Key result
Sinus node ablation or modification for inappropriate sinus tachycardia achieved 88.9% acute success, but severe procedural complications occurred in 8.5% and symptomatic recurrence was 19.6%.
Why the study?
Does sinus node ablation or modification improve outcomes in patients with refractory inappropriate sinus tachycardia?
Systematic Review (n=153)
Does sinus node ablation or modification improve outcomes in patients with refractory inappropriate sinus tachycardia?
Sinus node ablation or modification for inappropriate sinus tachycardia achieves high acute success but is associated with significant complications, including a 9.8% pacemaker implantation rate, and substantial long-term symptomatic recurrence.
Answers are grounded in this paper and cite their sources.
Severe complications and recurrence warrant caution with sinus node ablation for IST; leaves open need for randomized trials.
OBJECTIVES: 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. BACKGROUND: Sinus node (SN) ablation/modification has been proposed for patients refractory to pharmacological therapy. However, available data derive from limited series. METHODS: 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. RESULTS: 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. CONCLUSIONS: Inappropriate sinus tachycardia ablation/modification achieves acute success in the vast majority of patients. Complications are fairly common and diverse. However, symptomatic relief decreases substantially over longer follow-up periods, with a corresponding high recurrence rate.
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Rodríguez‐Mañero et al. (2016) conducted a systematic review in Inappropriate sinus tachycardia (n=153). Sinus node ablation or modification was evaluated on Procedural acute success. Sinus node ablation or modification for inappropriate sinus tachycardia achieved 88.9% acute success, but severe procedural complications occurred in 8.5% and symptomatic recurrence was 19.6%.
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