Diagnosis Of Paroxysmal Supraventricular Tachycardia Research Articles

Characterising paroxysmal supraventricular tachycardia episodes by patient-perceived episode duration, symptoms, and severity: longitudinal patient-reported outcomes

Abstract Background/Information Paroxysmal supraventricular tachycardia (PSVT) encompasses a range of heart rhythms that are often associated with clinical symptoms. The duration and symptoms a patient experiences during a PSVT episode are variable. The impact of episode duration and symptom type on a patient’s perceived severity of an episode of PSVT has not been well defined. Purpose To characterise the relationship between duration, symptom type, and patient-perceived episode severity in a longitudinal study of patient-reported outcomes in the US and UK. Methods The survey included patients >18 years of age with a self-reported diagnosis of PSVT, without a history of ablation. Surveys included a 30-minute baseline survey (Mar 2019), 5-minute weekly tracking surveys (Mar 2019 to Dec 2019), and a 15-minute closing survey (Dec 2019). Patients were asked during the baseline survey to rate the severity of their PSVT (mild/moderate/severe). Weekly episode surveys assessed patient-reported episode duration, symptoms, severity, and interventions. If multiple episodes occurred, characteristics of the most recent episode were assessed. Results Among 117,252 patients screened, 368 met the inclusion criteria and completed the baseline survey, while 247 patients in the final cohort met the quality control checks. Most patients were White (92%), female (70%), and from the US (80%) and had a mean age of 52 years. At baseline, 47% of patients described their PSVT as moderate severity, while 39% reported mild and 14% reported severe. Overall, 5277 longitudinal weekly surveys were completed, of which 48% captured a PSVT episode (n=2518). Median reported duration of an episode was 15 minutes, with severe episodes having numerically longer duration (71 minutes) than moderate (20 minutes) or mild (6 minutes) episodes. Among severe episodes, 57% lasted 1 hour or longer; only 9% of mild episodes lasted 1 hour or longer (Figure 1). Among all assessed episodes of PSVT, 89% had palpitations, 35% shortness of breath, 26% dizziness, and 17% chest pain; mean number of symptoms per episode was 3.1, while numerically more symptoms were reported with severe episodes (mean 6.0) than with moderate (mean 3.5) or mild (mean 2.1) episodes. Shortness of breath was more frequently reported with severe episodes (81%) than with moderate (43%) or mild (17%) episodes. Similar findings were seen with dizziness and chest pain (Figure 2). Overall, approximately half of the reported episodes during follow-up were classified as moderate severity (47%), followed by mild (44%) and severe (9%). Conclusions Episodes of PSVT of longer duration and/or accompanied by a greater number of symptoms are reported by patients to be more severe. However, heterogeneity of symptoms and episode duration is substantial within a given classification of PSVT severity. Additional studies are needed to better understand how the optimal treatment of patients with PSVT may vary by duration, symptoms, and severity.

A Clinical Score for Predicting the Paroxysmal Supraventricular Tachycardia's Recurrence Risk; a Retrospective Cross-sectional Study.

Identifying prognostic variables associated with the probability of recurrent paroxysmal supraventricular tachycardia (PSVT) would aid decision-making regarding disposition of the patients. This study aims to develop a clinical scoring system to predict PSVT recurrence after adenosine administration in the emergency department (ED). This retrospective cross-sectional study was conducted on patients who were referred to the emergency department of Ramathibodi Hospital, a university-affiliated super-tertiary care hospital in Bangkok, Thailand, with diagnosis of PSVT during a 10-year period from 01 January 2010 until 31 December 2020. The cases were divided into recurrent and non-recurrent PSVT based on the response to standard treatment and the independent predictors of recurrence were studied using multivariable logistic regression analysis. 264 patients were diagnosed with PSVT and successfully converted by adenosine. 24 (9.1%) had recurrent PSVT, and 240 (90.9%) had no recurrent PSVT in the same ED visit. The risk of PSVT recurrence in ED corresponded with the history of hypertension (p = 0.059), valvular heart disease (p = 0.052), heart rate ≥ 100 (p = 0.012), and systolic blood pressure < 100 after electrocardiogram (ECG) converted to sinus rhythm (p = 0.022) and total dose of adenosine (p = 0.002). We developed a clinical prediction score of PSVT recurrence with an accuracy of 79.5%. A score of 0 (low risk), 1-2 (moderate risk), and > 2 (high risk) had a positive likelihood ratio (LR+) of 0.31, 0.56 and 2.33, respectively. It seems that, using the PSVT recurrence score we could screen the high-risk patients for PSVT recurrence (score>2) who need to be observed for at least 6-12 hours and receive cardiologist consultation in ED. In addition, the moderate and low-risk group (score 0-2) need to be observed for 1 hour and can be discharged from ED.

