Twenty‐Five Years of Insights into the Mechanisms of Supraventricular Arrhythmias

The introduction of programmed electrical stimulation of the heart and intracardiac activation mapping 35 years ago made it possible to study the site of origin or the pathway of a supraventricular tachycardia and to obtain insight into the mechanism of the tachycardia. Information from these studies has been the basis for the development of new therapies, such as arrhythmia surgery, antitachycardia pacing, and catheter ablation. Correlation of intracardiac findings with the 12-lead ECG recorded during the tachycardia resulted in the recognition of ECG patterns characteristic of the different types of supraventricular tachycardias. Currently, gross localization of the site of origin of the arrhythmia is based on the 12-lead ECG recorded during the arrhythmia, with fine-tuning using intracardiac activation mapping and pacing. These developments during the past 3 decades have made accurate arrhythmia diagnosis possible and allow us to offer curative therapies to many of our patients with a supraventricular tachycardia.