Sinoatrial Nodal Reentrant Tachycardia When Vagal Maneuvers and Adenosine Triphosphate Have Not Terminated the Arrhythmia

Sinoatrial nodal reentrant tachycardia (SANRT) involves a reentry circuit at the sinoatrial node. When acute termination with first-line measures is unsuccessful, a defined next-line procedural protocol is indicated to achieve termination of the tachycardia.

Why This Protocol — Previous Line Failure

The initial approach — acute termination with vagal maneuvers or intravenous administration of adenosine triphosphate — did not achieve its goal of terminating the sinoatrial node reentrant tachycardia. This protocol defines the next step taken after that failure.

Next-Line Approach

The next-line protocol involves a targeted catheter-based energy delivery procedure directed at a specific anatomical site within the reentry circuit responsible for maintaining the tachycardia.

The full procedural algorithm — including the precise anatomical target, energy delivery strategy, and decision points — is available in the complete structured regimen.

Clinical Goal

Immediate termination of the sinoatrial node reentrant tachycardia after onset of energy delivery, with no reinduction of the tachycardia confirmed on subsequent testing.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1161/JAHA.119.014472

A current of 15 to 20 W was delivered initially for 10 seconds with the temperature limit set to 55°C using a radiofrequency energy generator (CABL-IT; Central Inc., Ichikawa, Chiba).

When the SANRT was not terminated within 10 seconds, the energy application site was advanced in a step-wise fashion by 2 to 3 mm toward the EAAS under the guidance of the EnSite anatomical map, until the tachycardia terminated in order to identify the entrance of the I-SANC of the reentry circuit.

If the SANRT terminated within 10 seconds after onset of energy delivery, then we continued the energy delivery up to 30 to 60 seconds at that site.

A radiofrequency energy application to the entrance of the I-SANC, which was identified under navigation with entrainment, can eliminate the SANRT.

The SANRT was terminated immediately after onset of radiofrequency energy delivery (3.4±2.3 seconds; Table).

After termination of the tachycardia by the initial successful ablation, a reinduction of the tachycardia was attempted, but no reinduction of SANRT was observed in any of the patients.

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