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Aktuelle Kardiologie 2015; 4(2): 92-97
DOI: 10.1055/s-0035-1545886
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Inadäquate Sinustachykardie (IST) und posturales orthostatisches Tachykardiesyndrom (POTS) – muss man das behandeln?

Inappropriate Sinus Tachycardia and Postural Orthostatic Tachycardia Syndrome: is there a Need to Treat?
T. Klingenheben
1   Praxis für Kardiologie/Ambulante Herzkatheterkooperation Bonn, Bonn
,
P. Ptaszynski
2   Department of Electrocardiology, Medical University, Lodz, Polen
› Author Affiliations
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Publication History

Publication Date:
14 April 2015 (online)

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Zusammenfassung

Die inadäquate Sinustachykardie ist ein Syndrom, das durch eine exzessiv erhöhte Ruheherzfrequenz (HF) bzw. einen überschießenden HF-Anstieg unter Belastung charakterisiert ist. Die Behandlung mit den gängigen frequenzsenkenden Substanzen – namentlich β-Blocker oder Kalzium-Kanalblocker – ist bei diesen Patienten oft ineffektiv oder wird nicht toleriert. Im Gegensatz hierzu ist beim lageabhängigen (posturalen) orthostatischen Tachykardiesyndrom (POTS) die HF in Ruhe meist noch normal, jedoch bereits bei geringem Lagewechsel, z. B. beim Sitzen oder im Stehen, kommt es zu einem exzessiven Anstieg der HF. Ursächlich ist hier eine orthostatische Intoleranz und eine Exazerbation in eine klassische vasovagale/neurokardiogene Synkope ist möglich. In der vorliegenden Übersicht werden diese Syndrome charakterisiert und Möglichkeiten der Behandlung bei hochsymptomatischen Patienten diskutiert.

Abstract

Inappropriate sinus tachycardia (IST) is a clinical syndrome characterized by excessive resting heart rate (HR) or disproportional increasing HR during exercise. Beta-blocker or calcium channel blocker therapy is often non-effective or not well tolerated. Another clinical entity with inadequate sinus tachycardia is the postural orthostatic tachycardia syndrome (POTS). In these patients, HR at rest can be normal, but shows excessive increase secondary to postural changes. There is an overlap with syndromes of orthostatic intolerance and “degeneration” into typical neurocardiogenic syncope may occur. In this review, we summarize clinical features of both syndromes and discuss potential treatment strategies in highly symptomatic patients.

