Five Criteria Predict Induction and Ablation of Supraventricular Tachycardia

Introduction: Current guidelines recommend electrophysiological study (EPS) and ablation for primary treatment of supraventricular tachycardia (SVT), but there is little information to guide patient selection for the procedure. The purpose of this study was to identify preoperative features that would predict whether patients with signs or symptoms of tachycardia were likely to have SVT induced and ablated at EPS.

Methods: We performed a retrospective chart review of 1089 patients referred for EPS and ablation of SVT at 2 high volume centers. The population consisted of a derivation cohort of 810 patients and a validation cohort of 279 patients. We evaluated various clinical, EKG, and monitor features to determine which ones correlated with SVT induction or ablation.

Results: Five preoperative findings predicted a high probability that SVT would be induced and ablated at EPS: 1. A characteristic EKG recording of SVT. 2. Termination of SVT with adenosine. 3. Termination of SVT or symptoms with vagal maneuvers. 4. An episode of SVT lasting ≥ 30 s on a monitor recording. 5. Pre-excitation on the baseline EKG. Patients exhibiting at least one of these features had a high probability of SVT induction and ablation, while those exhibiting none had a low probability (Induction, 76% vs. 19%, RR = 3.96 (2.76-5.69), p < .001; Ablation, 88% versus 26%, RR = 3.32 (2.48-4.46), p < .001). A point-based score was derived and validated that can be used to estimate the probability of induction and ablation for individual patients.

Conclusion: Simple criteria classify patients as having a high or low probability of SVT induction and ablation at EPS. They can be used as a guide for clinical decision making when considering invasive testing for patients with symptoms of tachycardia.