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Melvin M. Scheinman - One of the best experts on this subject based on the ideXlab platform.

  • Epidemiology and definition of inappropriate Sinus Tachycardia.
    Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2015
    Co-Authors: Cara N. Pellegrini, Melvin M. Scheinman
    Abstract:

    Inappropriate Sinus Tachycardia (IST) is a clinical syndrome lacking formal diagnostic criteria. It is generally defined as an elevated resting heart rate (HR; >90-100 bpm) with an exaggerated response to physical or emotional stress and a clearly Sinus mechanism. Clinical manifestations are broad from a complete lack of symptoms to incapacitating incessant Tachycardia. Now understood to be relatively prevalent, it is observed to have a generally benign prognosis, though symptoms may persist for years. Whether IST is a single discrete entity or a heterogeneous condition with overlap to other syndromes such as postural orthostatic Tachycardia syndrome remains a matter of debate.

  • Ivabradine: a ray of hope for inappropriate Sinus Tachycardia.
    Journal of the American College of Cardiology, 2012
    Co-Authors: Melvin M. Scheinman, Vasanth Vedantham
    Abstract:

    Inappropriate Sinus Tachycardia (IST) is a poorly understood dysrhythmia characterized by palpitations and activity intolerance with an elevated daytime heart rate, exaggerated heart rate response to exercise, and otherwise normal cardiac structure and function. First described in 1979, the disorder

  • Radiofrequency Catheter Modification of the Sinus Node for “Inappropriate” Sinus Tachycardia
    Circulation, 1995
    Co-Authors: Randall J. Lee, Jonathan M. Kalman, Adam P. Fitzpatrick, Laurence M. Epstein, Westby G. Fisher, Jeffrey E. Olgin, Michael D. Lesh, Melvin M. Scheinman
    Abstract:

    Background Radiofrequency catheter ablation is the treatment of choice for patients with paroxysmal supraventricular Tachycardias refractory to medical therapy. However, in symptomatic patients with inappropriate Sinus Tachycardia resistant to drug therapy, catheter ablation of the His’ bundle with permanent pacemaker insertion is currently applied. We evaluated the safety and efficacy of radiofrequency modification of the Sinus node as alternative therapy for patients with inappropriate Sinus Tachycardia. Methods and Results Sixteen patients with disabling episodes of inappropriate Sinus Tachycardia refractory to drug therapy (4.2±0.3 drug trials) underwent either total Sinus node ablation or Sinus node modification. The region of the Sinus node was identified as the region of earliest atrial activation in Sinus rhythm during electrophysiological study. This region was further defined by use of intracardiac echocardiography (ICE) in 9 patients, in whom it was found that an ablation catheter could be guid...

Win-kuang Shen - One of the best experts on this subject based on the ideXlab platform.

  • Managing the patient with episodic Sinus Tachycardia and orthostatic intolerance
    Cardiology journal, 2014
    Co-Authors: Aalap Narichania, J. William Schleifer, Win-kuang Shen
    Abstract:

    Patients with episodic Sinus Tachycardia and associated orthostatic intolerance present a diagnostic and management dilemma to the clinician. We define this group of disorders to include Sinus node reentrant Tachycardia (SNRT), inappropriate Sinus Tachycardia (IAST), and postural orthostatic Tachycardia syndrome (POTS). After a brief review of the current understanding of the pathophysiology and epidemiology of this group of disorders, we focus on the diagnosis and management of IAST and POTS. Our approach attempts to recognize the considerable overlap in pathophysiology and clinical presentation between these two heterogeneous conditions. Thus, we focus on a mechanism-based workup and therapeutic approach. Sinus Tachycardia related to identifiable causes should first be ruled out in these patients. Next, a basic cardiovascular and autonomic workup is suggested to exclude structural heart disease, identify a putative diagnosis, and guide therapy. We review both nonpharmacologic and pharmacologic therapy, with a focus on recent advances. Larger randomized control trials and further mechanistic studies will help refine management in the future.

  • Modification and Ablation for Inappropriate Sinus Tachycardia: Current Status
    Cardiac Electrophysiology Review, 2002
    Co-Authors: Win-kuang Shen
    Abstract:

