Background

Medical treatment of inappropriate sinus tachycardia (IST) remains suboptimal. Radiofrequency sinus node (RF-SN) ablation has poor success and higher complication rates.

Objective

We aimed to compare clinical outcomes of the novel SN sparing hybrid ablation technique with those of RF-SN modification for IST management.

Methods

This is a multicenter prospective registry comparing the SN sparing hybrid ablation strategy with RF-SN modification. The hybrid procedure was performed using an RF bipolar clamp, isolating superior vena cava/inferior vena cava with the creation of a lateral line across the crista terminalis while sparing the SN region (identified by endocardial 3-dimensional mapping). RF-SN modification was performed by endocardial and/or epicardial mapping and ablation at the site of earliest atrial activation.

Results

Of the 100 patients (hybrid ablation group, n = 50; RF-SN group, n = 50), 82% were women, and the mean age was 22.8 years. Normal sinus rhythm and rate were restored in all patients in the hybrid group (vs 84% in the RF-SN group; P = .006). Hybrid ablation was associated with significantly better improvement in mean daily heart rate and peak 6-minute walk heart rate compared with RF-SN ablation. The RF-SN group had a significantly higher rate of redo procedures (100% vs 8%; P < .001), phrenic nerve injury (14% vs 0%; P = .012), lower acute pericarditis (48% vs 92%; P < .0001), permanent pacemaker implantation (50% vs 4%; P < .0001) than did the hybrid ablation group.

Conclusion

The novel sinus node sparing hybrid ablation procedure appears to be more efficacious and safer in patients with symptomatic drug-resistant IST with long-term durability than RF-SN ablation.

中文翻译：

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不适当窦性心动过速 (SUSRUTA-IST) 登记患者中保留窦房结的混合胸腔镜消融结果

背景

不适当的窦性心动过速 (IST) 的药物治疗仍然不是最理想的。射频窦房结 (RF-SN) 消融术成功率低，并发症发生率较高。

客观的

我们旨在比较新型 SN 保留混合消融技术与用于 IST 管理的 RF-SN 修改的临床结果。

方法

这是一个多中心前瞻性登记，比较了保留 SN 的混合消融策略与 RF-SN 修改。使用射频双极钳进行混合程序，隔离上腔静脉/下腔静脉，并在末端嵴创建侧线，同时保留 SN 区域（通过心内膜 3 维映射识别）。RF-SN 修改是通过心内膜和/或心外膜标测和消融在最早心房激活部位进行的。

结果

在 100 名患者中（混合消融组，n = 50；RF-SN 组，n = 50），82% 为女性，平均年龄为 22.8 岁。混合组中所有患者的窦性心律和心率均恢复正常（RF-SN 组为 84%；P = .006）。与 RF-SN 消融相比，混合消融与平均每日心率和峰值 6 分钟步行心率显着改善相关。RF-SN 组重做手术（100% 对 8%；P < .001）、膈神经损伤（14% 对 0%；P = .012）、急性心包炎（48% 对 92 %；P  < .0001)，永久性起搏器植入 (50% vs 4%；P  < .0001) 高于混合消融组。

结论

与 RF-SN 消融相比，新的保留窦房结的混合消融手术似乎对具有长期持久性的有症状耐药 IST 患者更有效、更安全。