Is sinus node modification appropriate for inappropriate sinus tachycardia with features of postural orthostatic tachycardia syndrome?

Win Kuang Shen, Phillip A. Low, Arshad Jahangir, Thomas M. Munger, Paul A. Friedman, Michael J. Osborn, Marshall S. Stanton, Douglas L. Packer, Robert F. Rea, Stephen C. Hammill

Research output: Contribution to journalArticle

55 Scopus citations

Abstract

Inappropriate sinus tachycardia and postural orthostatic tachycardia are ill-defined syndromes with overlapping features. Although sinus node modification has been reported to effectively slow the sinus rate, long-term clinical response has not been adequately assessed. Furthermore, whether patients with postural orthostatic tachycardia would benefit from sinus node modification is unknown. The study prospectively assessed the short- and long-term clinical outcomes of seven consecutive female patients with postural orthostatic tachycardia syndrome and inappropriate sinus tachycardia who were treated with sinus node modification. The study was conducted in a tertiary care center. The electrophysiological and clinical responses were prospectively assessed as defined by autonomic function testing, including Valsalva maneuver, deep breathing, tilt table testing, and quantitative sudomotor axonal reflex testing. Among the study population (mean age was 41 ± 6 years), 5 (71%) patients had successful sinus node modification. At baseline, heart rates were 101 ± 12 beats/min before modification and 77 ± 9 beats/min aider modification (P = 0.001). With isoproterenol, heart rates were 136 ± 9 and 105 ± 12 beats/min (P = 0.002) before and after modification, respectively. The mean heart rate during 24-hour Holter monitoring was also significantly reduced: 96 ± 9 and 72 ± 6 beats/min (P = 0.005) before and after modification, respectively. Despite the significant reduction in heart rate, autonomic symptom score index (based on ten categories of clinical symptoms) was unchanged before (15.6 ± 4.1) and after (14.6 ± 3.6) sinus node modification (P = 0.38). Sinus rate can be effectively slowed by sinus node modification. Clinical symptoms are not significantly improved after sinus node modification in patients with inappropriate sinus tachycardia and postural orthostatic tachycardia. A primary subtle autonomic disregulation is frequently present in this population. Sinus node modification is not recommended in this patient population.

Original languageEnglish (US)
Pages (from-to)217-230
Number of pages14
JournalPACE - Pacing and Clinical Electrophysiology
Volume24
Issue number2
DOIs
StatePublished - Jan 1 2001

Keywords

  • Inappropriate sinus tachycardia
  • Postural orthostatic tachycardia syndrome
  • Sinus node modification
  • Tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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