Key result
Isolated SVT ablation in the 10.1% of AF ablation candidates with inducible SVT was highly effective, with only 7.7% experiencing AF recurrence over 21 months.
Why the study?
Does isolated SVT ablation prevent AF recurrences in patients referred for AF ablation who have inducible SVT?
Observational (n=257)
Does isolated SVT ablation prevent AF recurrences in patients referred for AF ablation who have inducible SVT?
Approximately 10% of patients referred for AF ablation have an underlying inducible SVT, and isolated ablation of this triggering SVT is highly effective in preventing AF recurrences.
May support isolated SVT ablation in AF candidates with inducible SVT; hypothesis-generating and requires randomized confirmation.
AIMS: Supraventricular tachycardia may trigger atrial fibrillation (AF). The aim of the study was to evaluate the prevalence of supraventricular tachycardia (SVT) inducibility in patients referred for AF ablation and to evaluate the effects of SVT ablation on AF recurrences. METHODS AND RESULTS: Two hundred and fifty-seven patients (185 males; mean age: 53.4 ± 14.6 years) referred for AF ablation were studied. In all patients only AF relapses had been documented in the clinical history. Twenty-six patients (10.1%; mean age: 43.4 ± 13.3 years; 17 males) had inducible SVT during electrophysiological study and underwent an ablation targeted only at SVT suppression. Ablation was successful in all 26 patients. The ablative procedures are: 12 slow-pathway ablations for atrioventricular nodal re-entrant tachycardia; 9 concealed accessory pathway ablations for atrioventricular re-entrant tachycardia; and 5 focal ectopic atrial tachycardia ablations. No recurrences of SVT were observed during the follow-up (21 ± 11 months). Two patients (7.7%) showed recurrence of at least one episode of AF. Patients with inducible SVT had less structural heart disease and were younger than those without inducible SVT (interventricular septum thickness: 8.4 ± 1.6 vs. 11.0 ± 1.4 mm, P < 0.01; left atrial diameter: 37.0 ± 3.0 vs. 44.0 ± 2.2 mm, P < 0.01; age: 43.4 ± 13.3 vs. 57.3 ± 11.2 years, P < 0.01). Prevalence of paroxysmal AF was higher in patients with inducible SVT when compared with those with only AF (84.6 vs. 24.6%, P < 0.01). CONCLUSION: A significant proportion of candidates to AF ablation are inducible for a SVT. SVT ablation showed a preventive effect on AF recurrences. Those patients should be selected for simpler ablation procedures tailored only on the triggering arrhythmia suppression.
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Sciarra et al. (2010) conducted an observational in Atrial fibrillation (n=257). Isolated SVT ablation was evaluated on Atrial fibrillation recurrences. Isolated SVT ablation in the 10.1% of AF ablation candidates with inducible SVT was highly effective, with only 7.7% experiencing AF recurrence over 21 months.
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