Although basing recommendations on a cost-effectiveness approach to therapy is an important goal for the current and future healthcare economy, it also poses considerable challenges. For example, the cost of therapy, available technology, and practice patterns are highly dynamic, and there may Recommendations for Acute Treatment and Ongoing Management of SVT in Older Populations COR LOE Recommendation I B-NR Diagnostic and therapeutic approaches to SVT should be individualized in patients more than 75 years of age to incorporate age, comorbid illness, physical and cognitive functions, patient preferences, and severity of symptoms.66,67,530 538 See Online Data Supplement 20. Data have consistently demonstrated that ablation is highly successful (>95%) in selected older patients.66,67,531 536 Outcomes from 48 medical centers in Germany were reported among 3234 consecutive patients undergoing AVNRT ablation from 2007 to 2010; of the total, Acute success was achieved in 98.5% of the older patient group, similar to the 2 younger patient groups (98.7% for the group <50 years of age; 98.8% for the group 50 to 75 years of age). In this study, complication rates were low; hemodynamically stable pericardial effusion was observed in 2 of 259 patients (0.8%), and no pacemakers were needed in the older patient group. Similarly, additional studies from older patient cohorts have consistently shown that older patients have more comorbid medical conditions, have a higher incidence of structural heart disease or ischemic heart disease, and have more severe symptoms associated with A few studies have shown that complications may be slightly higher in older patients than in younger patients, although the overall complications are low and acceptable.530,538,539 These ablation outcome data should be balanced with the risks and benefits of pharmacological therapy when therapeutic options are reviewed with older patients. Figure 22. Acute treatment of SVT in ACHD patients. 