This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Morillo, C. A. Articles by Yee, R. Search for Related Content PubMed PubMed Citation Articles by Morillo, C. A. Articles by Yee, R. Pubmed/NCBI databases Compound via MeSH Substance via MeSH

Circulation, Vol 90, 873-877, Copyright © 1994 by American Heart Association

ARTICLES

Mechanism of 'inappropriate' sinus tachycardia. Role of sympathovagal balance

CA Morillo, GJ Klein, RK Thakur, H Li, M Zardini and R Yee
Department of Medicine, University of Western Ontario, London, Canada.

BACKGROUND: "Inappropriate" sinus tachycardia (IST) is an uncommon and poorly defined atrial tachycardia characterized by inappropriate tachycardia and exaggerated acceleration of heart rate with "normal" P wave. The mechanism of this tachycardia is unknown. The purpose of the present study was to determine the role of autonomic balance in the genesis of IST. METHODS AND RESULTS: Six female patients aged 23 to 38 years with IST and 10 age- and sex-matched control subjects were assessed with the following autonomic function tests: (1) sympathovagal balance to the sinus node assessed by calculating the LF/HF (low frequency/high frequency) ratio using power spectral analysis both in the supine position and after 10 minutes of head-up tilt to 60 degrees, (2) cardiovagal reflex assessed by cold face test (CFT), (3) beta- adrenergic sensitivity as determined by calculating isoproterenol dose- response curves and isoproterenol chronotropic dose 25 (CD25), and (4) intrinsic heart rate (IHR) assessed after autonomic blockade with atropine 0.04 mg/kg and propranolol 0.2 mg/kg administered as an intravenous bolus. No significant differences in the LF/HF ratio both in the supine position (2.8 +/- 0.3 versus 2.6 +/- 0.4) and during upright tilt (8.7 +/- 1.3 versus 8.5 +/- 0.5) were observed between control subjects and IST patients. Cardiovagal response to CFT was markedly depressed in all patients (6.3% IST patients versus 24.2% control subjects, P < .001). beta-Adrenergic hypersensitivity to isoproterenol was noted in all patients (mean CD25, 0.29 +/- 0.10 microgram IST patients versus 1.27 +/- 0.4 microgram control subjects; P < .001), and high IHR was noted in all cases. The patients were treated with high doses of beta-blockers with adequate short-term control. Radiofrequency catheter ablation of the sinus node area was performed in one drug-refractory patient. CONCLUSIONS: These findings suggest that the mechanism leading to IST is related to a primary sinus node abnormality characterized by a high IHR, depressed efferent cardiovagal reflex, and beta-adrenergic hypersensitivity.

This article has been cited by other articles:

				S. Carew, M. O. Connor, J. Cooke, R. Conway, C. Sheehy, A. Costelloe, and D. Lyons A review of postural orthostatic tachycardia syndrome Europace, January 1, 2009; 11(1): 18 - 25. [Abstract] [Full Text] [PDF]

				T. Taketani, R. K. Wolf, and J. V. Garrett Partial Cardiac Denervation and Sinus Node Modification for Inappropriate Sinus Tachycardia Ann. Thorac. Surg., August 1, 2007; 84(2): 652 - 654. [Abstract] [Full Text] [PDF]

				A. H. Shandling, D. Rieders, and D. M. Bethencourt Thoracoscopic Microwave Epicardial Ablation: Feasibility for the Treatment of Idiopathic Sinus Node Tachycardia Ann. Thorac. Surg., January 1, 2007; 83(1): 300 - 302. [Abstract] [Full Text] [PDF]

				D Sanchez-Quintana, J A Cabrera, J Farre, V Climent, R H Anderson, and S Y Ho Sinus node revisited in the era of electroanatomical mapping and catheter ablation Heart, February 1, 2005; 91(2): 189 - 194. [Abstract] [Full Text] [PDF]

