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
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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