AV nodal reentrant tachycardia or AV reentrant tachycardia using a concealed bypass tract-related adverse events
Abstract
Objectives
To jointly study paroxysmal supraventricular tachycardia (SVT)-related adverse events (AE) and ablation-related complications, with specific emphasis on the predictors of SVT-related AE as well as their significance by investigating their association with long-term mortality.
Methods
1770 patients were included, aged 6 to 97, with either atrioventricular nodal reentrant tachycardia (AVNRT) or orthodromic atrioventricular reciprocal tachycardia (AVRT) mediated by concealed accessory pathway, consecutively referred for SVT work-up in a tertiary care center.
Results
SVT-related AE were identified in 339 patients (19%). Major AEs were identified in 23 patients (1%; 15 cardiac arrests or ventricular arrhythmias requiring cardioversion and 8 hemodynamic collapses). Other AE were related to syncope (n = 236), acute coronary syndrome (n = 57) and heart failure/rhythmic cardiomyopathy (n = 21). In multivariable analysis, higher age, heart disease and requirement of isoproterenol to induce SVT were independently associated with a higher risk for SVT-related AE.
During follow-up (2.8 ± 3.0 years), death occurred more frequently in patients with SVT-related AE, especially in patients with major adverse events (p < 0.001). In multivariable analysis, major SVT-related AE remained significantly associated with occurrence of death (HR = 6.72, IC = (2.58–17.52), p < 0.001) independently of age and presence of underlying heart disease.
Major SVT-related AE in the whole population referred for SVT were more frequent than immediate major ablation complications in patients undergoing SVT ablation (5/1186 vs. 23/1770, p = 0.02).
Conclusions
SVT-related AE are independent predictors of mortality and are more frequent than immediate major ablation complications in patients undergoing SVT ablation. The present findings support systematically performing SVT ablation in patients with SVT-related adverse events.