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Surgical therapy for supraventricular tachycardia, a potentially curable disorder
Insights
Surgical treatment for supraventricular tachycardia (SVT) offers a high cure rate. Low-risk procedures effectively manage this potentially curable disorder, achieving excellent patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Supraventricular tachycardia (SVT) poses a significant clinical challenge.
- Surgical interventions have evolved to address various SVT mechanisms.
Purpose of the Study:
- To evaluate the efficacy and safety of surgical management for supraventricular tachycardia.
- To assess outcomes based on different types of accessory atrioventricular connections and tachycardia mechanisms.
Main Methods:
- Electrophysiologic study (EPS) pre- and post-operatively.
- Surgical intervention including His bundle section and curative operations for accessory atrioventricular connections.
- Follow-up assessment of tachycardia recurrence and medication status.
Main Results:
- Overall satisfactory results achieved in 96.5% of patients.
- High cure rates for free wall accessory atrioventricular connections (97.7%) and atrioventricular junctional reentrant tachycardia (100%).
- Good outcomes for posterior septal accessory atrioventricular connections (90% satisfactory, 84% cured at late EPS).
Conclusions:
- Supraventricular tachycardia is a potentially curable disorder with low-risk surgical procedures.
- Surgical management provides a high cure rate and excellent long-term outcomes.
- Electrophysiologic study is crucial for pre- and post-operative assessment.
Abstract:
One hundred fifty-six patients underwent investigation and operation for supraventricular tachycardia: 145 had attempts at curative operations and 11 had His bundle section. Operative mortality was 0.68% and there were no late deaths among patients having curative operations. One patient died suddenly 1 year after His bundle section. All patients underwent electrophysiologic study before discharge and 6 months postoperatively. A satisfactory result, without supraventricular tachycardia and without medication, was achieved in 96.5% of all patients. Ninety-three percent have no supraventricular tachycardia and no demonstrable reentrant pathway at electrophysiologic study. All free wall accessory atrioventricular connections were divided and 97.7% of the patients were cured. Ninety percent of patients with posterior septal accessory atrioventricular connections had a satisfactory result, with cure demonstrated at late electrophysiologic study in 84%. Fifteen patients with atrioventricular junctional reentrant tachycardia were all cured, with preservation of normal atrioventricular conduction. Eight (88%) of nine patients with right atrial tachycardia were cured, and two patients with nodoventricular fibers and one patient with incessant atrioventricular junctional tachycardia had satisfactory results. Supraventricular tachycardia is now a potentially curable disorder when managed by low risk surgical procedures that offer a high cure rate.