Is medication or radiofrequency ablation the generally preferred option for treating SVT?

I am a 65-year-old female who has recently been diagnosed with supraventricular tachycardia (SVT). My doctor said the SVT events occurred frequently enough to warrant treatment and offered me a choice of taking a beta blocker, probably for the rest of my life, or undergoing radiofrequency ablation. Between March 1 and October 31, I experienced a total of eight SVT incidents at varying intervals, with the shortest length of time between events being 2 weeks 5 days, and the longest being 13 weeks. During some of the events I felt slightly light-headed, but not at all like I was going to pass out. During one I did feel something in my chest. The events seemed to last 1-3 minutes; the one event caught on an eCardio monitor, which I wore for a month, lasted 1 min. 18 sec. with heart rate circa 210 bpm. None of these events interfered with what I was doing at the time. I am generally in excellent health, exercise vigorously for an hour or more several times a week, my cholesterol, blood pressure, heart rate etc. are all very good, and I am not taking any prescription medications. I am very unsure which treatment option I should choose, and my doctor didn’t spend much time talking the situation over with me.

My questions are:
1. In a situation such as described above, would either medication or radiofrequency ablation be the generally preferred option?
2. I have read that there is a small chance in a radiofrequency ablation that the heart’s electrical system could be damaged and the patient could then require a pacemaker, or that the process could cause a stroke. What is the likelihood of either of these or other serious problems occurring?
3. I have been given a referral to a doctor for a radiofrequency ablation consultation, but have not been able to find out enough about him and his practice through his information on the Internet to know whether or not he is very expert or experienced in this procedure. Is there a good, neutral way to find out who are the best, most experienced doctors in this procedure?
4. Is it possible that something like vagal maneuvers, life style changes (cutting out a daily glass or two of wine, trying to get more sleep, cutting back on caffeine) would be helpful in a situation such as that described above?
5. Would taking a beta blocker (Bystolic) as needed when future SVT events occur be a long term treatment option in such a situation?

Submitted by Emily from Bellaire, Texas on 11/11/2014

by Abdi Rasekh, MD

The treatment of choice for SVT is radiofrequency ablation. The risk of need for a pacemaker is less than 1%. Risk of stroke is even less than risk of need for a pacemaker. The success rate for ablation is 98%. Beta blockers can decrease the frequency of these episodes but would not be a cure. Vagal maneuvers can terminate some of these episodes but would not prevent them. They are several excellent electrophysiologists in the Texas Medical Center who have extensive experience and expertise in dealing with SVT.