Abstract
Background
Autonomic dysfunction presenting as inappropriate sinus tachycardia has been reported to occur following slow pathway ablation for atrioventricular node tachycardia. We report on a series of patients who developed new onset postural orthostatic tachycardia syndrome (POTS) following successful radiofrequency ablation of atrioventricular nodal reentrant tachycardia (AVNRT).
Methods
The study was a retrospective analysis that was approved by our Institutional Review Board. Patients were identified from those seen at our Syncope and Autonomic Disorders Clinic. A total of six patients were identified who were previously healthy except for supraventricular tachycardia. Each was found to have AVNRT during electrophysiology study and each underwent successful radiofrequency modification of the slow atrioventricular nodal pathway. Following ablation each patient developed the new onset of symptoms of orthostatic intolerance consistent with POTS.
Results
After an initial symptom-free period (3–6 weeks) post ablation each patient began to experience symptoms of orthostatic intolerance. All six patients began to experience progressive severe fatigue. Orthostatic tachycardia was reported by five patients, syncope by three patients, and presyncope by all six patients. Each patient reported the occurrence of symptom while upright that were relieved by becoming supine. Each patient had experienced symptoms for greater than 6 months prior to being seen at our center. Three patients reported such severe symptoms of orthostatic tachycardia that they underwent repeat electrophysiology study; however, none had evidence of AVNRT. Each patient demonstrated a POTS response within the first 10 min of upright tilt with reproduction of their clinical symptoms that had occurred post ablation.
Conclusion
POTS may be a complication of radiofrequency ablation of AVNRT.
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References
Jackman, W. M., Beckman, K. J., McClelland, J. H., Wang, X., Friday, K. J., Roman, C. A., et al. (1992). Treatment of supraventricular tachycardia due to atrioventricular nodal reentry, by radiofrequency catheter ablation of slow-pathway conduction. The New England Journal of Medicine, 327(5), 313–318.
Lee, M. A., Morady, F., Kadish, A., Schamp, D. J., Chin, M. C., Scheinman, M. M., et al. (1991). Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia. Circulation, 83(3), 827–835.
Sousa, J., El-Atassi, R., Rosenheck, S., Calkins, H., Langberg, J., & Morady, F. (1991). Radiofrequency catheter ablation of the atrioventricular junction from the left ventricle. Circulation, 84(2), 567–571.
Ehlert, F. A., Goldberger, J. J., Brooks, R., Miller, S., & Kadish, A. H. (1992). Persistent inappropriate sinus tachycardia after radiofrequency current catheter modification of the atrioventricular node. The American Journal of Cardiology, 69(12), 1092–1095.
Capulzini, L., Sarkozy, A., Semeraro, O., Paparella, G., Chierchia, G. B., De Asmundis, C., et al. (2010). Ivabradine to treat inappropriate sinus tachycardia after the fast pathway ablation in a patient with severe pectus excavatum. Pacing Clin Electrophysiol, 33, e32–35.
Skeberis, V., Simonis, F., Tsakonas, K., Celiker, A., Andries, E., & Brugada, P. (1994). Inappropriate sinus tachycardia following radiofrequency ablation of AV nodal tachycardia: incidence and clinical significance. Pacing and Clinical Electrophysiology, 17(5 Pt 1), 924–927.
Moreira, J. M., Curimbaba, J., Filho, H. C., & Pimenta, J. (2006). Persistent inappropriate sinus tachycardia after radiofrequency ablation of left lateral accessory pathway. Journal of Cardiovascular Electrophysiology, 17(6), 678–681.
De Sisti, A., Tonet, J., Benkaci, A., & Frank, R. (2010). A case of inappropriate sinus tachycardia after atrio-ventricular nodal reentrant tachycardia cryoablation successfully treated by ivabradine. Europace, 12, 1029–1031.
Grubb, B. P. (2005). Dysautonomic (orthostatic) syncope. In B. P. Grubb & B. Olshansky (Eds.), Syncope: Mechanisms and Management (pp. 72–91). Malden, MA: Blackwell Publishing.
Grubb, B. P. (2005). Neurocardiogenic Syncope. In B. P. Grubb & B. Olshansky (Eds.), Syncope: Mechanisms and Management (pp. 47–71). Malden, MA: Blackwell Publishing.
Raj, S. R. (2006). The Postural Tachycardia Syndrome (POTS): pathophysiology, diagnosis and management. Indian Pacing Electrophysiol Journal, 6(2), 84–99.
Grubb, B. P. (2008). Postural orthostatic tachycardia. Circulation, 117, 2814–2817.
Kanjwal, Y., Kosinski, D., & Grubb, B. P. (2003). The postural orthostatic tachycardia syndrome: definitions, diagnosis, and management. Pacing and Clinical Electrophysiology, 26(8), 1747–1757.
Kanjwal K, Saeed B, Karabin B, Kanjwal Y, Grubb BP. Preliminary Observations Suggesting That Treatment With Modafinil Improves Fatigue in Patients With Orthostatic Intolerance. Am J Ther. 2010 Apr 10. [Epub ahead of print]
Jacob, G., Costa, F., Shannon, J. R., Robertson, R. M., Wathen, M., Stein, M., et al. (2000). The neuropathic postural tachycardia syndrome. The New England Journal of Medicine, 343, 1008–1014.
Rowe, P. C., Barron, D. F., Calkins, H., Maumenee, I. H., Tong, P. Y., & Geraghty, M. T. (1999). Orthostatic intolerance and chronic fatigue syndrome associated with Ehlers–Danlos syndrome. Jornal de Pediatria, 135, 494–499.
Gazit, Y., Nahir, M., Grahame, R., & Jacob, G. (2003). Dysautonomia in the joint hypermobility syndrome. The American Journal of Medicine, 115, 33–40.
Jordan, J., Shannon, J. R., Diedrich, A., Black, B. K., & Robertson, D. (2002). Increased sympathetic activation in idiopathic orthostatic intolerance: role of systemic adrenoreceptor sensitivity. Hypertension, 39, 173–178.
Shibao, C., Arzubiaga, C., Roberts, L. J., et al. (2005). Hyperadrenergic postural tachycardia syndrome in mast cell activation disorders. Hypertension, 45, 385–390.
Fouad, F. M., Tadena-Thome, L., Bravo, E. L., & Tarazi, R. C. (1986). Idiopathic hypovolumia. Annals of Internal Medicine, 104(3), 298–303.
Rosen, S. G., & Cryer, P. E. (1982). Postural tachycardia syndrome. Reversal of sympathetic hyperresponsiveness and clinical improvement during sodium loading. The American Journal of Medicine, 72(5), 847–850.
Haensch, C. A., Lerch, H., Schlemmer, H., Jigalin, A., & Isenmann, S. (2010). Cardiac neurotransmission imaging with 123I-meta-iodobenzylguanidine in postural tachycardia syndrome. Journal of Neurology, Neurosurgery and Psychiatry, 81(3), 339–343.
Kanjwal, K., Karabin, B., Kanjwal, Y., & Grubb, B. P. (2009). Postpartum postural orthostatic tachycardia syndrome in a patient with the joint hypermobility syndrome. Cardiol Res Pract, 2009, 187543.
Kanjwal, K., Karabin, B., Kanjwal, Y., & Grubb, B. P. (2009). Outcomes of pregnancy in patients with preexisting postural tachycardia syndrome. Pacing and Clinical Electrophysiology, 32(8), 1000–1003.
Kanjwal K, Karabin B, Kanjwal Y, Grubb BP. Autonomic dysfunction presenting as Postural tachycardia syndrome following traumatic brain injury. Cardiology Journal, 17. April 30, 2010 [Epub ahead of print]
Kanjwal K, Karabin B, Kanjwal Y, Grubb BP. (2010). Postural Orthostatic Tachycardia Syndrome: A Rare Complication Following Electrical Injury. Pacing Clin Electrophysiol, 33, e59–e61
Grubb, B. P., & Karabin, B. (2007). New onset postural tachycardia syndrome following lightning injury. Pacing and Clinical Electrophysiology, 30(8), 1036–1038.
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Kanjwal, K., Karabin, B., Sheikh, M. et al. New onset postural orthostatic tachycardia syndrome following ablation of AV node reentrant tachycardia. J Interv Card Electrophysiol 29, 53–56 (2010). https://doi.org/10.1007/s10840-010-9506-4
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DOI: https://doi.org/10.1007/s10840-010-9506-4