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Alternative to medication for a common type of tachycardia may improve patients' quality of life

A common form of tachycardia (abnormally fast heart rate), atrioventricular nodal reentrant tachycardia (AVNRT), while rarely life threatening, frequently causes symptoms and occasionally disability. Symptoms range from a racing or fluttering heart and chest pain to fatigue, unexplained sweating, light-headedness, and shortness of breath. Medication has been reasonably successful in preventing frequent symptomatic episodes, but drug side effects can impair a person's quality of life. However, radiofrequency catheter ablation (RFA) of the slow pathway of the atrioventricular node can reduce the frequency of symptoms that patients experience and improve their quality of life, finds a study supported in part by the Agency for Healthcare Research and Quality (HS08362).

The study, which was conducted by researchers at the Stanford University School of Medicine and the Kaiser Santa Teresa Medical Center in San Jose, CA, assessed quality of life before and after RFA in highly symptomatic patients aged 18 years or older (median age 55 years) who underwent RFA for AVNRT between 1993 and 1996 at a large HMO medical center in California. The number of symptoms reported by patients declined from a mean of 5.8 to 3.1 per patient. The number of moderate to severe symptoms declined to an even greater extent, from a mean of 4.6 to 1.1 per patient.

In the 111 patients with at least 1 year of followup, urgent care visits for tachycardia decreased from a mean of 4.6 in the year before to 0.4 in the year after RFA. Also, after the RFA procedure, 79 percent of the patients were not taking medications for treatment of their abnormal heart rhythm, the numerical rating score for health improved from a mean of 56.6 to 77.3, and patient ratings of their quality of life improved from a mean of 0.71 to 0.88. Unfortunately, RFA costs more than $15,000 for physician and hospital charges, and cost-effectiveness of the procedure has not been established. However, the striking 90 percent reduction in use of emergency department and urgent care centers 1 year after RFA may partially offset the cost of the procedure.

See "Quality of life before and after radiofrequency catheter ablation in patients with drug refractory atrioventricular nodal reentrant tachycardia," by Mary S. Larson, M.D., Kathryn McDonald, M.M., Charlie Young, M.D., and others, in the August 15, 1999, American Journal of Cardiology 84, pp. 471-473.

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