Inappropriate Sinus Tachycardia Research Articles

Clinical Outcomes and Complications of Ablative Therapy of Inappropriate Sinus Tachycardia: A Case Series

Background: Sino-atrial node modification by radiofrequency ablation (RFA) is one of the management options in patients with inappropriate sinus tachycardia (IST). The broad application of RFA is limited owing to perceived low success and high complication rates.

Multipolar electrode spline embolization

Key Teaching Points•Complex architecture of novel mapping catheters may be prone to failure.•One should avoid entanglement of such catheters with other catheters when performing complex mapping.•In anatomically difficult-to-approach locations, removing fragments displaced or embolized from catheter failure could result in further complications. Hence, close monitoring with imaging may be a preferred strategy. •Complex architecture of novel mapping catheters may be prone to failure.•One should avoid entanglement of such catheters with other catheters when performing complex mapping.•In anatomically difficult-to-approach locations, removing fragments displaced or embolized from catheter failure could result in further complications. Hence, close monitoring with imaging may be a preferred strategy. We present a case of multipolar electrode spline embolization in a 30-year-old woman with a history of palpitations and syncope. A 30-year-old woman presented to our clinic with a history of palpitations and syncope since 4 years prior to her visit. Before presenting to our clinic she had 5 ablations for inappropriate sinus tachycardia and for multiple atrial tachycardias (AT). The patient was still symptomatic and was taking flecainide, propafenone, and ivabridine. Pacemaker interrogation revealed multiple episodes of AT. No specific right atrial or right ventricular structural abnormality such as diverticulum or dilatation had been identified. The patient was hence admitted for AT ablation. Using the Rhythmia system, multiple ATs from different areas of the right atrium were mapped and sequentially ablated. The Orion catheter was navigated using an Agilis (St. Jude Medical, St. Paul, MN) sheath, which was inserted into the right atrium, followed by insertion of the Orion catheter through the sheath. Ablation was performed around the Orion catheter and it was not forced against the sheath. The catheter was not advanced through the tricuspid valve. During the procedure, it was noted that some electrograms went silent and visualization of 1 spline was lost in the map. The Orion catheter was immediately withdrawn without any resistance when the Rhythmia system alarmed “missing electrode.” Upon withdrawal of the Orion catheter, 1 of the 8 splines was missing. Fluoroscopy showed the filament that was missing clearly visible in the left upper lung field adjacent to the left pulmonary artery, as shown in a computed tomography image in Figure 1. Our center had performed 25 cases with the Rhythmia system prior to this case. The fluoroscopic images were obtained after the electrodes were confirmed to be missing upon retraction of the catheter. The patient was asymptomatic for AT and symptoms of pulmonary or extrapulmonary embolism after the procedure, and she remains so at follow-up after 6 months. She was treated with anticoagulation. Serial chest computed tomographs have shown stable location of the spline without thrombus development. Iatrogenic foreign body from fragments of catheters, pacemaker electrodes, and stents have been reported in literature.1Sheldon S.H. Good E. PentaRay entrapment in a mechanical mitral valve during catheter ablation of atrial fibrillation.HeartRhythm Case Rep. 2016; 2: 200-201Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 2Said S.M. Suri R.M. Pislaru S.V. et al.Robot-assisted delayed extraction of retained Lasso catheter combined with mitral valve repair and arrhythmia ablation.HeartRhythm Case Rep. 2015; 1: 238-240Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Guidewires in great vessels and cardiac chambers have also been seen. The usual source of intrapulmonary foreign body is via the bronchial tree or embolization of catheter segments through peripheral veins. In this case, despite our taking all precautions, the proximity of the Orion catheter to the ablation sites could have led to ablation catheter entrapment on the spline and forced its attachments to break.

