Frequency of Disabling Symptoms in Supraventricular Tachycardia

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Abstract

The purposes of this study were to describe: clinical symptoms in a sample of consecutive patients with supraventricular tachycardia (SVT); incidence of sudden death, syncope, and other disabling symptoms; whether these symptoms differ by tachycardia mechanism; and to identify predictor variables of syncope in patients with SVT. Data were collected from chart reviews of 167 consecutive patients with SVT admitted for radiofrequency ablation. Three patients (2%) had nonlethal cardiac arrest, and a total of 16% (26 of 183) received at least 1 external direct-current shock for arrhythmia management. Twenty percent of subjects (33 of 167) reported at least 1 episode of syncope which was preceded by palpitations. The most frequent symptoms were: palpitations (96%), dizziness (75%), and shortness of breath (47%). We found atrioventricular nodal reentrant tachycardia (AVNRT) in 64 patients, atrioventricular-reciprocating tachycardia (AVRT) in 59, atrial tachycardia in 22, and atrial flutter in 22. The symptom profiles of patients with AVNRT, AVRT, and atrial tachycardia were very similar, but differed significantly (p <0.05) from those reported in the atrial flutter group. Multivariate analysis showed that heart rate ≥170 beats/min was the only independent risk factor for syncope. Chi-square analysis demonstrated that SVT patients with heart rate ≥170 beats/min had significantly more dizziness and syncope. Thus, despite a low incidence of associated heart disease, and good left ventricular function, there was a high frequency of disabling, potentially life-threatening symptoms associated with episodes of SVT in this sample. SVT can have potentially lethal consequences, and is more disruptive than previously thought.

Section snippets

Study Patients

This study included chart reviews of 183 consecutive patients with SVT admitted to the Moffitt-Long Hospital for radiofrequency ablation treatment between December 1992 and March 1994. Patients with atrial fibrillation (n = 16) were excluded from this analysis because their symptom profiles were expected to be very different from patients having other types of SVT. The initial evaluation of each patient consisted of a thorough history and physical examination. Most patients had also undergone

Patient Characteristics

Clinical characteristics of the 167 patients are listed in Table 1. The sample as a whole consisted of 94 women (56%), mean age 44 years. Sixty-four patients had AVNRT, 59 had AVRT, 22 had atrial tachycardia, and 22 patients had atrial flutter (Table 1). When the sample was divided into groups based on tachycardia mechanism, statistically significant differences in gender and age between the groups were noted (Table 1).

Noninvasive Findings

Overall, 22 patients (13%) had structural heart disease, with a mean left

Discussion

The major factor associated with syncope in this study was heart rate ≥170 beats/min during SVT. Heart rate during syncope appears to be a more important factor than mechanism of SVT. This supports findings by Hung et al,[18] who demonstrated that the hemodynamic changes seen in patients with SVT and normal left ventricular function were due to the increased heart rates during tachycardia. Additionally, Paul and colleagues[13] noted that the occurrence of atrial fibrillation with a fast

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