Inappropriate sinus tachycardia (IST) and postural orthostatic tachycardia syndrome (POTS) are complex autonomic tone disorders that affect predominantly young women, often leading to debilitating symptoms such as palpitations, fatigue, and exercise intolerance. Despite pharmacologic and conservative therapy, many patients remain symptomatic. Sinus node-sparing (SNS) hybrid ablation represents a novel strategy combining thoracoscopic epicardial ablation and endocardial 3D mapping. This approach is designed to selectively interrupt arrhythmogenic conduction pathways while preserving sinus node integrity. This article reviews our institutional protocol and first experience at PIM MSWiA, discusses underlying mechanisms, mapping tools, and outlines results from international studies including the HEAL-IST trial and SUSRUTA-IST registry. Hybrid SNS ablation appears to be a promising solution for refractory IST and POTS, meriting consideration among referring physicians and multidisciplinary teams.