title: How many atrial fibrillation ablation candidates have an underlying supraventricular tachycardia previously unknown? Efficacy of isolated triggering arrhythmia ablation.
abstract: OBJECTIVE
  Supraventricular tachycardia may trigger atrial fibrillation (AF). The aim of the study was to evaluate the prevalence of supraventricular tachycardia (SVT) inducibility in patients referred for AF ablation and to evaluate the effects of SVT ablation on AF recurrences.
  
  
  RESULTS
  Two hundred and fifty-seven patients (185 males; mean age: 53.4 ± 14.6 years) referred for AF ablation were studied. In all patients only AF relapses had been documented in the clinical history. Twenty-six patients (10.1%; mean age: 43.4 ± 13.3 years; 17 males) had inducible SVT during electrophysiological study and underwent an ablation targeted only at SVT suppression. Ablation was successful in all 26 patients. The ablative procedures are: 12 slow-pathway ablations for atrioventricular nodal re-entrant tachycardia; 9 concealed accessory pathway ablations for atrioventricular re-entrant tachycardia; and 5 focal ectopic atrial tachycardia ablations. No recurrences of SVT were observed during the follow-up (21 ± 11 months). Two patients (7.7%) showed recurrence of at least one episode of AF. Patients with inducible SVT had less structural heart disease and were younger than those without inducible SVT (interventricular septum thickness: 8.4 ± 1.6 vs. 11.0 ± 1.4 mm, P < 0.01; left atrial diameter: 37.0 ± 3.0 vs. 44.0 ± 2.2 mm, P < 0.01; age: 43.4 ± 13.3 vs. 57.3 ± 11.2 years, P < 0.01). Prevalence of paroxysmal AF was higher in patients with inducible SVT when compared with those with only AF (84.6 vs. 24.6%, P < 0.01).
  
  
  CONCLUSIONS
  A significant proportion of candidates to AF ablation are inducible for a SVT. SVT ablation showed a preventive effect on AF recurrences. Those patients should be selected for simpler ablation procedures tailored only on the triggering arrhythmia suppression.
authors.affiliation: Cardiology Department, Via Montaione 20 00139, Policlinico Casilino, Rome, Italy. lui.sciarra@libero.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Sciarra
authors.forename: Marco
authors.initials: M
authors.lastname: Rebecchi
authors.forename: Ermenegildo
authors.initials: E
authors.lastname: De Ruvo
authors.forename: Lucia
authors.initials: L
authors.lastname: De Luca
authors.forename: Lorenzo Maria
authors.initials: LM
authors.lastname: Zuccaro
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fagagnini
authors.forename: Leonardo
authors.initials: L
authors.lastname: Corò
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Allocca
authors.forename: Ernesto
authors.initials: E
authors.lastname: Lioy
authors.forename: Pietro
authors.initials: P
authors.lastname: Delise
authors.forename: Leonardo
authors.initials: L
authors.lastname: Calò
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology* / Q000517:prevention & control*; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D055502:Secondary Prevention; D013617:Tachycardia, Supraventricular / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome