Paroxysmal supraventricular tachycardia, also known as supraventricular tachycardia, is a type of cardiac arrhythmia. Patients with this condition may experience a sudden increase in heart rate (mostly more than 150 beats per minute) for a period of time (from a few seconds to several hours) and then a sudden change to a normal heart rate. What causes supraventricular tachycardia? The cause of supraventricular tachycardia is one of two things: First, the heart is born with an extra muscle (probably less than a hair’s breadth) between the atria and the ventricles, which, to use a common analogy, is like a short circuit caused by an extra wire. This extra muscle is what we call an atrioventricular bypass, or bypass for short. Although congenitally bypassed, the vast majority of people do not have episodes of tachycardia for a very long time, and only a small percentage of people will have an electrocardiogram that reveals evidence of the presence of bypass, medically known as pre-excitation syndrome. The second condition is when two pathways with significantly different properties are created in the area of the atrioventricular node, a key tissue that normally controls the heartbeat, forming a double pathway in the atrioventricular node. This condition tends to be more common after middle age and is mostly associated with acquired aging, but of course there are some congenital factors as well. Whether there is an atrioventricular bypass or an AV node double pathway, patients may not have an episode of supraventricular tachycardia for many years or may only have an episode once in a very long time. This is mainly because the presence of a bypass or a double pathway is only one condition for the onset of an attack, a trigger is needed for the onset of an attack – a premature beat! Both atrial and ventricular premature beats can cause episodes of supraventricular tachycardia. The older you get, the more likely you are to have premature beats. This is the main reason why many patients experience more frequent episodes of supraventricular tachycardia as they get older. In general, supraventricular tachycardia is a benign condition that does not lead to death, but may affect the patient’s quality of life. In cases of frailty, cardiac insufficiency, or pregnancy, episodes of supraventricular tachycardia may be more troublesome. During an attack, patients can terminate it by holding their breath, stimulating the throat with their fingers causing dry heaving, or jumping. You can also press on the eyeballs or massage the neck, but both of these methods may lead to retinal detachment or even fainting if not done properly and are generally best avoided. If you feel a sudden rapid heartbeat, you should count your own pulse or heartbeat for a minute to see how many times, and also go to a nearby hospital as soon as possible for an electrocardiogram to confirm the diagnosis. If it is confirmed to be supraventricular tachycardia, your doctor will usually give you an injection of medication to terminate it. Occasionally, it will be terminated with esophageal stimulation. When you have supraventricular tachycardia, medications can only control it temporarily. To eradicate the disease, catheter ablation is necessary. Many patients with supraventricular tachycardia are worried about their ablation procedure, and some doctors even make it sound difficult, but this fear is completely unwarranted. In fact, ablation of supraventricular tachycardia is an introductory procedure for all physicians who perform catheter ablation, which is equivalent to appendectomy in general surgery. It can be done in general tertiary care hospitals. The procedure is performed under local anesthesia, and the patient and the surgeon can talk and even joke with each other during the procedure. The surgeon only needs to make several punctures in the neck or chest, or at the base of the thighs, place the surgical instrument into the heart, and after examination, find a bypass or confirm a double pathway, and destroy the lesion by distributing radiofrequency or freezing energy. The success rate is usually over 95%, with high level specialized hospitals approaching 100%. Even if the bypass is close to the AV node-Hirschsprung bundle or a double pathway, most of them can be ablated safely and successfully. Of course, individual patients may require two ablations for special reasons, but this is rare. Radiofrequency ablation is a minimally invasive procedure with a quick recovery. The patient usually needs to lie down for 8 to 12 hours after the procedure and can be discharged from the hospital the next day.