Key questions are helpful to prevent an unnecessary pulmonary veins isolation ablation procedure: reply

We thank Dr Wiesfeld for his interest in our study. We do agree with his view that meticulous evaluation is mandatory before subjecting a patient to a cumbersome procedure such as pulmonary vein isolation, and we do hope this message was clear in our report. 1 Dr Wiesfeld also advocates the use of detailed medical history for the identification of patients who are most likely to benefit from a standard ablation procedure aimed at the source of supraventricular tachycardia (SVT) other than atrial fibrillation (AF). We shall be the last ones to even question the value of medical history and thorough clinical examination in every patient who is being investigated for arrhythmia. However, the identification of these patients before a diagnostic electrophysiology study is of rather limited clinical importance. Electrophysiology testing may be necessary for the establishment of diagnosis, and, for most case of SVT, there is now substantial evidence that catheter ablation is preferable to medical therapy by means of future arrhythmia episodes and quality of life. 2–4 Thus, a diagnostic electrophysiology procedure followed by catheter ablation is the usual scenario in this setting. In any case, ablation of the pulmonary veins should be deferred, although in certain patients AF may recur despite elimination of the underlying arrhythmia. 1