182 History of stroke in patients with paroxysmal supraventricular tachycardia. clinical significance

Abstract

Atrial fibrillation (AF) is a major cause of embolic event, but the significance of other arrhythmias remains unknown. The purpose of study was to assess the significance of unexplained stroke in patients who had apparently only supraventricular tachycardia (SVT). Unexplained stroke was noted in 26 patients (pts) (group I) admitted for palpitations and electrophysiological study (EPS); they were issued from a population of 1002 pts with normal ECG in sinus rhythm, palpitations or tachycardia and with inducible SVT at EPS; 976 pts had no history of stroke (group II). EPS consisted of atrial pacing and programmed atrial stimulation in control state and if necessary after infusion of isoproterenol. Clinical and electrophysiological data of both groups were studied. Pts with stroke had a normal carotid ultrasound study and transcranial Doppler ultrasonography. Pts with unexplained stroke represent 2.5% of population with SVT. They were older than remaining pts without stroke (65±10 vs 50±19 years) (p 0.001). They have more frequently associated heart disease (8/26, 31% vs 37/976, 4%) (p < 0.001). Male gender was more frequent in group I (16/26, 60%) than in group II (355/956, 37%) (p< 0.05). Typical AV node re-entrant tachycardia was noted in 17 group I pts (65%) and 693/976 (68%) (NS); AV re-entrant tachycardia associated with a concealed accessory pathway was noted in 2 group I pts (8%) and 168 group I pts (17%) (NS); atypical AV node re-entrant tachycardia was more frequent in group I (7/26, 27%) than in group II (115/976, 12%) (p<0.05). AF induction was more frequent in group I (6/26, 23%) than in group II (35/976, 3.5%) (p< 0.001). Ablation was performed in 6 group I pts; one of them died from another stroke; another one died suddenly; another one developed a permanent AF. Old age, male gender, associated heart disease, and induction of atrial fibrillation were significant factors associated with the history of stroke in pts with SVT. They have a risk of adverse events during the follow-up. However, unexplained stroke was a rare event in patients with paroxysmal SVT, noted in 2.5% of this population.