Pericarditis prophylactic therapy after sinus node-sparing hybrid ablation for inappropriate sinus tachycardia/postural orthostatic sinus tachycardia

Carlo de Asmundis; Lorenzo Marcon; Luigi Pannone; Domenico Giovanni Della Rocca; Dhanunjaya Lakkireddy; Thomas M Beaver; Chad R Brodt; Cinzia Monaco; Antonio Sorgente; Charles Audiat; Giampaolo Vetta; Robbert Ramak; Ingrid Overeinder; Rani Kronenberger; Gezim Bala; Alexandre Almorad; Erwin Ströker; Juan Sieira; Andrea Sarkozy; Pedro Brugada; Gian Battista Chierchia; Mark La Meir

doi:10.1016/j.hroo.2024.01.001

Pericarditis prophylactic therapy after sinus node-sparing hybrid ablation for inappropriate sinus tachycardia/postural orthostatic sinus tachycardia

Heart Rhythm O2. 2024 Jan 10;5(2):137-144. doi: 10.1016/j.hroo.2024.01.001. eCollection 2024 Feb.

Authors

Carlo de Asmundis¹, Lorenzo Marcon¹, Luigi Pannone¹, Domenico Giovanni Della Rocca¹, Dhanunjaya Lakkireddy², Thomas M Beaver³, Chad R Brodt⁴, Cinzia Monaco¹, Antonio Sorgente¹, Charles Audiat¹, Giampaolo Vetta¹, Robbert Ramak¹, Ingrid Overeinder¹, Rani Kronenberger⁵, Gezim Bala¹, Alexandre Almorad¹, Erwin Ströker¹, Juan Sieira¹, Andrea Sarkozy¹, Pedro Brugada¹, Gian Battista Chierchia¹, Mark La Meir⁵

Affiliations

¹ Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
² Kansas City Heart Rhythm Institute, Overland Park, Kansas.
³ Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
⁴ Sequoia Hospital, Palo Alto, California.
⁵ Cardiac Surgery Department, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium.

Abstract

Background: Pericarditis is the most common complication following hybrid sinus node-sparing ablation for inappropriate sinus tachycardia (IST)/postural orthostatic tachycardia syndrome (POTS).

Objective: The study sought to evaluate the association of prophylaxis therapy on the risk of symptomatic pericarditis following hybrid IST/POTS ablation.

Methods: All consecutive patients undergoing to hybrid ablation of symptomatic IST/POTS refractory or intolerant to drugs were retrospectively analyzed. Pharmacological prophylaxis therapy was based on acetylsalicylic acid and colchicine started on the day of the ablation and continued for at least 3 months. The primary endpoint was occurrence of symptomatic pericarditis. The secondary endpoint was occurrence of pericarditis-related complications, including the following: duration of pericarditis >3 months, hospitalization for pericarditis, postpericardiectomy pleuro-pericarditis, and pericardiectomy.

Results: A total of 220 patients undergone to hybrid IST/POTS ablation were included and 44 (20%) underwent prophylaxis therapy. Pericarditis occurred in 101 (45.9%) patients, with 97 (96%) in the first 5 days. At survival analysis, prophylaxis was associated with higher rate of freedom from pericarditis (81.9% vs 47.2%, log-rank P < .001). Pericarditis-related complications were low, occurring in 7 (3.2%) patients. There was no difference in pericarditis-related complications between the patients who underwent prophylaxis therapy and patients who did not. At Cox multivariate analysis, predictors of pericarditis were IST (vs POTS) (hazard ratio 0.61, 95% confidence interval0.39-0.99, P = .04) and prophylaxis therapy (hazard ratio 0.27, 95% confidence interval 0.13-0.55, P < .001).

Conclusion: In a large cohort of patients undergoing hybrid ablation for IST/POTS, a prophylaxis therapy with acetylsalicylic acid and colchicine was associated with a lower rate of symptomatic pericarditis.

Keywords: Hybrid ablation; Inappropriate sinus node tachycardia; Pericarditis; Postural orthostatic sinus tachycardia; Sinus node.