Patients underwent revascularisation
and slow pathway ablation did not report typical angina by supraventricular
tachycardia
G. Duray, Á. Székely, T. Borsányi,
A. Szabó, E. Marosi, I. Préda
National Health Service Center,
Department of Cardiology and Internal Medicine
and Semmelweis University
2nd Department of Cardiology, Budapest
Szabolcs u.33-35, Budapest, HUNGARY, H-1135
Abstract:
Paroxysmal supraventricular
tachycardias (PSVT) can cause angina-like symptoms and can provoke in cases
of ischemic heart disease (IHD) a typical angina as well.
We retrospectively studied the
demand of catheter or operative revascularisation and pertinent clinical parameters
of the 140 patients who underwent radiofrequency catheter ablation (RFA) of
atrioventricular nodal re-entry tachycardia (AVNRT) between 1996 and 2001.In our cases of RFA of AVNRT
the patients had a diagnosis of ischemic heart disease in 16%. In 3 cases were
RFA and percutaneous coronary intervention within a six-week interval done.
In two other cases aorto-coronary bypass graft surgery (ACBG) or PCI and ACBG
was performed within 18 month.
Our cases:
1. Acute PCI because
of de novo typical angina by a known PSVT patient and ABL of recurrent AVNRT.
2. Coronary angiography on the base of atypical chest discomfort, elective
stent-graft implantation for an RDA stenosis and aneurysm, and one month later
RFA of drug-resistant AVNRT.
3. In a post–infarct patient
behind the palpitations and atypical chest discomfort reversible ischemia was
verified by isotope-scintigraphy. PCI and RFA of AVNRT were performed on the
same day.
4. RFA of AVNRT, and 18 month later unstable angina and urgent ACBG.
5. In a patient after infarction, ACBG and several PCIs RFA of a new onset
AVNRT. One year later PCI and ACBG after angina and positive exercise ECG. The
patients’ age: 63-76 years. None of the patients reported typical angina under
AVNRT, though revascularisation had to be performed in three cases within 6
weeks, in two cases within 18 month.
In our patients suffering in ischemic
heart disease who underwent RFA of AVNRT the absence of typical angina during
AVNRT did not predict that the patient will not need coronary revascularisation.
In cases of typical angina independently from the paroxysmal tachycardia the
usual IHD protocols should be used in the diagnosis and therapy of myocardial
ischemia.
