Inappropriate sinus tachycardia affects 1% of the population. At San Raffaele the intervention conducted by a cardiac surgeon and a cardiologist
Two women, a heart surgeon and a cardiologist. A 21-year-old girl whose heart beats too fast. At the San Raffaele Hospital in Milan a hybrid intervention was performed for the correction of the so-called inappropriate sinus tachycardiaan arrhythmia characterized by an increase in the rate of the heart rhythm, which it can reach 180 beats per minute (the normal values are between 60 and 100 beats / minute).
The electrical system of the heart
When the heart beats too fast, it is unable to effectively pump blood around the body, resulting in the organs and tissues no longer receiving the necessary amount of oxygen. Symptoms can be: shortness of breath, palpitations, irregular heartbeat, chest discomfort or pain, fainting. Sinus tachycardia is called this because it arises from sino-atrial node. The heart has its own internal electrical system, through which impulses travel. The electrical signal it arises in a group of cells (precisely the sino-atrial node) located in the right atrium, which determines the frequency of the heartbeat. From the sinoatrial node the electrical signal propagates to the rest of the right atrium and to the nearby left atrium, the atria contract and pump blood into the ventricles. The right ventricle sends oxygen-poor blood to the lungs, and the left ventricle sends oxygen-rich blood to the whole body. When something disrupts this impulse transmission system, it can happen that the heart beats too fast (tachycardia), too slowly (bradycardia) or with an irregular rhythm (arrhythmia).
The minimally invasive intervention
Sinus tachycardia can also have rather trivial causes, such as the consumption of caffeine or alcohol, smoking and certain medications. In other cases, it can arise with fever, physical exertion, very intense emotions, states of anxiety or conditions that require a greater supply of oxygen, such as pregnancy. In fact, a greater need for oxygen translates into a greater blood flow, which the body is able to reach by increasing the frequency of the heartbeat. Once the causes are exhausted, the heartbeat also returns to being regular. The 21-year-old treated at the San Raffaele in Milan had been suffering from inappropriate sinus tachycardia for eight years. The syndrome, which affects approx 1% of the population, cause of an incessant and uncontrollable heartbeat even at rest. The innovative hybrid intervention, conducted simultaneously with minimally invasive surgical approach and electrophysiological cardiac mappingwas performed by a multidisciplinary team coordinated by Elisabetta Lapennacardiochirurga dell’Heart Valve Center, e Manuela Cireduelectrophysiologist and cardiologist of the Cardiac Arrhythmology and Electrophysiology Unit, in collaboration with Carlo De Asmundis of the Heart Rhythm Management Center in Brussels and Mark La Meir, head of the Department of Cardiac Surgery of the University Hospital of Brussels.
A disabling syndrome
a very important result that once again highlights how multidisciplinary collaboration can bring continuous innovation, with increasingly precise and personalized treatment strategies for our patients. This minimally invasive hybrid intervention offers a new possibility to cure the 1% of people, mainly young women, who suffer from this disabling syndrome, explain Cireddu and Lapenna. In inappropriate sinus tachycardia (Tsi) the heart rate, at rest, exceeds 100 beats per minute and increases with minimal physical exertion, suddenly and significantly. The disturbance, incessant and uncontrollable, is more frequent in women between 20 and 50 years of age and it can compromise the quality of life, even from a psychological point of view. Tsi is usually treated with pharmacological therapy (beta-blockers, calcium channel blockers or through selective drugs on the function of the sinus node, including ivabradine), aimed at reducing the frequency. In cases resistant to therapy they are performed radiofrequency catheter ablations which, however, do not appear to have effective and lasting benefits.
300 cases treated worldwide
The hybrid surgery performed in Milan represents a new possibility of treatment: it is a procedure developed by the experts in Brussels, with whom the specialists of San Raffaele underwent specific training. To date, around 300 cases have been treated worldwide. The minimally invasive operation, performed under general anesthesia, was possible thanks to the integration and collaboration of the cardiac surgeon and electrophysiologist, who operated simultaneously. Through an access in thoracoscopy a modulation – by application of radiofrequency – of the conduction of the sinoatrial node, where the arrhythmia originates, was performed. However, to identify specific areas where to act, it was necessary simultaneous transcatheter mapping of the right atrium of the heart. This made it possible to identify and treat exclusively the cardiac areas of origin of the arrhythmia, avoiding the complications of traditional surgery. The postoperative course was rapid: the patient was discharged 4 days after the operation and sent for rehabilitation.
October 27, 2022 (change October 27, 2022 | 17:54)
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