The Effects of Radiofrequency Ablation Versus Medical Therapy on the Quality‐of‐Life and Exercise Capacity in Patients with Accessory Pathway‐Mediated Supraventricular Tachycardia: A Treatment Comparison Study

This study aims to evaluate the impact of transcatheter radiofrequency ablation on quality‐of‐life (QOL) and exercise capacity in patients with paroxysmal Supraventricular tachycardia (SVT) on stable medical therapy and the extent of symptomatic benefits of this treatment in patients with SVT of different clinical severity. A total of 55 patients with SVT on stable medications for 3 months were randomly selected for either radiofrequency ablation treatment (46 patients) or continuation of medical therapy (medical control group, 9 patients). Severity of SVT was classified based on the frequency and duration of SVT episodes, hemodynamic disturbance, and the presence of preexcited atrial fibrillation during an episode. Treadmill exercise capacity (Bruce protocol) and QOL (questionnaire study and interview) were assessed before and at 3‐month intervals for 1 year after the radiofrequency procedure and at 3 months in the medical control group. Thirty‐six of 46 patients were successfully ablated in one session, and a QOL measure before and at 3 months after ablation in these patients showed an improvement in total scores for “General Health Questionnaire” (20.3 ± 6.2 vs 16.9 ± 5.3, P < 0.01), “Somatic Symptoms Inventory” (73. 0 ± 6.0 vs 76.1 ± 4.1, P < 0.02), and “Sickness Impact Profile” (12.6 ±1.7 vs 4.9 ± 3.9, P < 0.01). This improvement in QOL was progressive and sustained over a 1‐year period. Major arrhythmia limitations, such as apprehension of strenuous activities and long distance travel, were alleviated after a successful procedure. The extent of improvement in QOL was significant for patients considered to have “mild” or “severe” arrhythmia. Maximum exercise capacity during treadmill exercise increased from 13.1 ± 5.5 to l4.9 ± 4.5 minutes at 3 months after successful ablation (P < 0.002), which was mainly due to suppression of exercise induced SVT. There was no change in QOL or exercise capacity in the medical control group and in patients with an initially unsuccessful radiofrequency ablation. Thus, transcatheter radiofrequency ablation is superior to medical therapy in improving QOL and exercise capacity of patients with SVT of different clinical severity.