Sinus Node Sparing Hybrid Thoracoscopic Ablation Outcomes in Patients with Inappropriate Sinus Tachycardia (SUSRUTA-IST) Registry
Dhanunjaya Lakkireddy, Jalaj Garg, Carlo DeAsmundis, Mark LaMeier, Ahmed Romeya, Justin Vanmeetren, Peter Park, Rangarao Tummala, Scott Koerber, Chandra Vasamreddy, Alap Shah, Poojita Shivamurthy, Ken Frazier, Yashi Awasthi, Gian Battista Chierchia, Donita Atkins, Sudha Bommana, Luigi Di Biase, Amin Al-Ahmad, Andrea Natale, Rakesh Gopinathannair, Dhanunjaya Lakkireddy, Jalaj Garg, Carlo DeAsmundis, Mark LaMeier, Ahmed Romeya, Justin Vanmeetren, Peter Park, Rangarao Tummala, Scott Koerber, Chandra Vasamreddy, Alap Shah, Poojita Shivamurthy, Ken Frazier, Yashi Awasthi, Gian Battista Chierchia, Donita Atkins, Sudha Bommana, Luigi Di Biase, Amin Al-Ahmad, Andrea Natale, Rakesh Gopinathannair
Abstract
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.
Keywords: Ablation; Hybrid thoracoscopic ablation; Inappropriate sinus tachycardia; RF clamp; Sinus node modification.
Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Source: PubMed