Schlüsselwörter

inadäquate Sinustachykardie - POTS - β-Blocker - Ivabradin

Key words

inappropriate sinus tachycardia - POTS - β blockers - ivabradine
 

  • Literatur

  • 1 Olshansky B, Sullivan RM. Inappropriate sinus tachycardia. J Am Coll Cardiol 2013; 61: 793-801
    CrossrefPubMedGoogle Scholar
  • 2 Marcus B, Gilette PC, Garson A. Intrinsic heart rate in children and young adults: An index of sinus node function isolated from autonomic control. Am Heart J 1990; 119: 911-916
    CrossrefPubMedGoogle Scholar
  • 3 Femenía F, Baranchuk A, Morillo CA. Inappropriate sinus tachycardia: current therapeutic options. Cardiol Rev 2012; 20: 8-14
    CrossrefPubMedGoogle Scholar
  • 4 Still AM, Raatikainen P, Ylitalo A et al. Prevalence, characteristics and natural course of inappropriate sinus tachycardia. Europace 2005; 7: 104-112
    PubMedGoogle Scholar
  • 5 Morillo CA, Klein GJ, Thakur RK et al.. Mechanism of ‘inappropriate sinus tachycardia. Role of sympathovagal balance. Circulation 1994; 90: 873-877
    CrossrefPubMedGoogle Scholar
  • 6 Leon H, Guzman J, Kuusela T et al. Impaired baroreflex gain in patients with inappropriate sinus tachycardia. J Cardiovasc Electrophysiol 2005; 16: 64-68
    CrossrefPubMedGoogle Scholar
  • 7 Grubb BP, Klingenheben T. Posturales orthostatisches Tachykardie-Syndrom (POTS): Ätiologie, Diagnose, und Therapie. Med Klin 2000; 95: 442-446
    CrossrefPubMedGoogle Scholar
  • 8 Grubb BP, Klingenheben T. Syndrome der autonomen Dysfunktion mit orthostatischer Intoleranz: Klassifikation, Diagnostik und Therapie. Z Kardiol 1999; 88: 541-549
    CrossrefPubMedGoogle Scholar
  • 9 Kanjwal Y, Kosinski D, Grubb BP. The postural orthostatic tachycardia syndrome: definitions, diagnosis, and management. Pacing Clin Eletrophysiol 2003; 26: 1747-1757
    PubMedGoogle Scholar
  • 10 Ptaszynski P, Kaczmarek K, Klingenheben T et al. Noninvasive assessment of autonomic cardiovascular activity in patients with inappropriate sinus tachycardia. Am J Cardiol 2013; 112: 811-815
    CrossrefPubMedGoogle Scholar
  • 11 Nwazue VC, Pranjape SY, Black BK et al. Postural tachycardia syndrome and inappropriate sinus tachycardia: role of autonomic modulation and sinus node automaticity. J Am Heart Assoc 2014; 3: e000700
    CrossrefPubMedGoogle Scholar
  • 12 Benarroch EE. Postural tachycardia syndrome: a heterogenous and multifactorial disorder. Mayo Clin Proc 2012; 87: 1214-1225
    CrossrefPubMedGoogle Scholar
  • 13 Carew S, Sonnor MO, Cooke J et al. A review of postural orthostatic tachycardia syndrome. Europace 2009; 11: 18-25
    PubMedGoogle Scholar
  • 14 Jacob G, Costa F, Shannon JR et al. The neuropathic postural tachycardia syndrome. N Engl J Med 2000; 343: 1008-1014
    CrossrefPubMedGoogle Scholar
  • 15 Schondorf W, Low PA. Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pan-dysautonomia?. Neurology 1993; 43: 132-137
    CrossrefPubMedGoogle Scholar
  • 16 Li H, Yu X, Liles C et al. Autoimmune basis for postural tachycardia syndrome. J Am Heart Assoc 2014; 3: e000755
    CrossrefPubMedGoogle Scholar
  • 17 Vernino S, Low PA, Fealey RD et al. Autoantibodies to ganglionic acetylcholine receptors in autoimmune autonomic neuropathies. N Engl J Med 2000; 343: 847-855
    CrossrefPubMedGoogle Scholar
  • 18 Shannon JR, Flattem NL, Jordan J et al. Orthostatic intolerance and tachycardia associated with norepinephrine-transporter deficiency. N Engl J Med 2000; 342: 541-549
    CrossrefPubMedGoogle Scholar
  • 19 Haensch CA, Lerch H, Schlemmer H et al. Cardiac neurotransmission imaging with 123I-meta-idobenzylguanidine in postural tachycardia syndrome. J Neurol Neurosurg Psych 2010; 81: 339-343
    CrossrefPubMedGoogle Scholar
  • 20 Marrouche N, Beheiry S, Tomassoni G et al. Three-dimensional nonfluoroscopic mapping and ablation of inappropriate sinus tachycardia. Procedural strategies and long-term outcome. J Am Coll Cardiol 2002; 39: 1046-1054
    CrossrefPubMedGoogle Scholar
  • 21 Vatasescu R, Shalganov T, Kardos A et al. Right diaphragmatic paralysis following endocardial cryothermal ablation of inappropriate sinus tachycardia. Europace 2006; 8: 904-906
    CrossrefPubMedGoogle Scholar
  • 22 Jacobson JT, Kraus A, Lee R et al. Epicardial/endocardial sinus node ablation after failed endocardial ablation for the treatment of inappropriate sinus tachycardia. J Cardiovasc Electrophysiol 2014; 25: 236-241
    CrossrefPubMedGoogle Scholar
  • 23 Calò L, Rebecchi M, Sette A et al. Efficacy of ivabradine administration in patients affected by inappropriate sinus tachycardia. Heart Rhythm 2010; 7: 1318-1323
    CrossrefPubMedGoogle Scholar
  • 24 Zellerhoff S, Hinterseer M, Felix Krull B et al. Ivabradine in patients with inappropriate sinus tachycardia. Naunyn Schmiedebergs Arch Pharmacol 2010; 382: 483-486
    CrossrefPubMedGoogle Scholar
  • 25 Ptaszynski P, Kaczmarek K, Ruta J et al. Ivabradine in combination with metoprolol succinate in the treatment of inappropriate sinus tachycardia. J Cardiovasc Pharmacol Ther 2013; 18: 338-344
    CrossrefPubMedGoogle Scholar
  • 26 Ptaszynski P, Kaczmarek K, Ruta J et al. Metoprolol succinate vs. ivabradine in the treatment of inappropriate sinus tachycardia in patients unresponsive to previous pharmacological therapy. Europace 2013; 15: 116-121
    CrossrefPubMedGoogle Scholar
  • 27 Thieben MJ, Sandroni P, Sletten DM et al. Postural orthostatic tachycardia syndrome: the Mayo clinic experience. Mayo Clin Proc 2007; 82: 308-313
    CrossrefPubMedGoogle Scholar
  • 28 McDonald C, Frith J, Newton JL. Single centre experience of ivabradine in postural orthostatic tachycardia syndrome. Europace 2011; 13: 427-430
    CrossrefPubMedGoogle Scholar
  • 29 Ross AJ, Ocon AJ, Medow MS et al. A double-blind placebo-controlled cross-over study of the vascular effects of midodrine in neuropathic compared with hyperadrenergic postural tachycardia syndrome. Clin Sci (Lond) 2014; 126: 289-296
    CrossrefPubMedGoogle Scholar
  • 30 Zhang Q, Chen X, Li J et al. Orthostatic plasma norepinephrine level as a predictor for therapeutic response to metoprolol in children with postural tachycardia syndrome. J Transl Med 2014; 12: 249-254
    CrossrefPubMedGoogle Scholar
  • 31 Kirchhof P, Auricchio A, Bax J et al. Outcome parameters for trials in atrial fibrillation: executive summary. Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eur Heart J 2007; 28: 2803-2817
    CrossrefPubMedGoogle Scholar
  • 32 Klingenheben T. [Autonomic dysfunction and orthostatic intolerance]. Internist 2002; 43: 1055-1060
    CrossrefPubMedGoogle Scholar