Intracardiac Echocardiography Guided Anatomical Ablation of the Arcuate
Ridge for Drug Refractory Inappropriate Sinus Tachycardia
INTRODUCTION: Inappropriate sinus tachycardia (IST) is a common
condition with frequently not tolerated beta-blockers or ivabradine and
a high rate of complication in ablation strategy; we describe an
alternative anatomical approach of sinus node modulation.
METHODOLOGY: This retrospective study describes a case series
of 6 patients from two centers diagnosed with symptomatic IST undergoing
sinus node ablation. RESULTS: The mean age was 40.6 ± 13.9
years; five of the six patients were female, 100% of patients reported
heart palpitations, and 66% reported dizziness, the average HR on a
24-h Holter was 93.2 ±7.9 bpm. HR during the first stage of a stress
test using a standard Bruce protocol was 150 ±70 bpm, The average HR on
24-hour Holter post-ablation was 75 ± 5.6 bpm, the sinus rate HR during
stage 1 of a Bruce protocol exercise stress test was 120 ± 10 bpm.
CONCLUSION: This is the first case series reporting the acute
and long-term results of a novel anatomical approach for SNM to treat
IST targeting the AR under ICE guidance, The novel anatomic ICE-guided
catheter ablation approach aimed to identify the earliest activation at
the AR with an extension of RF lesions towards its septal region seems
effective and safe to modulate the SN in symptomatic patients with IST
refractory to medical treatment.