Inappropriate sinus tachycardia – symptom and heart rate reduction with ivabradine: pooled analysis of prospective studies

Objective: Inappropriate sinus tachycardia (IST), is a debilitating condition despite currently available treatment. Ivabradine, a selective sinus node blocker, has been used off-label to treat IST. We therefore systematically reviewed the literature and analyzed the quality of existing data and calculated sample size estimates for adequately powered studies. Methods: We included all available trials, open label prospective studies studies with ivabradine, specifically for IST among subjects with no structural heart disease with a minimum follow-up period of > 2 weeks. Heart rate and symptom reduction with ivabradine were estimated based on results of subjective change in symptoms assessed by data instruments used in the studies. All studies were assessed for quality using two validated checklists scoring the quality of studies. Sample size estimates for future studies were calculated based on the magnitude of symptom reduction encountered after treatment with ivabradine. Results: Nine studies met study criteria, culminating in 145 patients pooled with the majority being women (> 70%). All studies were small, most inadequately powered. All studies reported a decrease in maximum and/or mean resting heart rate with ivabradine. Symptom reduction demonstrated either complete or considerable amelioration. Most studies were at least of moderate quality. Excellent consistency of study quality was gauged by both data-quality tools and narrow limits of agreement between these tools. Calculated sample size estimates for adequately powered studies with a placebo effects of 30 and 50% was 56 and 242 patients respectively. Conclusions: Although ivabradine is effective in reducing heart rate and symptoms in IST patients, none of the studies were adequately powered to account for the expected placebo effect on symptoms. A multicenter-randomized, placebo controlled active comparative study with a beta-blocker is needed to confirm these findings. This is relevant given the ivabradine’s potential teratogenic effect as many IST patients are females of childbearing potential.

Inappropriate sinus tachycardia–symptom and heart rate reduction with ivabradine: A pooled analysis of prospective studies

Inappropriate sinus tachycardia (IST) is debilitating despite available treatment. Off-label use of ivabradine for IST prompted this systematic analysis of existing data quality and sample size estimates for adequately powered studies. To determine clinical efficacy of ivabradine in IST from pooled prospective studies. Analysis included ivabradine studies for IST participants without structural heart disease and with follow-up of ≥2 weeks. Heart rate and symptom reduction with ivabradine were estimated based on results of subjective change in symptoms assessed by various data instruments used in each study. Studies were assessed for quality using validated checklists. Sample sizes were calculated based on the magnitude of symptom reduction encountered after treatment with ivabradine. Nine studies met criteria, culminating in 145 patients pooled. Most patients were women (≥70%). Studies were small and not adequately powered, and all reported a decrease in maximum or mean resting heart rate or both, with complete or considerable amelioration of symptoms with ivabradine. Most studies had moderate quality with excellent consistency of study quality and narrow limits of agreement between the quality checklists. Sample size estimates for adequately powered studies with various placebo effects and comparisons with β-blockade are reported. Ivabradine effectively reduces heart rate and symptoms in IST, but no study was adequately powered to account for the expected placebo effect on symptoms. A multicenter, randomized, placebo-controlled, active, comparative study with a β-blocker is needed for confirmation. This is especially relevant given the ivabradine's potential teratogenic effect, as many IST patients are females of childbearing potential.

Taquicardia sinusal y taquicardia sinusal inapropiada

IntroductionSinus tachycardia is one of the most frequently encountered arrhythmias in clinical practice and its identification should place us on the trail of an intercurrent process in our patient, which may be benign (anxiety or painful) or life threatening (sepsis Severe or pulmonary thromboembolism, among others). On the other hand, inappropriate sinus tachycardia does not respond to a normal pathophysiological mechanism. DiagnosisThe diagnosis will be based on a correct differential electrocardiographic diagnosis to differentiate it from other arrhythmias, fundamentally the atrial tachycardia and in a complete study that allows us to identify the cause that causes it, or to rule out its existence. A 24-hour holter-ECG may be useful in the diagnosis of inappropriate sinus tachycardia. ManagementIn the case of appropriate sinus tachycardia, the treatment will correspond to the underlying pathology that has triggered the arrhythmia. For the inappropriate sinus tachycardia, the braking agents, particularly ivabradine, are useful because of their selective effect on the sinus node and its excellent hemodynamic profile, which makes them very safe and well tolerated drugs.

Treatment for Inappropriate Sinus Tachycardia.

Inappropriate Sinus Tachycardia (IST) is a chronic medical condition with a wide variety of clinical presentations making it, sometimes, very insidious at the time of the diagnosis. Several therapeutic options, including, pharmacotherapy, cardiac rehabilitation, and modification or ablation of the sinus node, have been proposed for the management of IST, but because of the complexity and lack of understanding of pathophysiology, it can be difficult to manage, despite the numerous treatment options currently available. The purpose of this review is to analyze the treatment for IST, focusing on the role of newer therapy and the potential benefits in the management of this cardiac rhythm disturbance.

