(Note: Although the success rate of radiofrequency ablation of supraventricular tachycardia is high and the number of complicated or failed cases is relatively small, two points should be emphasized as follows: First, the high success rate and low recurrence or failure rate of the procedure mainly refer to a few major hospitals with abundant cases and skilled surgeons; second, objectively, there are indeed recurrence and failure cases. cases, and even more highly skilled doctors have them, just relatively few. Before the surgery, the doctor will fully communicate with the patient about these issues, objectively explain the possibility of recurrence or failure, and obtain the patient’s informed consent. In recent years, Dr. Cheng has been impressed by the number of “recurrent” or “failed” cases of “supraventricular tachycardia” (including pre-excitation syndrome) he has treated. Most of these cases had been treated in other hospitals, and some of them had undergone radiofrequency ablation twice in other hospitals, but they all recurred. I deeply understand the confusion and helplessness that these patients face after recurrence or failure, and I know that most of these patients actually still have the possibility of success. The results of radiofrequency ablation in our hospital also prove this point. (Therefore, Dr. Cheng wrote this article in the hope that patients facing the above problems, after reading it, can increase their confidence in overcoming the disease) Paroxysmal supraventricular tachycardia, referred to as “supraventricular tachycardia”, is a rapid arrhythmia, the heartbeat during the attack is very fast (most in 150-200 beats per minute), often sudden and sudden stop, when not attacked similar to normal people It is often sudden and abrupt, and resembles a normal person when it does not occur. But in fact, it is not a separate disease, but contains several different types of tachycardia, the common types are as follows: 1. Atrioventricular node double pathway, atrioventricular node foldback tachycardia: common, the heartbeat during the attack 120-220 beats/min, basically regular and neat; 2. Atrioventricular foldback tachycardia (pre-excitation syndrome, bypass): common, the heartbeat during the attack 130-220 Atrial tachycardia (atrial tachycardia): rare, with a heartbeat of 120-200 beats/min during an attack, which can be regular and neat, or irregular and uneven; 4. Atrial flutter (atrial flutter): rare, with a heartbeat of 80-180 beats/min during an attack, which can be regular and neat, or irregular and uneven; 5. 6. Sinus tachycardia (sinus tachycardia): 100-160 heartbeats/minute, regular, neat From the above description, it is easy to see that several types of tachycardia, in terms of the number of heartbeats and clinical characteristics at the onset, have a large “overlap range The above description shows that several types of tachycardia have a large “overlap” in terms of the number of heartbeats and clinical characteristics at the onset. In addition, some “ventricular tachycardias (ventricular tachycardia)” can, in rare cases, have an ECG presentation that resembles “supraventricular tachycardia”. These factors can make it difficult or even misleading to rely on the general ECG alone for diagnosis. In fact, sometimes this is one of the difficulties of the procedure. Generally speaking, what is commonly referred to as “supraventricular tachycardia” is the first and second types listed above, namely “atrioventricular nodal tachycardia” and “atrioventricular tachycardia (preexcitation syndrome, bypass) “, which are also the two most common types. However, the real final diagnosis does not rely on a general ECG, but rather on the first step in RF ablation —— i.e. cardiac electrophysiological examination, in order to determine the cause. The second step, radiofrequency ablation, is done after the diagnosis is confirmed. With radiofrequency ablation, the vast majority of these two types of supraventricular tachycardias can be effectively treated with a high success rate and a low recurrence rate, making it the first-line treatment of choice. For example, the intraoperative success rate of radiofrequency ablation for “AV nodal regurgitation tachycardia” is almost 100%, with hundreds or thousands of consecutive cases without failure, and the recurrence rate is generally less than 1% in the few top hospitals (not all) that have experience with it; for “AV regurgitation The intraoperative success rate for “atrioventricular fold tachycardia (pre-excitation syndrome, bypass)” is generally above 98%, and the recurrence rate varies slightly from 1% to 5% depending on the specific lesion site. However, in reality, there are still a few patients who have undergone RF ablation for supraventricular tachycardia and have experienced recurrence or failure, and some patients are under great psychological pressure, frustrated, disappointed, and even lose confidence in trying RF ablation again. In fact, this is not necessary! Because patients who have recurred or failed, most of them still have the possibility of success when they go to top and large hospitals for the surgery again. In order to have a successful re-operation, first of all, it is necessary to simply understand why some patients have recurrence or failure, and how to work so that these patients with recurrence or failure can have a successful re-operation? In this regard, our hospital has more insights and experiences. The following is a brief analysis of the causes and treatment of recurrence or failure. I. Analysis of recurrence and treatment of recurrence Recurrence mainly refers to the surgery, in which the surgeon repeated electrophysiological testing after ablation and concluded that the lesion had been eliminated and success had been achieved. However, after the procedure, the episodes of supraventricular tachycardia still occur again. In general, recurrences occur mainly within 2 months to 6 months after the procedure, but are less common after 6 months and even less common after 1 year. One of the reasons for recurrence is the return of the original lesion, and the other is a new lesion that did not show up intraoperatively at the time but only showed up some time after surgery. Treatment: If it is determined to be a recurrence (e.g., there is electrocardiographic evidence of another attack, or exactly the same attack symptoms as before surgery), radiofrequency ablation can be performed again, and it is almost always successful. II. Analysis and management regarding failure Failure means that at the end of the procedure, it is known that the procedure was not successful and that the lesion was not eliminated despite repeated efforts. The surgeon will usually explain and justify the reasons for failure with the patient. In general, the reasons for failure are complex, varied, and even unsolved, involving many aspects. The majority of patients with failed RF ablation of supraventricular tachycardia are “atrial fibrillation tachycardia (preexcitation syndrome, bypass)”, i.e., type 2 above. The possible reasons for failure are as follows. 1. The cause of the disease itself, i.e., the difficulty of the disease itself. Admittedly, most cases of supraventricular tachycardia are not complex. However, some special cases do exist, such as: the location of the lesion is special, involving important parts, and the risk of radiofrequency ablation is high; or the lesion is in the epicardium or in a rare location, which is technically extremely difficult; or the patient cannot be induced with supraventricular tachycardia after repeated examinations during surgery, resulting in the inability to locate the location of the lesion, and there is no way to ablate it; or the tachycardia is “extremely cunning ” coolly resembling another type of tachycardia, causing the surgeon to misjudge; and so on. Moreover, this peculiarity is often still difficult to predict before the surgery. 2, the patient’s reasons. For example, the location of the lesion is special, the risk of radiofrequency ablation is relatively large, and the patient, after understanding the condition, is not willing to take this risk, thus giving up the ablation. 3.The doctor’s reason. Objectively speaking, all doctors have had failed cases, the problem is how to practice hard, to make up for the shortcomings, and to become steel. Therefore, the level of the doctor, the amount of experience, and even courage, patience, tenacity and other character factors have an important impact on the outcome of the surgery. A highly qualified surgeon is less likely to fail. Overall, recurrence or failure, although a minority, is indeed a problem that neither the doctor nor the patient wants to happen but does exist. After such a situation, it is recommended not to be discouraged and depressed, but to analyze and discuss the condition with the doctor and decide the next step of treatment calmly and objectively, and if necessary, to change the doctor. Theoretically, in cases of recurrence, secondary ablation can be successful in most cases. In the case of failed cases, if the patient, after weighing the options, is determined to try again and finds an experienced doctor willing to work on his or her behalf (ablating again for a failed case is a test of the doctor’s skill, courage and patience), there is still a great chance of achieving success.