Inappropriate Sinus Tachycardia Diagnosed and Treated as Depression Successfully Treated by Radiofrequency Catheter Ablation

Abstract

We experienced a man in his 20s with inappropriate sinus tachycardia (IST) initially diagnosed and treated as depression who was steadily treated with radiofrequency catheter ablation (RFCA) using an EnSite™ system. The patient has remained well without any symptoms or medications, including antidepressants, for two years since the RFCA. To avoid missing IST and treating it as an emotional problem and/or mental illness such as depression, physicians - including cardiologists - should be aware of these conditions when examining patients with multiple and incapacitating complaints including palpitations and general fatigue and/or tachycardia, especially characterized by an elevated resting heart rate or a disproportionate increase in the heart rate with minimal exertion.

Figures

Figure 1.

A 12-lead electrocardiogram at rest (heart rate 90 bpm) (A), on minimal exertion (heart rate 120 bpm) (B), under intravenous administration of a beta-adrenergic agonist (heart rate 150 bpm) (C), and after delivering radiofrequency energy (heart rate 130 bpm) (D). bpm: beats per minute

Figure 2.

Right anterior oblique view of the EnSiteTM voltage (A, B) and activation (C) maps showing the right atrium (RA). The breakout sites (BOSs) with a heart rate (HR) of less (green circle with 80 and 90) or more (yellow circle with 100, 110, 120, 130, 140, and 150) than 100 bpm could easily and clearly be separated (A, C). The area in the red circle with the dotted line was the target site for the radiofrequency catheter ablation (RFCA) (A, B). After the RFCA, the BOSs observed during an HR of more than 100 bpm (yellow circles with 100, 110, 120, 130, 140, and 150) completely moved to the sites for an HR of less than 100 bpm (green circles with 80 and 90) (B, C). bpm: beats per minute