly better improvement in mean daily heart rate and peak 6-minute walk heart rate compared with RF-SN ablation. The RF-SN group had a significantly higher rate of redo procedures (100% vs 8%; P < .001), phrenic nerve injury (14% vs 0%; P = .012), lower acute pericarditis (48% vs 92%; P< .0001), permanent pacemaker implantation (50% vs 4%; P<.0001) than did the hybrid ablation group. The novel sinus node sparing hybrid ablation procedure appears to be more efficacious and safer in patients with symptomatic drug-resistant IST with long-term durability than RF-SN ablation.

Highlights

Inappropriate sinus tachycardia (IST) is a cardiac dysautonomic disorder characterized by a resting heart rate (HR) of more than 100 beats/min, a mean 24-hour HR of more than 90 beats/min, and an exaggerated response to exercise or stress and associated with debilitating symptoms—palpitations, Funding sources: The authors have no funding sources to disclose
The 2 groups were well balanced with respect to major baseline demographic characteristics
The only significant difference between the 2 groups was low mean resting HR and increased fraction of patients treated with ivabradine or class Ic antiarrhythmic agents in the hybrid ablation group than in the RF-sinus node (SN) group

Summary

Introduction

Inappropriate sinus tachycardia (IST) is a cardiac dysautonomic disorder characterized by a resting heart rate (HR) of more than 100 beats/min, a mean 24-hour HR of more than 90 beats/min, and an exaggerated response to exercise or stress and associated with debilitating symptoms—palpitations, Funding sources: The authors have no funding sources to disclose. Disclosures: Dr Lakkireddy is a consultant to AtriCure. Mr Frazier and Dr Awasthi are employees of AtriCure. Address reprint requests and correspondence: Dr Dhanunjaya Lakkireddy, Cardiac Arrhythmia Service, Kansas City Heart Rhythm Institute and Research Foundation, HCA Midwest Health, 12200 W 106th St, Suite 320, Overland Park, KS 661215. Medical treatment of inappropriate sinus tachycardia (IST) remains suboptimal. Radiofrequency sinus node (RFSN) ablation has poor success and higher complication rates

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Results

Conclusion