Symptom burden guiding invasive electrophysiological study in paroxysmal supraventricular tachycardia: The believe SVT registry

Abstract

Background and objectivePatients with palpitations clinically suggestive of paroxysmal supraventricular tachycardia (PSVT) are often managed conservatively until ECG-documentation of the tachycardia, leading to high impact on life quality and healthcare resource utilisation. We evaluated results of electrophysiological study (EPS), and ablation when appropriate, among these patients, with special focus on gender differences in management. MethodsBELIEVE SVT is a European multi-centre, retrospective registry in tertiary hospitals performing EPS in patients with palpitations, without ECG-documentation of tachycardia or preexcitation, and considered highly suggestive of PSVT by a cardiologist or cardiac electrophysiologist. We analysed clinical characteristics, results of EPS and ablation, complications, and clinical outcomes during follow-up. Results680 patients from 20 centres were included. EPS showed sustained tachycardia in 60.9% of patients, and substrate potentially enabling AVNRT in 14.7%. No major/permanent complications occurred. Minor/transient complications were reported in 0.84% of patients undergoing diagnostic-only EPS and 1.8% when followed by ablation. During a 3.4-year follow-up, 76.2% of patients remained free of palpitations recurrence. Ablation (OR: 0.34, p<0.01) and male gender (OR: 0.58, p=0.01) predicted no recurrence. Despite a higher female proportion among patients with recurrence, (77.2% vs. 63.5% among those asymptomatic during follow-up, p<0.01), 73% of women in this study reported no recurrence of palpitations after EPS. ConclusionsEPS and ablation are safe and effective in preventing recurrence of non-documented palpitations clinically suggestive of PSVT. Despite a lower efficacy, this strategy is also highly effective among women and warrants no gender differences in management.