P1704Prevalence and characteristics of inappropriate sinus tachycardia in the outpatient clinic of a tertiary hospital

P1704Prevalence and characteristics of inappropriate sinus tachycardia in the outpatient clinic of a tertiary hospital

Differential Diagnosis of Supraventricular Tachycardia

Supraventricular tachycardia (SVT) refers to a heterogeneous group of arrhythmias localized within the upper part of the heart (the His bundle or above). In general, the term SVT does not include atrial fibrillation. Common forms of SVT include atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, focal atrial tachycardia, and atrial flutter. Other, less common arrhythmias also fall under the category of SVT, including inappropriate sinus tachycardia and junctional reentrant/ectopic tachycardia. Paroxysmal supraventricular tachycardia refers to AVNRT and AVRT. SVTs can be identified and classified by clinical manifestation/physical examination, ECG, and/or electrophysiologic analysis. Key words: Supraventricular Tachycardia; Electrocardiography

IVABRADINE IN PATIENTS WITH SYMPTOMATIC INAPPRIOPRATE SINUS TACHYCARDIA: LONG-TERM OBSERVATIONAL STUDY

Background: Inappropriate sinus tachycardia (IST) is a clinical syndrome characterized by excessive resting heart rate (HR) or a disproportional increase in HR during exercise. Ivabradine is a new agent inhibiting sinus node I(f) current, resulting in a decrease of HR without haemodynamic compromise

Ablation of Inappropriate Sinus Tachycardia: A Systematic Review of the Literature.

The goal of this study was to describe short- and long-term outcomes in all patients referred for inappropriate sinus tachycardia ablation, along with the potential complications of the intervention. Sinus node (SN) ablation/modification has been proposed for patients refractory to pharmacological therapy. However, available data derive from limited series. The electronic databases MEDLINE, Embase, CINAHL, Cochrane, and Scopus were systematically searched (January 1, 1995-December 31, 2015). Studies were screened according to predefined inclusion and exclusion criteria. A total of 153 patients were included. Their mean age was 35.18 ± 10.02 years, and 139 (90.8%) were female. All patients had failed to respond to maximum tolerated doses of pharmacological therapy (3.5 ± 2.4 drugs). Mean baseline heart rates averaged 101.3 ± 16.4 beats/min according to electrocardiography and 104.5 ± 13.5 beats/min according to 24-h Holter monitoring. Two electrophysiological strategies were used, SN ablation and SN modification, with the latter being used more. Procedural acute success (using variably defined pre-determined endpoints) was 88.9%. Consistently, all groups reported high-output pacing from the ablation catheter to confirm absence of phrenic nerve stimulation before radiofrequency delivery. Need of pericardial access varied between 0% and 76.9%. Thirteen patients (8.5%) experienced severe procedural complications, and 15 patients (9.8%) required implantation of a pacemaker. At a mean follow-up interval of 28.1 ± 12.6 months, 86.4% of patients demonstrated successful outcomes. The symptomatic recurrence rate was 19.6%, and 29.8% of patients continued to receive antiarrhythmic drug therapy after procedural intervention. Inappropriate sinus tachycardia ablation/modification achieves acute success in the vast majority ofpatients. Complications are fairly common and diverse. However, symptomatic relief decreases substantially overlonger follow-up periods, with a corresponding high recurrence rate.

Our experience in the diagnosis and treatment of postural orthostatic tachycardia syndrome, vasovagal syncope, and inappropriate sinus tachycardia in children

