title: Empiric slow pathway ablation in non-inducible supraventricular tachycardia.
abstract: BACKGROUND
  The data supporting the practice of empiric slow pathway ablation (ESPA) in patients with documented supraventricular tachycardia (SVT) who are non-inducible at electrophysiology study (EPS) is limited. The aim of this study is to assess the efficacy of ESPA in adults.
  
  
  METHODS
  A multi-center cohort study of patients who had ESPA between January 2008 and October 2013 was performed. Patients were identified by screening sequential SVT ablation procedures.
  
  
  RESULTS
  Forty-three (5%) out of 859 SVT ablation procedures were identified as ESPA. The median age was 53 (IQR: 24) years; 63% were female. All patients had pre-EPS documentation of SVT (either strip or ECG). In 23 (53.5%) cases, pre-EPS ECG showed short RP tachycardia. Thirty-two (74.4%) patients had dual atrioventricular nodal physiology (DAVNP) plus echo beats. Junctional rhythm (JR) as procedural endpoint was noted in 39 (90.7%) patients. In 18 (41.9%) patients, the abolishment of DAVNP was achieved. No complications were encountered. A median follow-up of 17 months (range: 6 to 31 months) revealed 83.7% (36 of 43) success rate, defined as the absence of pre-procedural symptoms and any documented sustained arrhythmia. As compared to patients with recurrence (n=7), patients with no recurrence (n=36) had significantly higher prevalence of clinical short RP tachycardia (61.1% vs. 14.3%, p=0.038), and EPS finding of DAVNP plus echo beats (80.6% vs. 42.9%, p=0.034).
  
  
  CONCLUSIONS
  ESPA is a reasonable approach in patients with documented SVT, in particular in short RP tachycardia, who are not inducible at EPS. Larger studies are required to assess this practice.
authors.affiliation: Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Shurrab
authors.affiliation: Clinical Electrophysiology, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Tamas
authors.initials: T
authors.lastname: Szili-Torok
authors.affiliation: Clinical Electrophysiology, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Ferdi
authors.initials: F
authors.lastname: Akca
authors.affiliation: Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Irving
authors.initials: I
authors.lastname: Tiong
authors.affiliation: Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: Kagal
authors.affiliation: Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Newman
authors.affiliation: Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ilan
authors.initials: I
authors.lastname: Lashevsky
authors.affiliation: Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Onalan
authors.affiliation: Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: Eugene.Crystal@sunnybrook.ca.
authors.forename: Eugene
authors.initials: E
authors.lastname: Crystal
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013617:Tachycardia, Supraventricular / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome
keywords: AVNRT; Electrophysiology; Empiric slow pathway ablation; Outcomes