Department of Cardiology, Khyber Medical Institute Srinagar, 190010 Jammu and Kashmir, India.
Department of Cardiology, Walter Reed Medical Center, Bethesda, MD 20814, USA.
Rev Cardiovasc Med. 2021 Dec 22;22(4):1331-1339. doi: 10.31083/j.rcm2204139.
Inappropriate sinus tachycardia (IST) has been defined as a resting heart rate of >100 beats per minute and an average 24-hour heart rate >90 bpm with distressing symptoms resulting from the persistent tachycardia. IST is prevalent in 1% of the middle-aged population, mostly females. Rarely can elderly patients also present with IST. Possible mechanisms of IST include intrinsic sinus node abnormality, beta-adrenergic receptor stimulating autoantibody, beta-adrenergic receptor supersensitivity, muscarinic receptor autoantibody, or hyposensitivity, impaired baroreflex control, depressed efferent parasympathetic/vagal function, nociceptive stimulation, central autonomic overactivity, aberrant neurohumoral modulation, etc. Symptoms associated with IST are palpitations, chest pain, fatigue, shortness of breath, presyncope, and syncope. Despite these distressing symptoms, IST has not been associated with tachycardia-associated cardiomyopathy or increased major cardiovascular events. Various treatment options for patients with IST are ivabradine, beta-adrenergic blockers, calcium channel blockers, psychiatric evaluation, and exercise training. Although, endocardial radiofrequency ablation targeting the sinus node has been used as a treatment modality for otherwise treatment-refractory IST, the results have been dismal. The other modalities used for refractory IST treatment are endocardial modification of the sinus node using radiofrequency energy, combined endo and epicardial ablation of the sinus node, thoracoscopic epicardial ablation of the sinus node, sinus node sparing thoracoscopic and endocardial hybrid ablation. The goal of this review is to provide the readership with the pathophysiological basis of IST and its management options.
不适当窦性心动过速（IST）被定义为静息心率>100 次/分钟，平均 24 小时心率>90 次/分钟，且持续心动过速引起令人困扰的症状。IST 在中年人群中发病率为 1%，以女性为主。老年人也很少出现 IST。IST 的可能机制包括固有窦房结异常、β-肾上腺素能受体刺激自身抗体、β-肾上腺素能受体超敏性、毒蕈碱受体自身抗体或低敏性、压力感受器反射控制受损、传出副交感/迷走神经功能下降、伤害性刺激、中枢自主神经活动过度、神经体液调节异常等。与 IST 相关的症状有心悸、胸痛、疲劳、呼吸急促、晕厥前和晕厥。尽管有这些令人困扰的症状，但 IST 与心动过速相关心肌病或增加主要心血管事件无关。IST 患者的各种治疗选择包括伊伐布雷定、β-肾上腺素能阻滞剂、钙通道阻滞剂、精神科评估和运动训练。尽管针对窦房结的心内膜射频消融已被用作治疗难治性 IST 的一种方法，但结果不佳。用于难治性 IST 治疗的其他方法有心内膜窦房结射频能量修改、窦房结心内膜和心外膜联合消融、胸腔镜心外膜窦房结消融、窦房结保留胸腔镜和心内膜杂交消融。本综述的目的是为读者提供 IST 的病理生理基础及其治疗选择。