The aim of this study was to share our experience in the diagnosis and treatment of patients who presented at our clinic with syncope, pre-syncope, dizziness, and palpitations. Patients who were treated at pediatric cardiology clinic for complaints of syncope, dizziness, and palpitations between 2014 and 2016 were enrolled in the study. Detailed history of the patients, physical examination findings, laboratory and electrocardiogram results were recorded. Tilt table test, 24-hour Holter rhythm monitoring, and exercise test were performed, as required. Patients were diagnosed as vasovagal syncope, postural orthostatic tachycardia syndrome (POTS), or inappropriate sinus tachycardia based on these findings. Treatment of the patients was evaluated. Thirty patients were diagnosed as vasovagal syncope, 7 patients as POTS, and 2 as inappropriate sinus tachycardia. POTS accompanied Raynaud's phenomenon in 1 patient, hypertrophic cardiomyopathy in 1 patient, and homocystinuria in another patient. Complaints of patients with vasovagal syncope improved with non-medical therapy. Medical treatment was administered to the patients with diagnosis of POTS and inappropriate sinus tachycardia. In patients with complaints of syncope, pre-syncope, dizziness, and palpitations without structural heart disease or non-rhythm problems, cardiovascular autonomic disorders, such as POTS and inappropriate sinus tachycardia should be kept in mind, as well as vasovagal syncope.

Inappropriate Sinus Tachycardia Presenting with Palpitations and Syncope During Pregnancy. Successful Treatment with Metoprolol

Inappropriate Sinus Tachycardia Presenting with Palpitations and Syncope During Pregnancy. Successful Treatment with Metoprolol

Inappropriate sinus tachycardia – cardiac syndrome or anxiety related disorder?

Inappropriate sinus tachycardia – cardiac syndrome or anxiety related disorder?

Inappropriate sinus tachycardia: focus on ivabradine.

Inappropriate sinus tachycardia (IST) is an incompletely understood condition, characterised by an elevation in heart rate (HR) accompanied by wide ranging symptoms in the absence of an underlying physiological stimulus. The condition often takes a chronic course with significant adverse effects on quality of life. Currently, there is no effective treatment for IST. Beta-blockers, generally considered the cornerstone of treatment, are often ineffective and poorly tolerated. Ivabradine is a novel sinus node If 'funny current' inhibitor, which reduces the HR. It has been approved for the treatment of beta-blocker refractory chronic systolic heart failure and chronic stable angina but more recently has shown promise in the treatment of IST. This review provides an overview of IST prevalence and mechanisms followed by an examination of the evidence for the role and efficacy of ivabradine in the treatment of IST.

Cerebral Blood Flow, Heart Rate, and Blood Pressure Patterns during the Tilt Test in Common Orthostatic Syndromes.

Objective. The head-up tilt test is widely used for evaluation of orthostatic intolerance. Although orthostatic symptoms usually reflect cerebral hypoperfusion, the cerebral blood flow velocity (CBFv) profile in orthostatic syndromes is not well described. This study evaluated CBFv and cardiovascular patterns associated with the tilt test in common orthostatic syndromes. Methods. This retrospective study analyzed the tilt test of patients with history of orthostatic intolerance. The following signals were recorded: ECG, blood pressure, CBFv using transcranial Doppler, respiratory signals, and end tidal CO2. Results. Data from 744 patients were analyzed. Characteristic pattern associated with a particular orthostatic syndrome can be grouped into abnormalities predominantly affecting blood pressure (orthostatic hypotension, orthostatic hypertension syndrome, vasomotor oscillations, and neurally mediated syncope—cardioinhibitory, vasodepressor, and mixed), cerebral blood flow (orthostatic hypoperfusion syndrome, primary cerebral autoregulatory failure), and heart rate (tachycardia syndromes: postural tachycardia syndrome, paroxysmal sinus tachycardia, and inappropriate sinus tachycardia). Psychogenic pseudosyncope is associated with stable CBFv. Conclusions. The tilt test is useful add-on in diagnosis of several orthostatic syndromes. However diagnostic criteria for several syndromes had to be modified to allow unambiguous pattern classification. CBFv monitoring in addition to blood pressure and heart rate may increase diagnostic yield of the tilt test.

Ivabradine: A Review of Labeled and Off-Label Uses.

