Abstract 14607: Management of Inappropriate Sinus Tachycardia: A Promising Breakthrough

Introduction: Inappropriate Sinus Tachycardia (IST) is a cardiac dysautonomia with limited treatment options. This case highlights the effectiveness of a novel sinus node-sparing hybrid surgical ablation (SNSHA) for IST.

Objective: To describe a novel hybrid surgical approach for management of IST.

Case Description: A 43 y/o female presented with history of palpitations/tachycardia for 5 years. A comprehensive evaluation directed towards the diagnosis of IST with resting heart rates (HR) above 100 bpm and HR changes greater than 30% with minimal exertion. A trial of ivabradine & beta blockers along with lifestyle modifications offered limited relief. Patient was offered the novel SNSHA after a shared decision-making process.

Methods: The SNSHA is a minimally invasive procedure performed by a CT surgeon in conjunction with an electrophysiologist involving thoracoscopic epicardial ablation of the sympathetic connections from the SVC to the IVC. The thoracoscopic approach allows for safeguarding of the phrenic nerve and sinus node followed by endocardial ablation along the lateral wall.

Results: Intraprocedural pre and post ablation electroanatomic map (EAM) and electrogram (EGM) demonstrated an immediate drop in HR as shown in the Figure 1(a-d). An ILR was implanted during the procedure. On 45-day post-op visit, the patient experienced significant symptom relief and improvement in her HR as well as HR variability on ILR as shown in Figure 1(e).

Conclusion: SNSHA offers a reasonable treatment option for patients with drug resistant IST. This procedure provided symptom alleviation and improvement in HR without increasing the risk of complications in comparison to sinus node modification ablation, which has previously been shown to be associated with higher incidence of pacemaker implantation.