Symptoms in supraventricular tachycardia: Is it simply a manifestation of increased heart rate?

A new score model to predict the inducibility of supraventricular tachycardia in patients with palpitation without documented electrocardiography

OBJECTIVE

Although electrophysiological study (EPS) is one of the most useful diagnostic approaches to detect the cardiac origin of palpitations, there is no clear indication for EPS in patients with palpitation in the absence of documented supraventricular tachycardia (SVT). In this study, we aimed to create a new SVT score model to detect the requirement of EPS in patients with palpitation without documented tachycardia.

METHODS

A total of 154 patients with palpitation were included in this study. To create the SVT score, we considered four main criteria with their subunits. They were severity, frequency, duration, and termination of the symptoms. EPS was performed on all the patients after their scoring assessment.

RESULTS

Median SVT score of induced tachycardia and non-induced patients was determined as 10 and 6 points, respectively; and it was found to be statistically significant; p<0.001. The cut-off value for inducibility was found to be 7.5 points through receiver operating characteristic curve analysis, (94.9% sensitivity, 92.1% specificity), and the area under the curve was determined to be 97.2 (94.8-99.5, p<0.001).

CONCLUSION

According to our new SVT score model, ≥8 points strongly correlates with the inducibility of SVT during EPS.

Chilling-Like Attacks Terminated by Slow Pathway Ablation

Symptoms of patients or the way of presenting complaints by the patients may be indefinite, obscure or misleading for the diagnosis of supraventricular tachycardia. The content of the history shows variability depending on the present symptoms, patient concerns and priority. Herein, an unusual case of a young woman suffering from chilling-like attacks for one and half years and treated by slow pathway ablation has been presented.

Swallowing-induced supraventricular arrhythmia: A different perspective to mechanism

Atypical presentations of supraventricular arrhythmias constitute a diagnostic challenge which are not frequently reported in literature. Swallowing-induced supraventricular arrhythmia (SI-SVA), which was first described in 1926, is an intriguing presentation of supraventricular tachycardia and occurs during a wet or solid swallow. A 67-year-old man presented to our outpatient clinic complaining from recurrent episodes of sensation of palpitations and short duration pressure on his chest while swallowing since the last 2 weeks. Ambulatory rhythm Holter monitoring was suggestive of atrial fibrillation (AF) or atrial tachycardia attacks during swallowing. In addition, electrocardiography performed during solid food swallowing, showed short duration of AF consistent with the patient's symptoms. The patient was successfully treated with amiodarone. The main cause of SI-SVA is not known. Cross-talk of nerves during the impulse propagation might be the underlying cause of this phenomenon.

Clinical presentation of paroxysmal supraventricular tachycardia: evaluation of usual and unusual symptoms

Objective

Clinical presentation of paroxysmal supraventricular tachycardia may vary from asymptomatic occurrence or mild perception of palpitation to severe chest pain or syncope. This variation is the most challenging issue in the diagnostic evaluation of rhythm disturbances and paroxysmal supraventricular tachycardia as well. This study sought to evaluate the symptoms during the tachycardia attack or index event in patients who underwent electrophysiological study and ablation procedure.

Methods

This retrospective study included 100 consecutive patients who underwent electrophysiological study and ablation procedures due to supraventricular tachycardia. Structural heart disease, moderate/severe valvular pathology, systemic pathologies, such as connective tissue disease and chronic obstructive lung disease, history of pacemaker implantation was defined as exclusion criteria. In addition, medically managed patients and patients with unsuccessful ablation were not included in the study.

Results

Palpitation was the most frequently observed symptom in 84% of patients, followed by chest pain in 47%, dyspnea in 38%, syncope 26%, lightheadedness in 19%, and sweating in 18% of the patients. The most common symptoms after tachycardia event were fatigue and lightheadedness with frequencies of 56% and 55%, respectively. Forty-five percent of the patients reported more than one, unusually frequent urination within the following 1-3 hours after the index event.

