Diagnostic usefulness of electrophysiology study in patients with unexplained palpitations and suspected supraventricular arrhythmias

Abstract

Objectives: To evaluate the usefulness of electrophysiology study (EPS) in the early diagnosis of supraventricular tachycardia (SVT) in patients with paroxysmal palpitations (PP), with no documented arrhythmia. Materials and methods: Retrospective, observational, cohort study. Eighty-one consecutive patients (pts) with PP and no documented arrhythmia, who underwent EPS for SVT induction. Catheter ablation (ABL) was proposed if SVT was inducible. Exclusion criteria: structural heart disease (previous infarction, ejection fraction <45%, congenital or chagasic heart disease), history of ABL, and ventricular preexcitation. Two groups were compared: inducible arrhythmia (IA) and non-inducible arrhythmia (NI) looking for PP or documented arrhythmias. The sensitivity (Se), specificity (Sp), and predictive value (PV) of EPS were determined, and potential inducibility predictors (IP) were explored. Results: Women 75%, mean age 43 years. IA 71.6%: AV nodal reentrant tachycardia 79.3%, orthodromic AV reciprocating tachycardia 12.1%, focal atrial tachycardia 6.9%, and atrial flutter 1.72%. ABL was performed in 98.3% of IA. Mean follow-up: 84 months. IA: 3 PP and 3 documented arrhythmias. NI: 3 PP and 1 documented arrhythmia. The Se, Sp, PPV and NPV were 98%, 88%, 94.8% and 95.7% respectively. No IP was identified. Conclusion: The high rate of SVT inducibility in pts with unexplained PP and the low recurrence of symptoms and documented arrhythmia after ABL demonstrate the usefulness of EPS for early diagnosis and treatment of these patients.