				A.-M. Still, P. Raatikainen, A. Ylitalo, H. Kauma, M. Ikäheimo, Y. A. Kesäniemi, and H. V. Huikuri Prevalence, characteristics and natural course of inappropriate sinus tachycardia Europace, January 1, 2005; 7(2): 104 - 112. [Abstract] [Full Text] [PDF]

				N. F. Marrouche, S. Beheiry, G. Tomassoni, C. Cole, D. Bash, T. Dresing, W. Saliba, A. Abdul-Karim, P. Tchou, R. Schweikert, et al. Three-dimensional nonfluoroscopic mapping and ablation of inappropriate sinus tachycardia: Procedural strategies and long-term outcome J. Am. Coll. Cardiol., March 20, 2002; 39(6): 1046 - 1054. [Abstract] [Full Text] [PDF]

				N Saoudi, F Cosio, A Waldo, S.A Chen, Y Iesaka, M Lesh, S Saksena, J Salerno, and W Schoels A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases. A Statement from a Joint Expert Group from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology Eur. Heart J., July 2, 2001; 22(14): 1162 - 1182. [PDF]

				K. C. Man, B. Knight, H.-F. Tse, F. Pelosi, G. F. Michaud, M. Flemming, S. A. Strickberger, and F. Morady Radiofrequency catheter ablation of inappropriate sinus tachycardia guided by activation mapping J. Am. Coll. Cardiol., February 1, 2000; 35(2): 451 - 457. [Abstract] [Full Text] [PDF]

				H. V. Huikuri, A.-M. Poutiainen, T. H. Makikallio, M. J. Koistinen, K. E. J. Airaksinen, R. D. Mitrani, R. J. Myerburg, and A. Castellanos Dynamic Behavior and Autonomic Regulation of Ectopic Atrial Pacemakers Circulation, September 28, 1999; 100(13): 1416 - 1422. [Abstract] [Full Text] [PDF]

				D. J. Callans, J.-F. Ren, D. Schwartzman, C. D. Gottlieb, F. A. Chaudhry, and F. E. Marchlinski Narrowing of the superior vena cava-right atrium junction during radiofrequency catheter ablation for inappropriate sinus tachycardia: analysis with intracardiac echocardiography J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1667 - 1670. [Abstract] [Full Text] [PDF]

				G. Jacob, J. R. Shannon, F. Costa, R. Furlan, I. Biaggioni, R. Mosqueda-Garcia, R. M. Robertson, and D. Robertson Abnormal Norepinephrine Clearance and Adrenergic Receptor Sensitivity in Idiopathic Orthostatic Intolerance Circulation, April 6, 1999; 99(13): 1706 - 1712. [Abstract] [Full Text] [PDF]

				K. A. Glatter, J. Cheng, P. Dorostkar, G. Modin, S. Talwar, M. Al-Nimri, R. J. Lee, L. A. Saxon, M. D. Lesh, and M. M. Scheinman Electrophysiologic Effects of Adenosine in Patients With Supraventricular Tachycardia Circulation, March 2, 1999; 99(8): 1034 - 1040. [Abstract] [Full Text] [PDF]

				H. V. Huikuri, T. H. Makikallio, K. E. J. Airaksinen, T. Seppanen, P. Puukka, I. J. Raiha, and L. B. Sourander Power-Law Relationship of Heart Rate Variability as a Predictor of Mortality in the Elderly Circulation, May 26, 1998; 97(20): 2031 - 2036. [Abstract] [Full Text] [PDF]

				P. Zimetbaum and M. E. Josephson Evaluation of Patients with Palpitations N. Engl. J. Med., May 7, 1998; 338(19): 1369 - 1373. [Full Text] [PDF]

				R. J. Lee, J. M. Kalman, A. P. Fitzpatrick, L. M. Epstein, W. G. Fisher, J. E. Olgin, M. D. Lesh, and M. M. Scheinman Radiofrequency Catheter Modification of the Sinus Node for "Inappropriate" Sinus Tachycardia Circulation, November 15, 1995; 92(10): 2919 - 2928. [Abstract] [Full Text]