    Inappropriate Sinus Tachycardia is an ill-defined clinical syndrome with diverse clinical manifestations. Clinical symptoms can range from intermittent palpitations to multisystem complaints. Although there is a general consensus that when the heartbeat exceeds 100 beats per minute at rest or with minimal physiologic challenge, it is considered “inappropriate,” this quantitative differentiation is quite arbitrary, while validation of the reproducibility of the heart rate/activity correlation can be challenging. Once the clinical diagnosis of inappropriate Sinus Tachycardia is expected, other supraventricular tachyarrhythmias and medical conditions causing Sinus Tachycardia should be excluded. The underlying mechanism of inappropriate Sinus Tachycardia is not well understood. “Intracardiac” mechanisms such as enhanced intrinsic automaticity, enhanced sympathetic tone, increased sympathetic receptor sensitivity, and blunted parasympathetic tone have been proposed. Evidences for “extracardiac” mechanisms such as length-dependent autonomic neuropathy, excessive venous pooling, beta-receptor hypersensitivity, alpha-receptor hyposensitivity, altered sympathovagal balance, and brainstem dysregulation have also been reported. Currently, our ability to differentiate primary (intracardiac) from secondary (extracardiac) mechanisms of inappropriate Sinus Tachycardia is limited. It has been reported that ablative therapy of Sinus node is effective in treating patients with symptomatic inappropriate Sinus Tachycardia. Acute success of Sinus node modification/ablation can be accomplished in 70%–100% of the various study populations. Although long-term successful outcome may be accomplished in a few patients, symptoms of palpitations and autonomic characteristics frequently persist. Identification and differentiation of patients who are suitable for ablative therapy versus medical therapy should be one of the central clinical research issues in this patient population. This brief review first considers the clinical and electrophysiologic diagnosis of inappropriate Tachycardia and then summarizes the mechanisms of inappropriate Sinus Tachycardia and related syndromes such as postural orthostatic Tachycardia syndrome. Techniques of mapping and ablation of Sinus node are discussed briefly. A critical review of the acute and long-term clinical outcomes following Sinus node ablation and modification is updated. In conclusion, the precise role of Sinus node modification in patients with inappropriate Sinus Tachycardia remains to be determined. Sinus node modification could be considered in patients with inappropriate Sinus Tachycardia with persistently increased heart rate in the absence of any autonomic abnormalities. Autonomic laboratory testing should be performed to exclude any evidence of autonomic dysregulation. Clinical research on the pathophysiology of inappropriate Sinus Tachycardia should be pursued vigorously.

  • Modification and Ablation for Inappropriate Sinus Tachycardia: Current Status
    Cardiac electrophysiology review, 2002
    Co-Authors: Win-kuang Shen
    Abstract:

    Inappropriate Sinus Tachycardia is an ill-defined clinical syndrome with diverse clinical manifestations. Clinical symptoms can range from intermittent palpitations to multisystem complaints. Although there is a general consensus that when the heartbeat exceeds 100 beats per minute at rest or with minimal physiologic challenge, it is considered “inappropriate,” this quantitative differentiation is quite arbitrary, while validation of the reproducibility of the heart rate/activity correlation can be challenging. Once the clinical diagnosis of inappropriate Sinus Tachycardia is expected, other supraventricular tachyarrhythmias and medical conditions causing Sinus Tachycardia should be excluded.

Carlos A. Morillo - One of the best experts on this subject based on the ideXlab platform.

  • Inappropriate Sinus Tachycardia: current therapeutic options.
    Cardiology in review, 2012
    Co-Authors: Francisco Femenía, Adrian Baranchuk, Carlos A. Morillo
    Abstract:

    Inappropriate Sinus Tachycardia (IST) is an uncommon form of arrhythmia characterized by an increased heart rate that is out of proportion to a normal physiologic demand. The etiology of IST remains ill-defined and controversial. Clinical presentation of IST is highly variable, from isolated to sustained palpitations, and can cause deterioration in one's quality of life. IST is usually a diagnosis of exclusion and it is important to rule out other causes of Sinus Tachycardia before reaching a final diagnosis. evaluation of cardiac auto- nomic reflex function is essential to support the diagnosis of IST. The treatment of IST aims to target the multiple mechanisms involved in this disease, and multidisciplinary management, including cardiac rehabilitation, pharmacother - apy, and occasionally radiofrequency modification of the Sinus node, should be considered. The prognosis is usually benign, although regular follow-up is required to optimize therapy and prevent the onset of tachycardiomyopathy.

  • Inappropriate Sinus Tachycardia: an update
    Revista espanola de cardiologia, 2007
    Co-Authors: Carlos A. Morillo, Juan C. Guzman
    Abstract:

    Inappropriate Sinus Tachycardia (IST) is an uncommon form of arrhythmia which is characterized by an exaggerated increase in heart rate that is out of proportion to normal physiologic demands. Usually, IST is triggered by orthostasis, minimal exertion, and psychological stress. The etiology of IST remains ill-defined. However, proposed mechanisms include: enhanced Sinus node automaticity, alterations in autonomic function associated with increased sympathetic activity or reduced parasympathetic activity, and impaired baroreflex control. Recently, increased levels of autoantibodies to beta-adrenergic receptors have been observed in patients with IST. The clinical presentation of IST is highly varied and ranges from short episodes of palpitations associated with dyspnea, atypical precordial pain, cephalalgia, fatigue, and occasional syncope and presyncope to incapacitating incessant Tachycardia. In general, IST is a diagnosis of exclusion. It is important that other causes of Sinus Tachycardia are excluded before making a diagnosis. Evaluation of autonomic function is essential for a diagnosis of IST. Treatment of IST is based on autonomic function findings and involves multidisciplinary management, including cardiac rehabilitation. Control and restitution of normal autonomic function is essential. The prognosis is benign though regular follow-up is required to optimize therapy.

