Abstract
Inappropriate sinus tachycardia (IST) is a syndrome characterized by a sinus tachycardia not related to a medical condition, to a physiological response, or to medication or drugs and associated with symptoms, often invalidating and altering the quality of life of affected patients. It occurs predominantly in adolescents and young adults, and in the female sex. The diagnosis requires a complete work-up in order to exclude other causes of sinus tachycardia and one or several additional tests: 24-h ECG ambulatory recordings, echocardiogram, exercise testing, and autonomous nervous system assessment. It should be differentiated from the postural orthostatic tachycardia syndrome, with which it shares a number of symptoms, and other supraventricular tachycardias originating in the high right atrium. An electrophysiological study should be considered in selected cases in order to differentiate IST from other supraventricular tachycardias. The mechanism is still unclear, and possible etiologies may include intrinsic abnormality of the sinus node, autonomic dysfunction, hypersensitivity of the sinus node to catecholamines, blunted vagal system, or a combination of the above. The authors emphasize the wide spectrum of clinical presentations and the need to better define the IST and the criteria required to ascertain its diagnosis.
Similar content being viewed by others
References
Codvelle, M. M., & Boucher, H. (1939). Tachycardie sinusale permanente à haute fréquence sans troubles fonctionnels. Bulletins et Mémoires de la Société Médicale des Hôpitaux de Paris, 54, 1849–1852. see text.
Castellanos, A., Jr., Moleiro, F., Chakko, S., Acosta, H., Huikuri, H., Mitrani, R. D., & Myerburg, R. J. (1998). Heart rate variability in inappropriate sinus tachycardia. American Journal of Cardiology, 15(82), 531–534.
Bauernfeind, R. A., Amat-Y-Leon, F., Dhingra, R. C., Kehoe, R., Wyndham, C., & Rosen, K. M. (1979). Chronic nonparoxysmal sinus tachycardia in otherwise healthy persons. Annals of Internal Medicine, 91, 702–710.
Lerebours, G. (2007). Sinus rhythm: mechanisms and function. Medical Science (Paris), 23(6–7), 657–662.
Morillo, C. A., Klein, G. J., Thakur, R. K., Li, H., Zardini, M., & Yee, R. (1994). Mechanism of “inappropriate” sinus tachycardia. Role of sympathovagal balance. Circulation, 90, 873–877.
Sanchez-Quintana, D., Cabrera, J. A., Farre, J., Climent, V., Anderson, R. H., & Ho, S. Y. (2005) Sinus node revisited in the era of electroanatomical mapping and catheter ablation. Heart, 91, 189–194.
Olshansky, B., & Sullivan, R. M. (2013). Inappropriate sinus tachycardia. Journal of the American College of Cardiology, 61, 793–801.
Verkerk, A. O., Wilders, R., van Borren, M. M. J. V., Peters, R. J. G., Broekhuis, E., Lam, K., Coronel, R., de Bakker, J. M. T., & Tan, H. L. (2007). Pacemaker current (If) in the human sinoatrial node. European Heart Journal, 28, 2472–2478.
Scheinman, M. M., & Vedantham, V. (2012). Ivabradine: a ray of hope for inappropriate sinus tachycardia. Journal of the American College of Cardiology, 60, 1330–1332.
Calò, L., Rebecchi, M., Sette, A., Martino, A., de Ruvo, E., Sciarra, L., De Luca, L., Zuccaro, L. M., Giunta, G., Ciccaglioni, A., Lioy, E., & Fedele, F. (2010). Efficacy of ivabradine administration in patients affected by inappropriate sinus tachycardia. Heart Rhythm, 7, 1318–1323.
Cappato, R., Castelvecchio, S., Ricci, C., Bianco, E., Vitali-Serdoz, L., Gnecchi-Ruscone, T., Pittalis, M., & De Ambroggi, L. (2012). Clinical efficacy of ivabradine in patients with inappropriate sinus tachycardia: a prospective, randomized, placebo-controlled, double-blind, crossover evaluation. Journal of the American College of Cardiology, 60, 1323–1329.
Lopera, G., Castellanos, A., Moleiro, F., Huikuri, H., & Myerburg, R. J. (2003). Chronic inappropriate sinus tachycardia in elderly females. Annals of Noninvasive Electrocardiology, 8, 139–143.
