TY - JOUR
T1 - Approaches to empiric ablation of slow pathway
T2 - Results from the Canadian EP web survey
AU - Laish-Farkash, Avishag
AU - Shurrab, Mohammed
AU - Singh, Sheldon
AU - Tiong, Irving
AU - Verma, Atul
AU - Amit, Guy
AU - Kiss, Alex
AU - Morriello, Florence
AU - Birnie, David
AU - Healey, Jeff
AU - Lashevsky, Ilan
AU - Newman, David
AU - Crystal, Eugene
PY - 2012/11/1
Y1 - 2012/11/1
N2 - Aim: Dual atrioventricular nodal physiology (DAVNP) is a frequent finding in patients with suspected or documented supraventricular tachycardia (SVT). Empiric slow pathway ablation (ESPA) is sometimes performed in patients with DAVNP without inducible SVT at the time of electrophysiological study. Evidence to guide this practice in the adult population is limited. This study was aimed to assess the practice of ESPA by adult electrophysiologists in Canada. Methods: All Canadian interventional electrophysiologists (n=81) were invited to complete a web-based questionnaire assessing their practice of ESPA in patients with suspected and documented SVT. Operator experience, reimbursement models, diagnostic, and treatment decisions regarding ESPA were assessed with case scenarios. Results: Forty-one responses (50 %) were obtained. Ninety-five percent of the responders stated that the evidence for ESPA is lacking or limited. Responders were more likely to perform ESPA in the setting of non-inducible SVT when there was documentation of the clinical arrhythmia (64 vs. 31 % (p=0.017)). The threshold to perform ESPA was highly variable. Longer time in practice (r=0.38, p=0.017) and less perceived complications with ESPA (r=0.31, p=0.05) were correlated with the practice of ESPA, whereas length of ablation waiting lists (r=-0.15, p=0.38), number of procedures performed per day (r=0.11, p=0.51) and type of reimbursement (p=0.24) were not associated with the practice of ESPA. The perceived complication rate with ESPA was <1 %. Conclusion: Variability in the practice of ESPA in cases of non-inducible SVT exists. Documentation of the clinical arrhythmia, operator experience, and perceived low complication rates positively influence this practice.
AB - Aim: Dual atrioventricular nodal physiology (DAVNP) is a frequent finding in patients with suspected or documented supraventricular tachycardia (SVT). Empiric slow pathway ablation (ESPA) is sometimes performed in patients with DAVNP without inducible SVT at the time of electrophysiological study. Evidence to guide this practice in the adult population is limited. This study was aimed to assess the practice of ESPA by adult electrophysiologists in Canada. Methods: All Canadian interventional electrophysiologists (n=81) were invited to complete a web-based questionnaire assessing their practice of ESPA in patients with suspected and documented SVT. Operator experience, reimbursement models, diagnostic, and treatment decisions regarding ESPA were assessed with case scenarios. Results: Forty-one responses (50 %) were obtained. Ninety-five percent of the responders stated that the evidence for ESPA is lacking or limited. Responders were more likely to perform ESPA in the setting of non-inducible SVT when there was documentation of the clinical arrhythmia (64 vs. 31 % (p=0.017)). The threshold to perform ESPA was highly variable. Longer time in practice (r=0.38, p=0.017) and less perceived complications with ESPA (r=0.31, p=0.05) were correlated with the practice of ESPA, whereas length of ablation waiting lists (r=-0.15, p=0.38), number of procedures performed per day (r=0.11, p=0.51) and type of reimbursement (p=0.24) were not associated with the practice of ESPA. The perceived complication rate with ESPA was <1 %. Conclusion: Variability in the practice of ESPA in cases of non-inducible SVT exists. Documentation of the clinical arrhythmia, operator experience, and perceived low complication rates positively influence this practice.
KW - AVNRT
KW - Ablation
KW - Canada
KW - Empiric
KW - Slow pathway
KW - Survey
UR - http://www.scopus.com/inward/record.url?scp=84869882488&partnerID=8YFLogxK
U2 - 10.1007/s10840-012-9696-z
DO - 10.1007/s10840-012-9696-z
M3 - Article
C2 - 22833011
AN - SCOPUS:84869882488
SN - 1383-875X
VL - 35
SP - 183
EP - 187
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
IS - 2
ER -