title: Approaches to empiric ablation of slow pathway: results from the Canadian EP web survey.
abstract: OBJECTIVE
  Dual atrioventricular nodal physiology (DAVNP) is a frequent finding in patients with suspected or documented supraventricular tachycardia (SVT). Empiric slow pathway ablation (ESPA) is sometimes performed in patients with DAVNP without inducible SVT at the time of electrophysiological study. Evidence to guide this practice in the adult population is limited. This study was aimed to assess the practice of ESPA by adult electrophysiologists in Canada.
  
  
  METHODS
  All Canadian interventional electrophysiologists (n = 81) were invited to complete a web-based questionnaire assessing their practice of ESPA in patients with suspected and documented SVT. Operator experience, reimbursement models, diagnostic, and treatment decisions regarding ESPA were assessed with case scenarios.
  
  
  RESULTS
  Forty-one responses (50 %) were obtained. Ninety-five percent of the responders stated that the evidence for ESPA is lacking or limited. Responders were more likely to perform ESPA in the setting of non-inducible SVT when there was documentation of the clinical arrhythmia (64 vs. 31 % (p = 0.017)). The threshold to perform ESPA was highly variable. Longer time in practice (r = 0.38, p = 0.017) and less perceived complications with ESPA (r = 0.31, p = 0.05) were correlated with the practice of ESPA, whereas length of ablation waiting lists (r = -0.15, p = 0.38), number of procedures performed per day (r = 0.11, p = 0.51) and type of reimbursement (p = 0.24) were not associated with the practice of ESPA. The perceived complication rate with ESPA was <1 %.
  
  
  CONCLUSIONS
  Variability in the practice of ESPA in cases of non-inducible SVT exists. Documentation of the clinical arrhythmia, operator experience, and perceived low complication rates positively influence this practice.
authors: Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite D-377, Toronto, ON, M4N 3M5, Canada.
authors: Avishag
authors: A
authors: Laish-Farkash
authors: Mohammed
authors: M
authors: Shurrab
authors: Sheldon
authors: S
authors: Singh
authors: Irving
authors: I
authors: Tiong
authors: Atul
authors: A
authors: Verma
authors: Guy
authors: G
authors: Amit
authors: Alex
authors: A
authors: Kiss
authors: Florence
authors: F
authors: Morriello
authors: David
authors: D
authors: Birnie
authors: Jeff
authors: J
authors: Healey
authors: Ilan
authors: I
authors: Lashevsky
authors: David
authors: D
authors: Newman
authors: Eugene
authors: E
authors: Crystal
mesh_terms: D000328:Adult; D002170:Canada; D017115:Catheter Ablation / Q000379:methods; D016009:Chi-Square Distribution; D006801:Humans; D020407:Internet; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000601:surgery*; D013617:Tachycardia, Supraventricular / Q000601:surgery*