Carlo Pappone, Giuseppe Stabile*,
Giuseppe Oreto**, Adriano Salvati, Maria Luisa Loricchio, Francesco Furlanello, Francesco
Badessa, Cristoforo D'Ascia, Maria Pia Calabro**, Stefano Bianchi, Cosimo Dicandia, Sergio
Chierchia.
Cardiology Department, San Raffaele Hospital, Milan,
*Laboratory of Electrophysiology, Clinica San Michele, Maddaloni (CE),
**Department of Cardiology, University of Messina, Italy
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Introduction. Inappropriate sinus
tachycardia (IST) has been observed following radiofrequency ablation (RFA) of
atrioventricular nodal fast pathway. This study was aimed to analyze the incidence and
clinical significance of IST following RFA of parahissian accessory pathways (APs).
Methods and results. Twenty-eight patients (pts) with parahissian AP
underwent RFA. Radiofrequency current was delivered at the atrial aspect of the tricuspid
annulus, to a site where the His bundle potential was < 0.15 mV. Time and frequency
domain analysis of heart rate variability was performed in 22 patients, before and after
RFA. Abolition of AP conduction was obtained in all pts, and no A-V conduction alteration
occurred. Six pts (21.4%) presented with IST 45 to 240 minutes after the procedure. In 5
of them, IST disappeared spontaneously within 72 hours, whereas in 1 pt ß-blockers were
required for 2 months. A decrease in heart rate variability was observed only in patients
who developed IST.
Conclusions. IST is a relatively frequent complication after RFA of
parahissian APs: it is generally short-lasting, and usually does not require any
treatment. IST after catheter ablation is likely to depend upon transient parasympathetic
denervation of the sinus node.
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