“Ghost” Tachycardias: Electrophysiologic Study Findings and Management

Aims: Management of patients with non-documented palpitations usually is challenging in most cases. The diagnostic value of electrophysiologic study (EPS) in patients with non-documented palpitations is not clearly determined. We assessed the type of treatment based on EPS findings and its effectiveness in this setting.

Methods: From January 2000 to December 2014, 76 patients (30 males, mean age 40.8 years old) with history of non-documented palpitations, normal resting ECG and 24h Holter recordings, underwent complete EPS. Among the 76 patients, 50 (65.8%) were followed-up by direct or telephone interviews for 84 ± 57 months. Severity of symptoms before and after EPS according to EPS findings and subsequent treatment was assessed.

Results: A total of 51 patients (67.1%) had inducible tachycardia, dual pathways at atrioventricular node ± echo beats were identified in 13 patients (17.1%) and 12 (15.8%) had negative EPS results. Among the 51 patients with inducible tachycardia, ablation was performed in 18 patients (35.3%) and 47.4% patients received medical treatment. Among the 50 patients with available follow-up data, only 1 patient (2%) mentioned deterioration of palpitations frequency, 7 (14%) reported no change on symptoms, 24 patients (48%) had less and 18 patients (36%) had no clinical recurrences. Independetly from the presence of recurrences or not, 52% of patients reported amelioration of symptoms after EPS. Focusing on patients with negative EPS results, 5 out of 8 patients (62.5%) remained symptom free at follow up despite the absence of any treatment. Patients who underwent ablation and had available follow-up (16 out of 50, 32%) compared to those with medical or no treatment reported amelioration of symptoms (75% vs. 41.2%, p=0.026).

Conclusions: Treatment and management of patients with ghost tachycardias can be safely based on EPS findings. Furthermore, a probable "placebo effect" of the EPS itself cannot be excluded.