title: Electrophysiological study generally is negative in patients <40 years suspected of supraventricular tachycardia but also complaining of chest pain and/or syncope.
abstract: BACKGROUND
  The diagnosis of paroxysmal supraventricular tachycardia (SVT) frequently is a dilemma. Electrophysiological study (EPS) is the only means to evaluate the nature of symptoms when noninvasive studies remain negative. Our objectives were to determine the clinical factors of negativity or positivity of (EPS) in patients suspected of SVT.
  
  
  METHODS
  EPS was performed in 2650 patients complaining of tachycardia and suspected of SVT. Transesophageal EPS consisted of programmed atrial stimulation in control state and after isoproterenol. Patients were followed from 1 month to 18 years (2.93 ± 4 years).
  
  
  RESULTS
  SVT was induced in 1944 patients, age 48 ± 19.5. EPS remained negative in 706 patients, age 34 ± 17 (p<0.0001). Age <40 years, feeling of dizziness/syncope or chest pain associated with tachycardia, the absence of heart disease or short PR interval was more frequent in patients with negative EPS (respectively 64, 42, 26, 96, 88.5%) than in patients with induced SVT (34, 14, 4, 88, 59%) (p<0.0001).The positive predictive value for the prediction of a negative EPS of age <40, chest pain, syncope or their association was 63.5, 42, 26.5, 11% and negative predictive value was 66, 86, 94.5, 99.5%. At multivariate analysis, age <40 (0.000, OR 2.79), the presence of syncope associated with tachycardia (0.000, OR 5.075) or chest pain (0.000, OR 17.923) was an independent factor of negative EPS.
  
  
  CONCLUSIONS
  Among patients complaining of nondocumented tachycardia, suspected of SVT, the association of tachycardia with chest pain and/or syncope and age <40 years generally was correlated with a negative EPS and did not indicate initially invasive studies. In the remaining patients transesophageal EPS is indicated.
authors.affiliation: Cardiology, CHU of Brabois, France. Electronic address: b.brembilla-perrot@chu-nancy.fr.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Brembilla-Perrot
authors.affiliation: Cardiology, CHU of Brabois, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Sellal
authors.affiliation: Cardiology, CHU of Brabois, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Olivier
authors.affiliation: Cardiology, CHU of Brabois, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Villemin
authors.affiliation: Cardiology, CHU of Brabois, France.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Manenti
authors.affiliation: Epidemiology, CHU of Besançon, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Brembilla
authors.affiliation: Cardiology, CHU of Brabois, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rizk
authors.affiliation: Cardiology, CHU of Brabois, France.
authors.forename: Christian De
authors.initials: CD
authors.lastname: Chillou
authors.affiliation: Paediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Moulin-Zinsch
authors.affiliation: Paediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: François
authors.initials: F
authors.lastname: Marçon
authors.affiliation: INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, Institut Lorrain du cœur et des vaisseaux, CHU de Nancy, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
mesh_terms: D000318:Adrenergic beta-Agonists / Q000494:pharmacology; D000328:Adult; D000367:Age Factors; D002637:Chest Pain / Q000175:diagnosis / Q000503:physiopathology*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007545:Isoproterenol / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013575:Syncope / Q000175:diagnosis / Q000503:physiopathology*; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000503:physiopathology*
chemical_list: D000318:Adrenergic beta-Agonists; D007545:Isoproterenol
keywords: Chest pain; Electrophysiological study; Syncope; Tachycardia