Role of coronary angiography before radiofrequency ablation in patients presenting with paroxysmal supraventricular tachycardia

During episodes of paroxysmal supraventricular tachycardia (PSVT), electrocardiograms frequently show ST-segment depressions, and patients may experience typical chest pain prompting invasive coronary angiography. We evaluated 114 patients presenting with PSVT for concomitant coronary artery disease (CAD). Patients were classified as to the type of PSVT, symptoms during PSVT, and cardiovascular risk factors. Maximum heart rate, extent of ST-segment depression, and cardiac troponin levels during PSVT were recorded. Patients were subjected to exercise testing and/or coronary angiography. During PSVT, symptoms suggestive of myocardial ischemia, including chest pain (31%), ST-segment depression (61%), and elevated troponin levels (12%), were common. Sixty-seven patients (59%) underwent coronary angiography. The overall prevalence of significant CAD was found to be low (4%) and did not correlate to symptoms during tachycardia. Routine coronary angiography cannot be recommended in patients with PSVT unless routine evaluation outside episodes of tachycardia suggests the presence of significant CAD.