Pericarditis prophylactic therapy after sinus node–sparing hybrid ablation for inappropriate sinus tachycardia/postural orthostatic sinus tachycardia

BackgroundPericarditis is the most common complication following hybrid sinus node sparing ablation for Inappropriate Sinus Tachycardia (IST)/Postural Orthostatic Tachycardia Syndrome (POTS).ObjectiveTo evaluate the association of prophylaxis therapy on the risk of symptomatic pericarditis following hybrid IST/POTS ablation.MethodsAll consecutive patients undergoing to hybrid ablation of symptomatic IST/POTS refractory or intolerant to drugs were retrospectively analyzed. Pharmacological prophylaxis therapy was based on acetylsalicylic acid and colchicine started on the day of the ablation and continued for at least 3 months. The primary endpoint was occurrence of symptomatic pericarditis. The secondary endpoint was occurrence of complications pericarditis-related, including the following: duration of pericarditis >3 months, hospitalization for pericarditis, post-pericardiectomy pleuro-pericarditis and pericardiectomy.ResultsA total of 220 patients undergone to hybrid IST/POTS ablation were included and 44 (20%) underwent to prophylaxis therapy. Pericarditis occurred in 101 patients (45.9%), of whom 97 patients (96%) in the first five days. At survival analysis, prophylaxis was associated with higher rate of freedom from pericarditis (81.9% vs 47.2%, Log-rank p<0.001). Complications pericarditis-related were low, occurring in 7 patients (3.2%). There was no difference in complications pericarditis-related between the patients underwent prophylaxis therapy and patients who did not receive it. At Cox multivariate analysis, predictors of pericarditis were: IST (vs POTS) (HR=0.61, CI 95% 0.39-0.99, p=0.04) and prophylaxis therapy (HR= 0.27, CI 95% 0.13-0.55, p<0.001),ConclusionIn a large cohort of patients undergoing hybrid ablation for IST/POTS, a prophylaxis therapy with acetylsalicylic Acid and colchicine was associated with a lower rate of symptomatic pericarditis.