Pulsed-field ablation of the sinus node for treatment of drug-refractory inappropriate sinus tachycardia

Sinus node (SN) ablation has traditionally been limited to patients with drug-refractory inappropriate sinus tachycardia (IST). Success of radiofrequency catheter ablation has been limited due to variable acute success, predominant epicardial location of the SN, proximity of the phrenic nerve to the SN, and high recurrence rates (1). To overcome these limitations, a combination of epicardial and endocardial approaches have been performed (2,3). However, this hybrid approach increases procedure complexity and increases likelihood of acute complications due to the addition of epicardial access (2-4).