From the Guidelines
Yes, supraventricular tachycardia (SVT) with a heart rate of 241 beats per minute is indicated for electrophysiological study (EPS) and therapeutic ablation. This approach is recommended for patients with SVT who have recurrent symptomatic episodes, especially with such a rapid heart rate that can cause significant symptoms and potential hemodynamic compromise. The procedure involves mapping the electrical pathways of the heart to identify the abnormal circuit or focus causing the tachycardia, followed by targeted ablation of this area using radiofrequency energy or cryotherapy.
According to the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1, electrophysiological (EP) study with the option of ablation is useful for the diagnosis and potential treatment of SVT. This is a Class I recommendation, indicating that the benefits of the procedure outweigh the risks. The guideline suggests that EPS and ablation can be considered for patients with symptomatic SVT who do not have ventricular pre-excitation during sinus rhythm.
The benefits of EPS and ablation for SVT include:
- High success rates, exceeding 95% for most SVT mechanisms
- Low complication rate, approximately 1-2%
- Ability to avoid lifelong medication
- Improvement in quality of life, as demonstrated by studies showing that symptomatic patients experience significant improvements in quality of life after catheter ablation 1
Before proceeding to EPS and ablation, patients typically undergo a trial of medical therapy with agents such as beta-blockers, calcium channel blockers, or antiarrhythmic drugs. However, catheter ablation offers a definitive cure and can be considered as first-line therapy for certain patients, such as those with Wolff-Parkinson-White syndrome or AV nodal reentrant tachycardia. Patients should be instructed to fast for 6-8 hours before the procedure and should discuss any blood thinners they're taking with their electrophysiologist, as these may need to be adjusted before the procedure.
From the Research
Indications for Electrophysiological Study and Therapeutic Ablation
- Supraventricular tachycardia (SVT) is a common cardiac rhythm disturbance that can cause significant symptoms and impact quality of life 2, 3, 4, 5, 6
- Electrophysiological study is considered the "gold standard" investigation for diagnosis of SVT and is essential for choosing therapeutic options 2
- Catheter ablation is a low-risk procedure with a high success rate and is recommended as the first-line method for long-term management of recurrent, symptomatic paroxysmal SVT 3, 4, 5, 6
- Patients with SVT should be referred for a heart rhythm specialist opinion, and long-term treatment is dependent on several factors including frequency of symptoms, risk stratification, and patient preference 4, 6
Diagnostic Evaluation and Management
- Diagnostic evaluation of SVT includes a comprehensive history and physical examination, electrocardiography, and laboratory workup 5, 6
- Extended cardiac monitoring with a Holter monitor or event recorder may be needed to confirm the diagnosis 5, 6
- Acute management of paroxysmal SVT includes vagal maneuvers, adenosine, and medication management with beta blockers and/or calcium channel blockers 3, 4, 5, 6
- Catheter ablation has a high success rate and is recommended for symptomatic patients with Wolff-Parkinson-White syndrome 5, 6
Recommendations for Electrophysiological Study and Therapeutic Ablation
- Electrophysiological study and catheter ablation should be offered to symptomatic patients with SVT early in the course of disease 2
- Clinicians should have a low threshold for referral to a cardiologist for electrophysiologic study and appropriate intervention such as ablation 6
- A patient-centered approach should be used when formulating a long-term management plan for atrioventricular nodal reentrant tachycardia 6