Ivabradine is a unique medication recently approved in the USA for the treatment of select heart failure patients. It was first approved for use in several countries around the world over a decade ago as an anti-anginal agent, with subsequent approval for use in heart failure patients. Since ivabradine has selective activity blocking the I f currents in the sinus node, it can reduce heart rate without appreciable effects on blood pressure. Given this heart-rate-specific effect, it has been investigated in many off-label indications as an alternative to traditional heart-rate-reducing medications such as beta blockers and calcium channel blockers. We conducted searches of PubMed and Google Scholar for ivabradine, heart failure, HFrEF, HFpEF, angina, coronary artery disease, inappropriate sinus tachycardia, postural orthostatic hypotension, coronary computed tomography angiography and atrial fibrillation. We reviewed and included studies, case reports, and case series published between 1980 and June 2016 if they provided information relevant to the practicing clinician. In many cases, larger clinical trials are needed to solidify the benefit of ivabradine, although studies indicate benefit in most therapeutic areas explored to date. The purpose of this paper is to review the current labeled and off-label uses of ivabradine, with a focus on clinical trial data.

Inappropriate Sinus Tachycardia

Since inappropriate sinus tachycardia (IST) occurs due to various reasons, it can be diagnosed after exclusion of all causes and diseases that may result in sinus tachycardia. In particular, it is important to differentiate postural orthostatic tachycardia syndrome (POTS), and a multidisciplinary approach is necessary for differentiating psychiatric events. In addition, whether the clinical symptoms coincide with tachycardia events should be checked before treatment. β-adrenergic blocker is the most effective drug, and exercise training is recommended for controlling clinical symptoms. Furthermore, discontinuation of smoking and alcohol consumption, and decrease in caffeine intake may be useful. Recently, ivabradine has been found effective, and catheter ablation can be considered in cases of drug refractory IST presenting with clinical symptoms. Key words: Sinus Tachycardia; Arrhythmia

Temporal sinus node modification by high-dose continuous intravenous administration of landiolol in a patient with persistent inappropriate sinus tachycardia

A 20-year-old woman underwent an electrophysiological study for drug-resistant persistent inappropriate sinus tachycardia (IST). Use of a high-dose continuous intravenous administration of landiolol, a short-acting beta-adrenoreceptor blocker, made the patient׳s heart rate suddenly drop with a slight change in the P-wave morphology. Three-dimensional right atrial (RA) activation mapping revealed that the earliest activation site moved 8mm to a lower anterior site around the high lateral RA. Radiofrequency energy applied to the earliest activation site during tachycardia was successful. A temporal sinus node modification with landiolol administration was useful for mapping and for safe catheter ablation of IST.

Recognizing postural orthostatic tachycardia syndrome

This article describes the pathophysiology, clinical presentation, differential diagnosis, diagnosis, and management of postural orthostatic tachycardia syndrome (POTS), a potentially debilitating autonomic disorder that can have many causes and presentations. POTS can be mistaken for panic disorder, inappropriate sinus tachycardia, and chronic fatigue syndrome. Clinician suspicion for the syndrome is key to prompt patient diagnosis and treatment.

Innapropriate sinus tachycardia – cardiac syndrome or anxiety-related disorder?

IntroductionRelation between psychology, psychiatry and cardiology are multidimensional and begin to have growing importance in the diagnosis and treatment of patients of cardiosurgery, electrocardiology and cardiac rehabilitation. Inappropriate sinus tachycardia (IST) is a rarely diagnosed clinical syndrome characterized by excessive resting heart rate (HR) or disproportional increasing HR during exercise. The mechanisms of IST are not well understood. It is speculated that psychological factors might be of importance.AimsThe purpose of the study was to evaluate possible relation between the level of anxiety, personality traits and control of emotions, emotional intelligence, coping with stress strategies and manifestation of IST.MethodsThe participants were 23 women with a diagnosis of IST (age range 31.8 ± 8.72) and 23 women (28.7 ± 4.4) without cardiac diseases. The research applied psychological tools including: State–Trait Anxiety Inventory, NEO-Five Factor Inventory, Courtauld Emotional Control Scale, Emotional Intelligence Questionnaire, Coping Inventory for Stressful Situations and an originally developed sociodemographic questionnaire.ResultsIt has been found that that the group of women with IST received higher results in Trait Anxiety Inventory compared to the group of healthy women and the relation was highly statistically significant (P = 0,009). No other differences were found.ConclusionsInappropriate sinus tachycardia can be considered as an anxiety related disorder. However, its pathogenesis and classification position remains elusive.Disclosure of interestThe authors have not supplied their declaration of competing interest.