Sheldon, R. S., Grubb, B. P., Olshansky, B., Shen, W. K., Calkins, H., Brignole, M., et al. (2015). 2015 Heart Rhythm Society Expert Consensus Statement on the diagnosis and treatment of postural tachycardia, inappropriate sinus tachycardia and vasovagal syncope. Heart Rhythm, 12(6), e41–e63.
Rubenstein, J. C., Freher, M., Kadish, A., & Goldberger, J. J. (2010). Diurnal HR pattern in inappropriate sinus tachycardia. Pacing and Clinical Electrophysiology, 33, 911–919.
Still, A. M., Raatikainen, P., Ylitalo, A., Kauma, H., Ikaheimo, M., Kesaniemi, Y. A., & Huikuri, H. V. (2005). Prevalence, characteristics and natural course of inappropriate sinus tachycardia. Europace, 7, 104–112.
Winum, P. F., Cayla, G., Rubini, M., Beck, L., & Messner-Pallenc, P. (2009). A case of cardiomyopathy induced by inappropriate sinus tachycardia and cured by ivabradine. Pacing and Clinical Electrophysiology, 32, 942–944.
Romeo, E., Grimaldi, N., Sarubbi, B., D’ Alto, M., Santarpia, G., Scognamiglio, G., et al. (2011). A pediatric case of cardiomyopathy induced by inappropriate sinus tachycardia: efficacy of ivabradine. Pediatric Cardiology, 32, 842–845.
Leon, H., Guzman, J. C., Kuusela, T., Dillenburg, R., Kamath, M., & Morillo, C. A. (2005). Impaired baroreflex in patients with inappropriate sinus tachycardia. Journal of Cardiovascular Electrophysiology, 16, 64–68.
Still, A. M., Huikuri, H. V., Airaksinen, K. E. J., Hartikainen, J., Mitrani, R. D., Castellanos, A., et al. (2002). Impaired negative chronotropic response to adenosine in patients with inappropriate sinus tachycardia. Journal of Cardiovascular Electrophysiology, 13, 557–562.
Brady, P. A., Low, P. A., & Shen, W. K. (2005). Inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome, and overlapping syndromes. PACE, 28, 1112–1121.
Grubb, B. P., Kanjwal, M. Y., & Kosinski, D. J. (2001). Postural orthostatic tachycardia syndrome: current concepts in pathophysiology diagnose and management. Journal of Interventional Cardiac Electrophysiology, 5, 11–18.
Schondorf, R., & Low, P. (1993). Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pan dysautonomia. Neurology, 43, 132–137.
Nwazue, V. C., Paranjape, S. Y., Black, B. K., Baggioni, I., Diedrich, A., Dupont, W.D., et al. (2014). Postural tachycardia syndrome and inappropriate sinus tachycardia and sinus node automaticity. Journal of the American Heart Association, 3.
Kanjwal, K., Saeed, B., Karabin, B., Kanjwal, Y., & Grubb, B. P. (2011). Clinical presentation and management of patients with hyperadrenergic postural orthostatic tachycardia syndrome. A single center experience. Cardiology Journal, 18, 527–531.
Roberts-Thomson, K. C., Kistler, P. M., & Kalman, J. M. (2006). Focal atrial tachycardia I: clinical features, diagnosis, mechanisms, and anatomic location. Pacing and Clin Electrophysiology, 229, 643–652.
Narula, O. S. (1974). Sinus node re-entry. A mechanism for supraventricular tachycardia. Circulation, 50, 1114–1128.
Kocovic, D. Z., Harada, T., Shea, J. B., Soroff, D., & Friedman, P. L. (1993). Alterations of heart rate and of heart rate variability after radiofrequency catheter ablation of supraventricular tachycardia. Delineation of parasympathetic pathways in the human heart. Circulation, 88, 1671.
Lee, R. J., Kalman, J. M., Fitzpatrick, A. P., Epstein, L. M., Fisher, W. G., Olgin, J. E., et al. (1995). Radiofrequency catheter modification of the sinus node for “inappropriate” sinus tachycardia. Circulation, 92, 2919–2928.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Peyrol, M., Lévy, S. Clinical presentation of inappropriate sinus tachycardia and differential diagnosis. J Interv Card Electrophysiol 46, 33–41 (2016). https://doi.org/10.1007/s10840-015-0051-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-015-0051-z