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Long-term outcomes of sinus node modification in patients with severely symptomatic drug-refractory inappropriate sinus tachycardia: a single-center experience

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

The purpose of the study was to evaluate the long-term outcomes of sinus node modification (SNM) in treating patients with severely symptomatic drug-refractory inappropriate sinus tachycardia (IST).

Methods

The study included 39 patients with symptomatic drug-refractory IST who have undergone SNM at Saint Louis University Hospital. Data was reviewed retrospectively. Recurrence of symptoms was assessed at 3–6-month follow-up intervals.

Results

The mean age of our cohort was 31.5 ± 11. The mean HR at diagnosis was 135 ± 25.4 beats per minute (BPM). Thirty-seven of 39 (94.8%) patients had complete resolution of symptoms. Of these 37 patients, 16 required 1 SNM, 17 patients required 2 SNM, and 4 patients required 3 SNM in order to achieve complete symptom resolution. Mean HR post-procedure was 78.6 ± 12.3 BPM. Thirteen of 39 patients required rate control medication post-procedure, all of whom were prescribed beta-blockers. Patients were followed every 3 to 6 months with a mean follow-up duration of 62.3 ± 42.9 months from the patient’s last SNM procedure. Thirteen of those 37 patients (35.1%) developed intermittent symptomatic bradycardia requiring permanent pacemaker implantation. Two of the 39 patients had phrenic nerve injury, and 6 patients had post-procedure pericarditis.

Conclusions

This study provides additional information to the limited dataset available in the literature and shows that SNM might provide patients with long-term symptomatic relief bearing in mind the potential increased risk for the need for permanent pacing.

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Data availability

Data and materials are available for review per request.

Abbreviations

IST:

Inappropriate sinus tachycardia

BPM:

Beats per minute

SNM:

Sinus node modification

SLUH:

Saint Louis University Hospital

HR:

Heart rate

RF:

Radiofrequency

PPM:

Permanent pacemaker

EGM:

Electrogram

LAEA:

Local atrial electrical activation

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Authors and Affiliations

  1. Department of Internal Medicine, Saint Louis University School of Medicine, 3635 Vista Ave, Saint Louis, MO, 63110, USA

    Ghassan Daher, Ihab Hassanieh, Nikhil Malhotra, Fernand Bteich & Karim Diab

  2. Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Rayan Jo Rachwan

  3. Division of Cardiovascular Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA

    Ali Mehdirad

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  1. Ghassan Daher
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Contributions

Ghassan Daher is the primary author of the manuscript. He was involved in writing the IRB proposal, writing the manuscript, analysis, and submission of the manuscript.

Rayan Jo Rachwan was involved in analysis and writing the manuscript.

Ihab Hassanieh was involved in data collection and analysis.

Nikhil Malhotra was involved in data collection and manuscript edits.

Fernand Bteich was involved in analysis of the manuscript.

Karim Diab was involved in data collection.

Ali Mehdirad is the senior author. He was involved in writing the IRB proposal, data analysis, writing, and editing the manuscript. He also supervised the execution of the entire project.

Corresponding author

Correspondence to Ghassan Daher.

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The authors declare that they have no conflict of interest.

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Daher, G., Rachwan, R.J., Hassanieh, I. et al. Long-term outcomes of sinus node modification in patients with severely symptomatic drug-refractory inappropriate sinus tachycardia: a single-center experience. J Interv Card Electrophysiol 61, 511–516 (2021). https://doi.org/10.1007/s10840-020-00846-3

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  • DOI: https://doi.org/10.1007/s10840-020-00846-3

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