| Autor: |
Carlo de Asmundis, Luigi Pannone, Dhanunjaya Lakkireddy, Thomas M. Beaver, Chad R. Brodt, Randall J. Lee, Antonio Sorgente, Anaïs Gauthey, Cinzia Monaco, Ingrid Overeinder, Gezim Bala, Alexandre Almorad, Erwin Ströker, Juan Sieira, Pedro Brugada, Gian-Battista Chierchia, Mark La Meir, Brian Olshansky |
| Přispěvatelé: |
Clinical sciences, Heartrhythmmanagement, Faculty of Medicine and Pharmacy, Cardio-vascular diseases, Medical Imaging, Vascular surgery, Cardiac Surgery |
| Rok vydání: |
2022 |
| Předmět: |
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| Zdroj: |
The American journal of cardiology. 183 |
| ISSN: |
1879-1913 |
| Popis: |
The purpose of this review is to determine the causal mechanisms and treatment of inappropriate sinoatrial tachycardia (IST), defined as a non-physiological elevation in resting heart rate. IST is defined as a resting daytime sinus rate >100 beats/minute and an average 24-hour heart rate >90 beats/minute. Potential causal mechanisms include sympathetic receptor hypersensitivity, blunted parasympathetic tone, or enhanced intrinsic automaticity within the sinoatrial node (SAN) pacemaker-conduction complex. These anomalies may coexist in the same patient. Recent ex-vivo near-infrared transmural optical imaging of the SAN in human and animal hearts provides important insights into the functional and molecular features of this complex structure. In particular, it reveals the existence of preferential sinoatrial conduction pathways that ensure robust SAN activation with electrical conduction. The mechanism of IST is debated because even high-resolution electroanatomical mapping approaches cannot reveal intramural conduction in the 3-dimensional SAN complex. It may be secondary to enhanced automaticity, intranodal re-entry, or sinoatrial conduction pathway re-entry. Different pharmacological approaches can target these mechanisms. Long-acting β blockers in IST can act on both primarily increased automaticity and dysregulated autonomic system. Ivabradine targets sources of increased SAN automaticity. Conventional or hybrid ablation may target all the described abnormalities. This review provides a state-of-the-art overview of putative IST mechanisms. In conclusion, based on current knowledge, pharmacological and ablation approaches for IST, including the novel hybrid SAN sparing ablation, are discussed. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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Full Text from ScienceDirect