INTRODUCTION: Inappropriate sinus tachycardia (IST) is a common condition with frequently not tolerated beta-blockers or ivabradine and a high rate of complication in ablation strategy; we describe an alternative anatomical approach of sinus node modulation. METHODOLOGY: This retrospective study describes a case series of 6 patients from two centers diagnosed with symptomatic IST undergoing sinus node ablation. RESULTS: The mean age was 40.6 ± 13.9 years; five of the six patients were female, 100% of patients reported heart palpitations, and 66% reported dizziness, the average HR on a 24-h Holter was 93.2 ±7.9 bpm. HR during the first stage of a stress test using a standard Bruce protocol was 150 ±70 bpm, The average HR on 24-hour Holter post-ablation was 75 ± 5.6 bpm, the sinus rate HR during stage 1 of a Bruce protocol exercise stress test was 120 ± 10 bpm. CONCLUSION: This is the first case series reporting the acute and long-term results of a novel anatomical approach for SNM to treat IST targeting the AR under ICE guidance, The novel anatomic ICE-guided catheter ablation approach aimed to identify the earliest activation at the AR with an extension of RF lesions towards its septal region seems effective and safe to modulate the SN in symptomatic patients with IST refractory to medical treatment.