My daughter is 17 and has been diagnosed with SVT with episodes that last up to 1 1/2 hours and her pulse has been as high as 240. She has had this for approximately 2 years, but we recently had her diagnosed. She has just started a calcium channel blocker and the cardiologist referred her to a cardiologist that does catheter ablation. Would it be better to see a pediatric cardiologist? Also, is this a recommended procedure for teens? How successful is the surgery without having to do a second one? She is very active and wants to play soccer in college. She is also a soccer referee and it causes her to loose a day of work when she has a spell. Her cardiologist tells us, SVT should not interfer, but she must take her medicine, however, she could still have spells. My daughter wants to have the ablation and my husband wants her to just take the medicine. Is it best to stay on medicines until the medicines no longer work?
Supraventricular tachycardia (SVT) is caused by an extra electrical "wire" that shouldn't be there connecting the top to the bottom of the heart. The likelihood of spontaneous resolution of this pathway at this age is essentially zero. The options of treatment are as follows: 1) do nothing and teach her to do vagal maneuvers (this is the least helpful for her, considering she seems to be having these fairly frequently); 2) take medications to prevent SVT events (this means lifelong daily therapy and routine follow-up); 3) undergo electrophysiology study with radiofrequencly ablation (EPS/RFA). This last option obviates the need for further medical management. The success rates of RFA in pediatric patients ranges from 92-98%, depending on the location of the pathway. EPS/RFA has been performed in pediatric patients for approximately 2 decades with excellent outcomes and very low risk. I would definitely recommend that it be done by a pediatric electrophysiologist. In the end, SVT in a structurally normal heart is a nuisance, but it is not without the problems of daily medication, possible breakthrough, and continued cardiology appointments. Without evaluating your daughter, I cannot assess her specific risk, though.
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