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Objective: To review the literature systematically to determine whether noninvasive or invasive risk stratification, such as with an electrophysiological study of patients with asymptomatic pre-excitation, reduces the risk of arrhythmic events and improves patient outcomes.Methods: PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (all January 1, 1970, through August 31, 2014) were searched for randomized controlled trials and cohort studies examining noninvasive or invasive risk stratification in patients with asymptomatic pre-excitation. Studies were rejected for low-quality design or the lack of an outcome, population, intervention, or comparator of interest or if they were written in a language other than English.Results: Of 778 citations found, 9 studies met all the eligibility criteria and were included in this paper. Of the 9 studies, 1 had a dual design-a randomized controlled trial of ablation versus no ablation in 76 patients and an uncontrolled prospective cohort of 148 additional patients-and 8 were uncontrolled prospective cohort studies (n=1594). In studies reporting a mean age, the range was 32 to 50 years, and in studies reporting a median age, the range was 19 to 36 years. The majority of patients were male (range, 50% to 74%), and <10% had structural heart disease. In the randomized controlled trial component of the dual-design study, the 5-year Kaplan-Meier estimates of the incidence of arrhythmic events were 7% among patients who underwent ablation and 77% among patients who did not undergo ablation (relative risk reduction: 0.08; 95% confidence interval: 0.02 to 0.33; P<0.001). In the observational cohorts of asymptomatic patients who did not undergo catheter ablation (n=883, with follow-up ranging from 8 to 96 months), regular supraventricular tachycardia or benign atrial fibrillation (shortest RR interval >250 ms) developed in 0% to 16%, malignant atrial fibrillation (shortest RR interval ≤250 ms) in 0% to 9%, and ventricular fibrillation in 0% to 2%, most of whom were children in the last case.Conclusions: The existing evidence suggests risk stratification with an electrophysiological study of patients with asymptomatic pre-excitation may be beneficial, along with consideration of accessory-pathway ablation in those deemed to be at high risk of future arrhythmias. Given the limitations of the existing data, well-designed and well-conducted studies are needed. [ABSTRACT FROM AUTHOR]

The article presents the report of the 2015 American College of Cardiology/American Heart Association (ACC/AHA) and the Heart Rhythm Society (HRS) guideline for supraventricular tachycardia management among adults. The report discusses topics on the guideline's general principles, the management of atrioventricular nodal reentrant tachycardia, and the recommended treatment for junctional tachycardia.

The article presents the report of the American College of Cardiology/American Heart Association (ACC/AHA) and the Heart Rhythm Society (HRS) guideline for supraventricular tachycardia management. The report discusses topics on the guideline's general principles, the management of atrioventricular nodal reentrant tachycardia, and the recommended treatment for junctional tachycardia.

Radiofrequency catheter ablation has very quickly generated considerable enthusiasm among electrophysiologists because it offers a less invasive alternative to an open surgical procedure and potentially offers an alternative to lifelong drug therapy. Early literature on RF catheter ablation focused on the technical aspects of the procedure. In contrast, the literature of the past several years is dominated by very favorable reports of large series of patients and the experience of individual institutions. The larger series have focused on the treatment of accessory pathways as opposed to AV nodal reentry pathways. The opinions of the DATTA panelists parallel the literature. The panelists considered the technology to be established in terms of its safety and effectiveness as a curative treatment of accessory pathways, and promising in terms of its safety and between promising and established in terms of its effectiveness as a treatment of AV nodal reentrant tachycardias. [ABSTRACT FROM AUTHOR]