Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
J Cardiovasc Electrophysiol. 2021 Apr;32(4):1053-1061. doi: 10.1111/jce.14942. Epub 2021 Feb 24.
Effective therapy for inappropriate sinus tachycardia (IST) remains challenging with high rates of treatment failure and symptom recurrence. It is uncertain how effective pharmacotherapy and procedural therapy are long-term, with poor response to medical therapy in general.
We retrospectively reviewed all patients with the diagnosis of IST at a tertiary academic medical center from 1998 to 2018. We extracted data related to prescribing patterns and symptom response to medical therapy and sinus node modification (SNM), assessing efficacy and periprocedural complication rates.
A total of 305 patients with a formal diagnosis of IST were identified, with 259 (84.9%) receiving at least one prescription medication related to the condition. Beta-blockers were the most commonly used medication (n = 245), with a majority of patients reporting no change or worsening of symptoms, and poor response was seen to other medication classes. Improvement was seen significantly more often with ivabradine than beta blockers, though the sample size was limited (p = .003). Fifty-five patients (18.0% of all IST patients), mean age 32.0 ± 9.1 years, underwent a SNM procedure, with an average of 1.8 ± 0.9 procedures per patient. Acute symptomatic improvement (<6 months) was seen in 58.2% of patients. Long-term complete resolution of symptoms was seen in 5.5% of patients, modest improvement in 29.1%, and no long-term benefit was seen in 65.5% of patients.
Among all medical therapies, there were high rates of treatment failure or symptom worsening in over three-quarters of patients in our study. Ivabradine was most beneficial, though the sample size was small. While most patients receiving SNM ablation for IST perceive an acute symptomatic improvement, almost two-thirds of patients have no long-term improvement, and resolution of symptoms is quite rare. AV node ablation with pacemaker implantation following lack of response to SNM offered increased success, though the sample size was limited.
不适当窦性心动过速（IST）的有效治疗仍然具有挑战性，治疗失败率和症状复发率都很高。目前尚不清楚药物治疗和程序治疗的长期效果如何，一般来说，对药物治疗的反应较差。
我们回顾性分析了 1998 年至 2018 年期间在一家三级学术医疗中心诊断为 IST 的所有患者。我们提取了与药物治疗和窦房结修改（SNM）相关的处方模式和症状反应数据，评估了疗效和围手术期并发症发生率。
共确定了 305 例有正式 IST 诊断的患者，其中 259 例（84.9%）接受了至少一种与该疾病相关的处方药物。β受体阻滞剂是最常用的药物（n=245），大多数患者报告症状无改善或恶化，其他药物类别的反应较差。与β受体阻滞剂相比，伊伐布雷定的改善更为显著，尽管样本量有限（p=0.003）。55 例（所有 IST 患者的 18.0%）患者，平均年龄 32.0±9.1 岁，接受了 SNM 手术，平均每位患者进行 1.8±0.9 次手术。58.2%的患者在急性症状改善（<6 个月）。5.5%的患者症状完全缓解，29.1%的患者症状适度缓解，65.5%的患者无长期获益。
在我们的研究中，超过四分之三的患者接受所有医学治疗后出现治疗失败或症状恶化。伊伐布雷定最有效，但样本量较小。虽然大多数接受 IST SNM 消融治疗的患者在急性症状上有所改善，但近三分之二的患者没有长期改善，症状缓解相当罕见。在对 SNM 无反应的情况下，行房室结消融并植入起搏器可提高成功率，但样本量有限。