Conclusions

Paroxysmal supraventricular tachycardia might manifest itself as gastrointestinal, neurological, psychosomatic symptoms, and unusual complaints in association with or without main symptoms, including palpitation, chest pain, syncope, and dyspnea. Symptoms after tachycardia or index event should be questioned systematically.

Synthetic Cannabinoids and Cardiac Arrhythmia Risk: Review of the Literature

Synthetic cannabinoids (SCBs) are widely used recreational substances especially among adults. Although they have been considered as safe during the marketing process, our knowledge about their adverse effects has evolved since years. SCBs are associated with various cardiac events including acute myocardial infarction and sudden cardiac death. There is also growing evidence that SCBs are associated with cardiac arrhythmia development both in acute and chronic exposure. SCBs have been shown to be associated with both supraventricular and ventricular arrhythmias. However, the exact mechanism of the SCB related arrhythmia remains unknown. Understanding the exact association and possible mechanisms may help us to identify high risk patients at an early stage and to develop treatment modalities to prevent or reverse the arrhythmic effects of SCBs.

Association between atrial septal aneurysm and arrhythmias

Objective. This study aimed to assess the association of atrial septal aneurysm (ASA) with cardiac arrhythmias by comparing patients with ASA with a control group with non-ASA, matched for age and gender. Methods. 641 patients with ASA who fulfilled the inclusion criteria were enrolled into the study. The control group consisted of 641 patients without ASA. Patients underwent physical, electrocardiographic and transthoracic echocardiographic examinations. Additional examinations such as transesophageal echocardiography, 24-h rhythm Holter monitoring, and electrophysiological study were performed when clinically needed. Results. There were no differences between the groups in respect to baseline demographic, clinical parameters and echocardiographic parameters except ischemic stroke and smoking status. Percentages of patients suffering from atrial premature complex (APC), ventricular premature complex (VPC), supraventricular tachycardia (SVT) and paroxysmal atrial fibrillation (AF) were higher in ASA patients compared to non-ASA patients. In addition, these parameters were independently associated with the presence of ASA in logistic regression analysis. Conclusions. Certain types of arrhythmias such as APC, VPC, SVT and paroxysmal AF have been shown to be independently associated with the presence of ASA.

Diagnostic challenges in supraventricular tachycardia: anticipating value of natriuretic peptides

It is important not to overlook supraventricular tachycardia (SVT) in patients complaining of palpitation or tachycardia-related symptoms but with normal ECG and heart rate in emergency department or outpatient clinics. The severity and presentation of symptoms is highly variable and depends on features including heart rate, duration of tachycardia, underlying heart disease, and individual patient perception. Early measurement of natriuretic peptides in patients presenting with palpitation and/or tachycardia-related symptoms would guide the clinician to rule out tachycardia and/or SVT. High levels of natriuretic peptides within 30 min of postattack period would certainly increase the likelihood of SVT.

Premature Ventricular Complex Causing Ice-Pick Headache

Ice pick headache is a momentary, transient, repetitive headache disorder and manifests with the stabbing pains and jolts. The exact mechanism causing this disease is unknown. Premature ventricular contractions are early depolarization of the ventricular myocardium and in the absence of a structural heart disease, it is considered to be a benign disease. In this report, we describe a male patient presenting with the symptom of momentary headache attacks accompanied with instant chest pain which is associated with premature ventricular contraction.

Asthma-like attacks terminated by slow pathway ablation

Asthma is a chronic airway disease in which the pathological mechanisms are reversible airway obstruction, bronchial hyper reactivity, and constriction of the lower airways. Supraventricular tachycardia (SVT) is a common arrhythmia which originates above the bundle of His and causing heart rates exceeding 150 beats/min. SVT patients present with palpitation, chest pain, chest discomfort, dyspnea, hyperventilation, and lightheadedness, occasionally. Besides, extraordinary presentations of SVT are available in literature. In this report, we describe a case of a patient presenting with treatment-resistant asthma-like attacks lasting for 20 years whom was suspected SVT as an underlying etiology and treated by slow pathway radiofrequency ablation.