  • Is Inappropriate Sinus Tachycardia Really Inappropriate
    Cardiac Arrhythmias 2001, 2002
    Co-Authors: Carlos A. Morillo, Hernando Leon, F. Pava
    Abstract:

    “Inappropriate Sinus Tachycardia” is a poorly defined clinical syndrome characterized by an increased resting Sinus rate or an inappropriate and exaggerated acceleration of heart rate with minor physiological or emotional stress. Patients with inappropriate Sinus Tachycardia have a wide spectrum of clinical manifestations that range from mild palpitations to severely symptomatic incessant Tachycardia [1]. Additionally, the clinical manifestation of orthostatic intolerance, primarily by severe Tachycardia provoked by orthostatic changes, may also be associated with presyncope and syncope. These features have raised the possibility that inappropriate Sinus Tachycardia is more likely to be an alteration of autonomic response to orthostatic stress than a primary Sinus node alteration.

Richard Sutton - One of the best experts on this subject based on the ideXlab platform.

  • when Sinus Tachycardia becomes too much negative effects of excessive upright Tachycardia on cardiac output in vasovagal syncope postural Tachycardia syndrome and inappropriate Sinus Tachycardia
    Circulation-arrhythmia and Electrophysiology, 2020
    Co-Authors: Julian M Stewart, Marvin S Medow, Paul Visintainer, Richard Sutton
    Abstract:

    Background: Upright posture reduces venous return, stroke volume, and cardiac output (CO) while causing reflex Sinus rate (heart rate [HR]) increase. Yet, in inappropriate Sinus Tachycardia (IST), ...

  • ivabradine in treatment of Sinus Tachycardia mediated vasovagal syncope
    Europace, 2014
    Co-Authors: Richard Sutton, Tushar V Salukhe, Annchristine Franzenmcmanus, Andrea Collins, Phang Boon Lim, Darrel P Francis
    Abstract:

    Aims Ivabradine, an I(f) current blocker, has shown promising results in treatment of postural orthostatic Tachycardia syndrome (POTS). There is a subgroup of vasovagal syncope (VVS) patients, who demonstrate Sinus Tachycardia before collapse on tilt testing mimicking some features of POTS. These patients may also respond to ivabradine therapy. University Hospital Syncope Clinic where ivabradine was prescribed in a prospective fashion on humanitarian grounds between October 2008 and December 2011. Methods and results Twenty-five patients of mean age 33±years presenting syncope in all and palpitation in 23, duration 9±years underwent tilt testing with reproduction of usual symptoms including Tachycardia preceding collapse. Ivabradine was prescribed in doses of 5–20 mg/day, mean 10.7 mg, as once or twice daily medication. The response to treatment was classified as deterioration in none, no change in 5, improvement in 10, and symptoms abolished in 8 patients. Side effects were minimal; one patient required discontinuation. Conclusion In this pilot study of ivabradine, in patients with VVS, of patients who demonstrated Sinus Tachycardia before collapse on tilt, 72% reported a marked benefit or complete resolution of symptoms. The drug was well tolerated. A randomized controlled trial against placebo is justified.

Randall J. Lee - One of the best experts on this subject based on the ideXlab platform.

  • Role of Radiofrequency Catheter Ablation and Intracardiac Echocardiography in the Treatment of Inappropriate Sinus Tachycardia
    Cardiac Electrophysiology Review, 2000
    Co-Authors: Martin R. Karch, Randall J. Lee, Jonathan M. Kalman, Jerold S. Shinbane, Michael D. Lesh
    Abstract:

    Inappropriate Sinus Tachycardia (IAST) is an uncommon disorder that is characterized by an increased resting heart rate (>100 bpm) and/or an exaggerated heart rate response to minimal exertion (>100 bpm). The P wave axis and morphology during Tachycardia are similar or identical to that during Sinus rhythm. Secondary causes of Sinus Tachycardia should be carefully excluded before establishing the diagnosis. Symptoms of palpitations and/or syncope need to be clearly related to the Sinus Tachycardia.

  • Radiofrequency Catheter Modification of the Sinus Node for “Inappropriate” Sinus Tachycardia
    Circulation, 1995
    Co-Authors: Randall J. Lee, Jonathan M. Kalman, Adam P. Fitzpatrick, Laurence M. Epstein, Westby G. Fisher, Jeffrey E. Olgin, Michael D. Lesh, Melvin M. Scheinman
    Abstract:

    Background Radiofrequency catheter ablation is the treatment of choice for patients with paroxysmal supraventricular Tachycardias refractory to medical therapy. However, in symptomatic patients with inappropriate Sinus Tachycardia resistant to drug therapy, catheter ablation of the His’ bundle with permanent pacemaker insertion is currently applied. We evaluated the safety and efficacy of radiofrequency modification of the Sinus node as alternative therapy for patients with inappropriate Sinus Tachycardia. Methods and Results Sixteen patients with disabling episodes of inappropriate Sinus Tachycardia refractory to drug therapy (4.2±0.3 drug trials) underwent either total Sinus node ablation or Sinus node modification. The region of the Sinus node was identified as the region of earliest atrial activation in Sinus rhythm during electrophysiological study. This region was further defined by use of intracardiac echocardiography (ICE) in 9 patients, in whom it was found that an ablation catheter could be guid...