Supraventricular tachycardia

Abstract

Introduction: the management of these patients. AV synchrony has been shown to improve stroke volume and is fundamental in the maintenance of appropriate cardiac output. The physiological pacing provided by dual chamber devices should reduce cardiovascular mortality and morbidity and improve patient quality of life (QOL). It is unclear however if the maintenance of AV synchrony achieved through the artificial means of physiological pacing correlates with intrinsi- cally maintained AV synchrony when comparing QOL scores and cardiac symptoms in these patients. QOL has become recognised as a valuable measure for assessing the benefits that therapeutic interventions such as pacemaker implantation can have on a patients’ well-being. Due to the life-long therapeutic intervention associated with pacemaker implant, there is increasing emphasis on improving QOL in these patients. This study is the first study to investigate the level of pacemaker dependency in patients with dual-chamber devices, its relationship to QOL and cardiac symptoms. Purpose: To determine the relationship between QOL, cardiac symptoms and the level of physiological dependency patients have on their dual chamber pacemaker to maintain AV synchrony. Methods: Thirty three patients with SSS or AV block were enrolled in a single centre, cross sectional study. To ensure patients had a dual chamber pacemaker implanted, participants were purposively recruited. Patients completed both the SF-36 QOL ques- tionnaire and the pacemaker specific Aquarel questionnaire to assess symptoms. The cumulative percentage of atrial and ventricular pacing required to maintain AV synchrony was recorded at clinic when the patient attended for their clinical review. Pacemaker dependency scores were correlated with SF-36 and Aquarel scores to determine if any relationship existed between pacemaker dependency and QOL and symptom scores. Results: Significant improvement in two SF-36 domains were reported by those patients who had increased pacemaker dependency; Vitality (r ¼ 0.41, p < 0.05) and social functioning (r ¼ 0.37, p ¼ < 0.05). Pacemaker dependency was also significantly correlated with the cognition domain of Aquarel (r ¼ -0.51, p ¼ < 0.05). Conclusion: No previous studies have examined relationships that exist between pacemaker dependency, QOL and symptoms in patients with dual chamber devices only. These findings will help supplement current clinical practice and patient educa- tion on QOL and symptom expectations following pacemaker implant. Conclusions: In our a routine is feasible, safe and effective in all procedures, thanks to An EA-EB Objective: The purpose of this study was to evaluate the impact on the quality of life (QoL), of interventional or medical treatment in patients with a history of supraventricular tachycardias (SVTs). Methods: 140 patients with SVTs were enrolled and divided into two groups accord- ing to the therapeutical approach of their personal choice. Group A consisted of 100 patients, (57% females, mean age 46.55 6 11.4 years) who underwent ablation proce- dure and group B consisted of 40 patients (52.5% females, mean age 43.55 6 11.18 years), who were treated medically. HRQoL was assessed using the Short Form-36 Health Survey (SF-36) and the arrhythmia-specific Umea22, translated into the Greek language, at baseline and 3 months after therapy. Results: The total SF-36 score in the ablation group showed a statistically significant increase by 13.75 6 9.7 (22.34%, p < 0.0001), while a statistically significant decrease of 3.85 6 12.163 (7.07%, p ¼ 0.001) was found in the group with pharmaceutical intervention. In the U22 questionnaire, the welfare score for group A increased statistically significant by 4.65 6 3.239 (132.47%, p < 0.0001), while in group B, a smaller increase was shown 0.21 6 2.25 (18.73%, p ¼ 0.003). Subsequently, the score for the inci- dence of episodes showed a statistically significant decrease of 3.31 6 2.312 (66.87%, p < 0.0001) in group A, while for group B episode’s recurrence remained unchanged (reduction by 0.25 6 1.88 (5.34%, p ¼ 0.405). Finally, the severity of episodes showed a statistically significant decrease by 2.21 6 1.641 (38.34%, p < 0.0001) in favour of the ablation, whist in the medically treated group, there was a statistically insignificant reduction of 0.15 6 1.51 (2.65%, p ¼ 0.541). In group A, female sex appears to corre- late with "Physical Functionality" (p ¼ 0.023) in the SF-36, while age was correlated with the "incidence of episodes" in U22 (p < 0.0001). In the medically treated group, factor "age" was statistically significant with both total score of the SF-36 (p ¼ 0.010) and "symptoms of episodes" in the U22 (p ¼ 0.001). Conclusion: QoL is markedly affected in patients with SVTs. RF ablation is a proved curative strategy that improves significantly HRQoL, in contrast to medical therapy, where patients remain symptomatic. Introduction and objectives: Current management of asymptomatic adult patients with the Wolff-Parkinson-white (WPW) syndrome remains controversial. Our objective was to analyze the reasons to perform an electrophysiological study (EPS) and abla- tion in asymptomatic patients with WPW and compare the results with the symptomatic patients. Methods: Adult patients with the WPW syndrome submitted for an EPS and ablation were divided between symptomatic (symptoms suggestive of tachycardia incorporat-ing the accessory pathway (AP) or atrial fibrillation) and asymptomatic, considering the reasons to perform the procedure. In all of them we analyzed the electrical and anatomic properties of the AP, the final success and the incidence of complications. Results: We have included 150 patients: 114 asymptomatic (39 6 14 years, 48% male) and 36 asymptomatic (38 6 14 years, 58% male; p ¼ NS). The most frequent symptoms were palpitations (88%) and syncope (5%). In 33% of them the tachycardia was docu-mented and 10% had preexcited atrial fibrillation. Of 154 AP ablated, 56% were left- sided, 17% right-sided and 27% septal, without significant differences between both groups. Anterograde refractory period of the AP was significantly longer in asymptomatic patients (319 6 59 ms) as compared with symptomatic patients (275 6 48 ms; p < 0,001) as well as tachycardia inducibility (67% y 25%; p < 0,001). Successful ablation with one procedure was achieved in 98% of the patients, without major complications. Conclusions: Catheter ablation in adult patients with the WPW syndrome offers excellent results without major complications, and may be performed also in many asymptomatic patients to avoid possible future arrhythmic events.