Empiric Slow Pathway Ablation vs. no Ablation in Patients With Non-Inducible Supraventricular Tachycardia

Paroxysmal supraventricular tachycardia (PSVT) is a common cause of palpitations, with atrioventricular nodal re-entrant tachycardia (AVNRT) accounting for up to 60% of cases. In approximately 5% of patients, tachycardia is non-inducible during electrophysiology (EP) study, despite the presence of dual AV nodal physiology (DAVNP). The optimal management of patients with DAVNP and non-inducible tachycardia, whether to perform empiric ablation or not to ablate remains uncertain.

To compare recurrence rates, mechanism of recurrence and timing of recurrence between patients who underwent empiric slow pathway ablation versus those who did not.

We retrospectively reviewed EP studies from 2010 to 2024. Patients with documented adenosine responsive PSVT, DAVNP but non-inducible tachycardia were included; those with accessory pathways or structural heart disease were excluded. Among 1, 890 patients, 76 met inclusion criteria: Group I (n = 20) underwent empiric ablation, and Group II (n = 56) did not.

The mean age was 50.2 ± 16 years, and 62% were female. During a mean follow-up of 3.8 years, recurrence rates were similar (15% vs. 26.7%, p = 0.28)., but no patients in empiric ablation group had AVNRT whereas 53% of non-ablation patients had AVNRT. All the early recurrences were due to AVNRT while the late recurrences were predominantly due to non AVNRT arrhythmias. Time to recurrence was longer in the ablation group (54 vs. 9.8 months). There were no AV blocks after empiric ablation CONCLUSION: In patients with DAVNP and non-inducible tachycardia, overall recurrence rates are similar regardless of empiric ablation, however it is efficacious is preventing early arrhythmia recurrence and true AVNRT recurrences.