Natural history and clinical outcomes of inappropriate sinus tachycardia

Abstract

Background: Limited data are available regarding the demographics, disease associations, and long-term prognosis of patients with inappropriate sinus tachycardia (IST).Objective: To establish epidemiologic data for patients with IST, including symptom onset, comorbid disease, and long-term outcomes. Methods:We retrospectively reviewed all patients with an IST diagnosis at the Mayo Clinic (Rochester, MN) during a 20-year period . We extracted demographic data and clinical outcomes compared to an age and gender-matched control group with atrioventricular nodal reentry tachycardia (AVNRT).Results: Within the study period, a total of 305 patients with IST were identified (mean follow-up 3.5 years) with 92.1% female and mean age 33.2 ± 11.2 years. The most frequently identified circumstances triggering the condition included pregnancy (7.9%) and infectious illness (5.9%) while the most common comorbid conditions were depression (25.6%) and anxiety (24.6%). At diagnosis, the mean left ventricular ejection fraction (LVEF) was 62.3 ± 6.2%, with 77 patients having follow-up echocardiographic data. No significant difference in LVEF was seen after a mean 4.9 ± 4.3-year follow-up (baseline LVEF 59.8 ± 10.7% vs subsequent 61.4 ± 8.1%; P = .2971). Two deaths occurred within the study period, with one related to myocardial infarction and the other noncardiac; compared to an age and gender-matched AVNRT control group there was no excess mortality during the follow-up period.Conclusions: In our study cohort, IST predominately affects young females with structurally normal hearts and modest coexistent psychiatric disease. In most cases of IST, a major event occurring just before or at the time of diagnosis could not be identified, although nearly 8% of patients first noted symptoms during or shortly after pregnancy. In our cohort, there was no evidence of cardiomyopathy or mortality related to IST. K E Y W O R D S arrhythmia, inappropriate sinus tachycardia, sinus tachycardia

Ivabradine use in pregnant women—treatment indications and pregnancy outcome: an evaluation of the German Embryotox database

“…A high number of women in our cohort received therapy for anxiety and/or other psychiatric conditions. This is in line with findings from other studies reporting high rates of anxiety (25%) and depression (26%) in IST patients [25]. Anxiety is considered as non-cardiac symptom of inappropriate sinus tachycardia, and vice versa, anxiety may trigger tachycardia.…”

“…Preconception counselling is of utmost importance in all women considering pregnancy under medication [27]. Sinus tachycardia is a condition diagnosed mainly in young females and the first diagnosis is frequently made during or after pregnancy [25]. Considering the increasing off-label use of ivabradine as well as the high rate of > 40% unplanned pregnancies [28], more exposed pregnancies can be expected in the future.…”

Inappropriate Sinus Tachycardia Following Viral Illness

“…Most patients with inappropriate sinus tachycardia are young and female. Among a single-center cohort of 305 patients with inappropriate sinus tachycardia seen between 1998 and 2018, 92% were female, with an average age of 33 years [ 8 ]. Affected patients have an elevated resting heart rate and/or an exaggerated heart rate response to exercise that is out of proportion to their body’s physiological needs; many patients have both.…”

The contribution of psychological distress to resting palpitations in patients recovering from severe coronavirus disease 2019

“…These findings suggested that anxiety and depression might be responsible, at least in part, for the resting palpitations symptoms in recovered COVID-19 patients. Importantly, a recent retrospective study from Mayo Clinic showed that anxiety and depression are the most common comorbid conditions in patients with inappropriate sinus tachycardia 25 , proposing a possible link between psychological distress and sinus tachycardia.…”