Bahar Abdul Rasheed, Kathawa Fadi, Le Tiffany, Farah Abubaker, Awadelkarim Abdalaziz, Minhas Hersimren, Afonso Luis
Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
Department of Medicine, Division of Cardiology, Wayne State University, Detroit, MI, USA.
AME Case Rep. 2025 Jun 17;9:80. doi: 10.21037/acr-24-262. eCollection 2025.
Sinoatrial nodal reentrant tachycardia (SANRT) is a rare form of focal atrial tachycardia, often linked with structural or congenital heart disease. Due to its electrocardiographic similarities with other supraventricular tachyarrhythmias, it is frequently misdiagnosed. Understanding its clinical presentation and effective management strategies is crucial for appropriate patient care.
We present a case of a 45-year-old female with severe pulmonary hypertension and obstructive sleep apnea who was admitted with progressive palpitations, chest pain, and dyspnea. Initial electrocardiographic evaluation suggested atrial fibrillation with rapid ventricular response (RVR), leading to treatment with metoprolol and amiodarone. However, the tachyarrhythmia persisted, and further investigation revealed features suggestive of SANRT. The diagnosis was confirmed by telemetry findings demonstrating atrial tachycardia with a prolonged PR interval, terminating abruptly after carotid sinus massage (CSM). This immediate response to vagal stimulation solidified the diagnosis of SANRT. The patient was managed conservatively with vagal maneuver training and discharged on oral bisoprolol.
This case highlights the diagnostic challenges associated with SANRT and emphasizes the role of CSM as both a diagnostic and therapeutic intervention. Early recognition of SANRT is crucial, as it can mimic other supraventricular arrhythmias, leading to mismanagement. While electrophysiological studies remain the gold standard for diagnosis, non-invasive measures such as vagal maneuvers can be highly effective in terminating the arrhythmia and providing symptomatic relief.
窦房结折返性心动过速（SANRT）是局灶性房性心动过速的一种罕见形式，常与结构性或先天性心脏病相关。由于其心电图表现与其他室上性快速心律失常相似，常被误诊。了解其临床表现和有效的管理策略对于为患者提供恰当的护理至关重要。
我们报告一例45岁女性患者，患有严重肺动脉高压和阻塞性睡眠呼吸暂停，因进行性心悸、胸痛和呼吸困难入院。初始心电图评估提示房颤伴快速心室反应（RVR），遂给予美托洛尔和胺碘酮治疗。然而，快速心律失常持续存在，进一步检查发现提示SANRT的特征。遥测结果显示房性心动过速伴PR间期延长，经颈动脉窦按摩（CSM）后突然终止，从而确诊。对迷走神经刺激的这种即时反应巩固了SANRT的诊断。该患者接受了迷走神经手法训练的保守治疗，并口服比索洛尔出院。
本病例突出了与SANRT相关的诊断挑战，并强调了CSM作为诊断和治疗干预措施的作用。早期识别SANRT至关重要，因为它可模仿其他室上性心律失常，导致治疗不当。虽然电生理检查仍是诊断的金标准，但迷走神经手法等非侵入性措施在终止心律失常和缓解症状方面可能非常有效。
