title: Diagnosis and management of phantom tachycardias based on an electrophysiologically guided approach.
abstract: BACKGROUND
  Non-documented palpitations, or phantom tachycardias, are palpitations deemed to be of unknown origin after evaluation with conventional diagnostic tools, such as 12-lead electrocardiogram and Holter recordings. Our aim was to determine the diagnostic value of an electrophysiologic study (EPS) and its role in the management of patients presenting with non-documented palpitations.
  
  
  METHODS
  We performed EPS in 78 consecutive patients with repeatable, poorly tolerated symptoms of paroxysmal, non-documented tachycardia, the absence of structural heart disease and at least one 24-h Holter recording. The duration and frequency of palpitations was registered in each patient.
  
  
  RESULTS
  Long-lasting palpitations (>1 hour) were present in 15.4% of patients. Half of patients reported symptoms less often than once per week. Only 13/78 patients (16.6%) had normal EPS findings, while dual pathways at the AV node ± echo beats were identified in another 13 patients without inducible tachycardia. At least one tachycardia event was induced in 52 patients (66.6%). AVNRT was provoked in 32 patients (41.2%). Ablation was performed in 14/52 patients with inducible tachycardia (26.9%). Slow pathway ablation was also performed in three patients with dual AV pathways and atrial echo-beats but without provoked tachycardia. Follow-up data were available in 52 patients, and 84.6% had fewer or no clinical recurrences.
  
  
  CONCLUSIONS
  EPS is safe and of enhanced diagnostic value in patients with unexplained palpitations because only 1/6 had negative results. EPS also provided an explanation about the mechanism of arrhythmia and successfully guided the management of these patients, as well as enhanced improvement in the quality of life.
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece; Athens Heart Center, Athens Medical Center, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tsiachris
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Iosif
authors.initials: I
authors.lastname: Koutagiar
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece. Electronic address: kgatzoul@med.uoa.gr.
authors.forename: Konstantinos A
authors.initials: KA
authors.lastname: Gatzoulis
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Arsenos
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Aggeliki
authors.initials: A
authors.lastname: Rigatou
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Polychronis
authors.initials: P
authors.lastname: Dilaveris
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Skevos
authors.initials: S
authors.lastname: Sideris
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Achilleas
authors.initials: A
authors.lastname: Papadopoulos
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Alekos
authors.initials: A
authors.lastname: Kritikos
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece; Athens Heart Center, Athens Medical Center, Athens, Greece.
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tousoulis
mesh_terms: D000328:Adult; D019468:Disease Management; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013610:Tachycardia / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*
keywords: ablation; electrophysiology; palpitations; tachycardia