Paroxysmal supraventricular tachycardia (paroxysmal supraventricular tachycardia, supraventricular tachycardia) is a rapid, regular arrhythmia in which the heart beats rapidly (mostly 150-200 beats per minute) and neatly during an attack, often suddenly and abruptly, and is no different from normal when it does not occur. The disease has a certain pattern of development: it becomes more and more prone to attacks, more and more frequent, and the duration of the attacks becomes longer and longer, and later it may become ineffective to some previously effective termination methods or drugs. At present, for the treatment of paroxysmal supraventricular tachycardia, the medical community has no dispute that radiofrequency ablation therapy is definitely recommended. This is because radiofrequency ablation therapy can achieve a radical cure and the procedure has a high success rate, low risk, and a low recurrence rate. In contrast, drug therapy can terminate only a portion of supraventricular tachycardia and has too many side effects for long-term use and is of low value for preventing supraventricular tachycardia attacks. However, in clinical practice, a small number of patients suffer from surgical failure or postoperative recurrence after the decision to undergo radiofrequency ablation, and some patients continue to face such dilemmas even after multiple procedures. Some patients are so stressed that they even lose their confidence to try the surgery again. So, what are the reasons for the failure or recurrence of surgery for these patients? What should be done to further manage them? Every year, dozens of patients with arrhythmias who have failed or relapsed in other hospitals come to my center seeking hope for reoperation. The vast majority of these patients are able to have another successful surgery and are free of the arrhythmia they have suffered for years. The following article will discuss the reasons for the failure or recurrence of surgery and how to deal with them in the context of our center’s experience with this group of patients. It is hoped that this article will provide useful information for this group of patients, and that this group of patients will be given the opportunity to have their supraventricular tachycardia (including pre-excitation) cured. First, we must face the reality of surgical failure or postoperative recurrence. In principle, from a technical point of view, although radiofrequency ablation has a very high success rate for supraventricular tachycardia, it should be understood that there is absolutely no 100% success rate in medical practice. Objectively, recurrence or failure does occur. Before radiofrequency ablation, the physician should communicate fully with the patient about these issues, explain the possibility of such situations, and obtain the patient’s informed consent. After that, let’s clarify what is surgical failure or postoperative recurrence? Surgical failure is the failure to eliminate a lesion at the end of surgery despite repeated efforts or abandonment because the location of the lesion was considered too close to some important structures of the heart. In short, it means that the operation has been known to have been unsuccessful after the operation. Postoperative recurrence is mainly when the surgeon confirms, after electrophysiological testing, that the lesion has been eliminated before the end of the operation, thus ending the operation; however, after the operation, the same episodes of supraventricular tachycardia as before still occur again. Generally, recurrence occurs within 2 months to 6 months after surgery, and is less common after 6 months, and even less common after 1 year. Next, we will analyze the causes of surgical failure or postoperative recurrence and how to deal with them further. 1. Wrong diagnosis. This is the more common reason for surgical failure. Clinically, our center has seen a few patients who failed surgery due to wrong diagnosis. In the process of electrophysiological examination, the diagnosis of common typical arrhythmias will be relatively clear. However, some difficult atypical and rare arrhythmias may pose a significant challenge to the surgeon. Generally, radiofrequency ablation should be performed after the electrophysiological examination is clear. If radiofrequency ablation is performed under wrong diagnosis, a few of them may be successful like “blind cat meets dead rat”, but most of them are in vain, and even unnecessary complications may occur. 2.The disease itself is a factor. It is a common cause of surgical failure and postoperative recurrence. Undeniably, the etiology of most cases of supraventricular tachycardia is not complicated. However, there do exist some surgical failures or postoperative recurrences caused by the disease itself. Common reasons such as: the special location of the lesion, or the higher risk of radiofrequency ablation due to its proximity to important parts of the heart, or the inability to label ablation due to its location in the epicardium or rare locations; in addition, some arrhythmias, even though repeatedly examined by multiple means during surgery, cannot be induced by supraventricular tachycardia or induce other non-clinical arrhythmias, resulting in the inability to determine the location of the lesion and prevent further surgery. 3. Patient factors. Some of the supraventricular tachycardia is clearly identified after electrophysiological examination, physicians will consider the special location of the lesion and the relatively high risk of radiofrequency ablation, and after communication with patients and families, some patients or families may give up further ablation after understanding the condition because they are not willing to bear the corresponding risk, and thus the operation fails. Because at present, most centers in China basically use local anesthesia when performing RF ablation treatment. Some patients may suffer from intraoperative pain or cannot tolerate the operation, which may lead to the lesion not being accurately marked or ablated incompletely, and eventually cause the operation to fail or recur after the operation. 4. Incomplete ablation of lesions. It is the main factor causing postoperative recurrence. Some lesions may be difficult to be stably attached during catheter operation because of the location factor, and may appear to be suppressed or partially successful for a short time after ablation. The lesion may not be detected before the end of the procedure, but after the procedure, it may “resurface” and reappear its electrical activity or electrical conductivity, resulting in postoperative recurrence. 5. Post-ablation detection method. If the post-ablation detection method is inappropriate or too hasty, some of the signs of “resurgence” may be missed during the post-operative observation period, causing post-operative recurrence, and some patients may even have a recurrence of supraventricular tachycardia immediately after the operation. 6, post-ablation observation time. Generally, a period of observation is needed after ablation to see if the lesion is completely eliminated. The observation time may be different for each center, but generally speaking, the longer the observation time, the lower the chance of recurrence after surgery. The current universal post-ablation observation time is half an hour. Clinically, some patients have experienced a recurrence of supraventricular tachycardia more than 20 minutes after radiofrequency ablation. Therefore, a strict postoperative detection protocol and observation time are essential. 7.Surgical instruments are limited. Some patients have a more specific location of the lesion, such as located in the epicardium or some special heart diverticulum, which requires the use of three-dimensional precise labeling or cold saline perfusion ablation catheters. And some cases may cause greater difficulties in surgery because of mistakes in catheter selection, even leading to surgical failure and even postoperative recurrence. 8. Factors of the surgeon. The most important factor. Whether a surgery can be successful, although the instrument or other factors may limit part of it, but the most critical still lies in the operator. Objectively speaking, there are very few doctors who have been without intraoperative failure or postoperative recurrence cases, just more or less. However, it is undeniable that there are indeed differences in the level, experience, and skill of the surgeon, and there are also many differences in the character of different surgeons in terms of courage, patience, tenacity, and other character factors, all of which have an important impact on the outcome of surgery. As physicians, as patients and as families, no one wants to encounter surgical failure or postoperative recurrence. Although the chances of their occurrence are low, it should be acknowledged that failure or recurrence cannot be completely avoided. When encountering these undesirable results, a comprehensive consideration should be made. It is recommended not to be discouraged or depressed at first, but to analyze and discuss the condition with the doctor and decide calmly and objectively on the next step of treatment. If the diagnosis of supraventricular tachycardia is clear, it is recommended that another electrophysiological examination and further radiofrequency ablation treatment can still be considered. Different doctors have different styles and specialties, and have different perspectives and thoughts on the problem. Theoretically, in cases of post-operative recurrence, secondary ablation can be successful in most cases. In the case of a failed procedure, if the patient is determined to try again after weighing the options and finding an experienced surgeon, there is still a better chance of success. It should be understood that reoperation in cases of failed surgery or post-operative recurrence is a burden to the patient and a test of the surgeon’s skill, courage and patience. For such patients, I personally recommend visiting a large center, as they have the surgical experience, guaranteed number of cases, and surgical skills that will help more in the success of reoperation for failed or recurring cases.