Palpitations Occur Frequently Following Radiofrequency Catheter Ablation for Supraventricular Tachycardia, But Do Not Predict Pathway Recurrence

Radiofrequency ablation of extranodal pathways is an effective treatment for supraventricular tachycardia, but late recurrences of pathway conduction do occur. To determine if recurrence of palpitations following ablation predicts pathway recurrence, we interviewed 77 patients who were at least 4 weeks status-post successful ablation of an accessory pathway (43 overt, 11 concealed) or slow pathway (23) for AV nodal reentrant tachycardia. Palpitations were reported by 45 (58%) patients postablation, and 28 (36%) patients reported palpitations lasting > or = 10 seconds and/or felt their symptoms represented recurrent tachycardia (major palpitations). Repeat electrophysiological testing was performed 3 months postablation in 53 patients, including 34 patients with palpitations (22 with major symptoms). Eight (10%) patients had recurrent pathway conduction demonstrated on repeat testing: two had no symptoms prior to restudy and six had major symptoms. One patient had major symptoms, but was found to have inducible atrial tachycardia and not pathway recurrence on restudy. Thus, 15 (68%) of 22 patients with major symptoms who were restudied had no pathway recurrence or inducible arrhythmia to explain their symptoms. Of the 24 patients not restudied, none has had documented recurrent tachycardia or overt pathway conduction by electrocardiogram over a mean follow-up of 335 +/- 138 (range 132-616) days. Thus, palpitations, including palpitations reminiscent of preablation symptoms, are common following radiofrequency ablation and often do not predict pathway recurrence. Repeat electrophysiological testing is frequently required to document long-term success of radiofrequency ablation for supraventricular tachycardia in patients with recurrence of major symptoms.