Sinus node sparing novel hybrid approach for treatment of inappropriate sinus tachycardia/postural sinus tachycardia: multicenter experience.
Arrhythmias ablation
Hybrid ablation
Hybrid therapy
Inappropriate sinus tachycardia
Postural orthostatic tachycardia
Sinus node
Journal
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
ISSN: 1572-8595
Titre abrégé: J Interv Card Electrophysiol
Pays: Netherlands
ID NLM: 9708966
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
received:
18
03
2021
accepted:
27
07
2021
pubmed:
24
8
2021
medline:
3
6
2022
entrez:
23
8
2021
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 34424446
doi: 10.1007/s10840-021-01044-5
pii: 10.1007/s10840-021-01044-5
pmc: PMC9151552
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
531-544Informations de copyright
© 2021. The Author(s).
Références
J Thorac Cardiovasc Surg. 2017 Jun;153(6):1330-1354.e1
pubmed: 28390766
Circulation. 1965 Oct;32(4):622-9
pubmed: 5825554
J Am Coll Cardiol. 1984 Feb;3(2 Pt 1):400-4
pubmed: 6141194
Ann Thorac Surg. 2007 Jan;83(1):300-2
pubmed: 17184688
Circulation. 1998 May 26;97(20):2031-6
pubmed: 9610533
J Thorac Cardiovasc Surg. 2010 Feb;139(2):506-7
pubmed: 19660289
Europace. 2013 Jan;15(1):116-21
pubmed: 22772053
Circulation. 1996 May 15;93(10):1836-44
pubmed: 8635263
J Cardiovasc Electrophysiol. 2014 Mar;25(3):236-41
pubmed: 24237687
Europace. 2005 Mar;7(2):104-12
pubmed: 15763524
Heart Rhythm. 2015 Jun;12(6):e41-63
pubmed: 25980576
Pacing Clin Electrophysiol. 2005 Oct;28(10):1112-21
pubmed: 16221272
Circulation. 1996 Mar 1;93(5):1043-65
pubmed: 8598068
Eur Heart J. 2015 Nov 7;36(42):2921-2964
pubmed: 26320112
Europace. 2006 Oct;8(10):904-6
pubmed: 16887866
Am J Physiol Heart Circ Physiol. 2012 May 1;302(9):H1773-83
pubmed: 22268110
Am J Cardiol. 2019 Jul 15;124(2):224-232
pubmed: 31084999
J Am Coll Cardiol. 2000 Feb;35(2):451-7
pubmed: 10676693