On the basis of this simula- tion, the authors concluded that, for symptomatic patients with monthly episodes of PSVT, radiofrequency ablation was the more effective and less expensive strategy when compared with medical therapy. An observational cohort study of patients with atrial flutter supported early ablation to significantly reduce hospital-based healthcare utilization and the risk of AF.547 These studies, along with other older literature, favor cath- eter ablation over medical therapy as the more cost-effective approach to treating PSVT and atrial flutter. However, the results of these studies were based on cost data and practice patterns that do not apply to the current environment and prac- tice. Therefore, no recommendations are provided. See Online Data Supplement 23 for additional data on cost-effectiveness. 12. Shared Decision Making It is important that the patient be included in clinical decision- making processes, with consideration of his/her preferences and goals for therapy, as well as his/her unique physical, psychological, and social situation. In selected cases, per- sonalized, self-directed interventions can be developed in partnership with the patient, such as vagal maneuvers and pill-in-the-pocket drug therapy. Shared decision making is especially important for patients with SVT. As seen in this guideline, SVT treatment can be nuanced and requires expert knowledge of EP pro- cesses and treatment options. Treatment options are highly specific to the exact type of arrhythmia and can depend on certain characteristics of a particular arrhythmia (eg, whether there is pre-excitation). The various choices for therapy, including drugs, cardioversion, invasive treatment, or a combination thereof, can be confusing to the patient, so a detailed explanation of the benefits and risks must be included in the conversation. Patients are encouraged to ask questions with time allot- ted for caregivers to respond. 