Trends in health care resource use and expenditures in patients with newly diagnosed paroxysmal supraventricular tachycardia in the United States

Few data are available on the temporal patterns of health resource utilization (HRU) and expenditures around paroxysmal supraventricular tachycardia (PSVT) diagnosis. This study assessed the longitudinal trends in HRU and expenditures in the 3 years preceding and subsequent to PSVT diagnosis. Adult patients (age 18-65 years) with newly diagnosed PSVT were identified using administrative claims from the IBM MarketScan Research Database between January 1, 2008 and December 31, 2016 and propensity-score matched (1:1) with non-PSVT controls. Among the 12,305 PSVT patients compared with matched controls, PSVT was associated with statistically significant higher annual rates of emergency department visits, physician office visits, inpatient hospitalizations, and diagnostic testing. HRU increased in the years preceding PSVT diagnosis, reaching its peak in the year following PSVT diagnosis. Over the 6-year follow-up period, PSVT was associated with higher mean annual per patient expenditures ($12,665) compared to matched controls ($6,004; P < .001). Upon diagnosis of PSVT, the mean expenditures per PSVT patient doubled from $11,714 in the year immediately preceding index diagnosis to $23,335 in the first postdiagnosis year. Inpatient services, diagnostic testing, and ablation procedures were the principle drivers of higher mean expenditures in the first year post-PSVT diagnosis versus the year prior to PSVT diagnosis. PSVT presents a substantial economic burden to health care systems. The annual expenditure per PSVT patient is within the range previously reported for atrial fibrillation. The increased HRU and expenditures in the year following diagnosis, which do not return to baseline, suggest a potential gap in non-interventional, long-term PSVT management.

PCV22 Trends in Diagnostic Testing Utilization and Expenditures in Patients with NEWLY Diagnosed Paroxysmal Supraventricular Tachycardia in the United States

Few data are available on longitudinal trends in health resource utilization and expenditures for paroxysmal supraventricular tachycardia (PSVT). We sought to assess the trends in diagnostic testing and expenditures around the time of PSVT diagnosis in a large, nationwide cohort. Adults (age 18 to 65 years) with newly diagnosed PSVT were identified in IBM MarketScan between 1/1/08 and 12/31/16. Patients were observable for three years before and after PSVT diagnosis. PSVT patients were propensity-score matched (1:1) with non-PSVT controls. Over the 6-year period around PSVT diagnosis, trends in the variation in diagnostic testing use and expenditures were evaluated. Among 24,624 matched patients, PSVT was associated with a higher rate of diagnostic testing (1292 tests per 1000 patient-years [PYs] vs. 313 per 1000 PYs; p<0.001). Diagnostic testing increased leading up to PSVT diagnosis, peaking in the year preceding and the year following PSVT diagnosis and remaining elevated after PSVT diagnosis, relative to matched controls. Among PSVT patients, the most common diagnostic tests were electrocardiograms (878 per 1000 PYs), echocardiograms (205 per 1000 PYs), event monitoring (205 per 1000 PYs), and stress testing (108 per 1000 PYs). Diagnostic testing accounted for 10% of the $12,675 mean annual expenditures for PSVT patients. Diagnostic testing was more common in PSVT than non-PSVT patients in both the pre- and post-diagnosis periods. A diagnosis of PSVT is resource intensive and expensive, and further research is required to determine the appropriate frequency of diagnostic testing and optimal patient care pathway.

Abstract 392: Incidence Of Paroxysmal Supraventricular Tachycardia In The United States

Background: Paroxysmal supraventricular tachycardia (PSVT) encompasses a range of heart rhythm disorders that lead to abrupt increases in heart rate. Given its episodic nature, PSVT can be difficult to capture in a clinical setting. Therefore, estimating incidence of PSVT is challenging and thus limited data is available on the incidence of this disease. Objective: Estimate the incidence of PSVT within the United States in contemporary practice. Methods: Using claims, enrollment, and demographic data from the IBM Marketscan® Commercial Research Database (&lt;65y) and the Medicare Limited Dataset (≥65y), individuals enrolled in health plans for at least 5 continuous years from 2008-2016 were identified. Patients having claims with a PSVT diagnosis (ICD-9: 427.0; ICD-10 I47.1) on 2+ outpatient visits, 1+ ED visit, or 1+ inpatient admission were included in the analysis. Only patients receiving an initial diagnosis of PSVT in year 5 of continuous enrollment were included in the incidence calculation in order to avoid including prevalent cases. Incidence was projected to the US population based on the 2018 US census data. Results: Among 18,057,297 patients, 86,614 met PSVT criteria. Incidence rates were higher in female and older patients. Within the 18-44y group, the incidence rate was 1.9-fold higher for females as compared to males. Overall incidence rate per 100,000 was 79.1 and 107.2 for males and females respectively (Table). Projected to the 2018 US Census, there were 305,548 incident PSVT cases in 2018. Conclusion: There were over 305,000 incident cases of PSVT in 2018 with higher rates in female and older patients. Further studies are needed to understand practice patterns in management of PSVT, given the high incidence of this disease.

Abdominal Pain as an Initial Manifestation of Paroxysmal Supraventricular Tachycardia in Children

Objectives: The aim of this study was to evaluate the importance of abdominal pain in children with paroxysmal supraventricular tachycardia (PSVT). Methods: The authors reviewed the medical records of patients aged between three and 18 years old, who were diagnosed and treated for PSVT between March, 2011 and February, 2016. According to the presence of abdominal pain, they were grouped and analyzed for the difference of patient’s age, gender, interval between symptom onset and diagnosis, response to adenosine infusion, and the relationship with levels of N-terminal fragments of pro-brain natriuretic peptide (NT-proBNP). Results: A total of 43 patients (24 males and 19 females) were registered and the mean age at diagnosis of PSVT was 10.65 ± 4.81 years old. Although palpitation was the most common symptom (n = 29, 67.4 %), abdominal pain was also common (n = 18, 41.9%) with more frequent symptoms under 10 years old (n = 15/16, 93.8% versus n = 3/27, 11.1% in older than 10 years old). The PSVT patients with abdominal pain (group 1) were younger, had more frequent vomiting, less palpitation, and longer time to diagnosis of PSVT than subjects without this complication (group 2). In group 1, the level of NT-proBNP was shown significantly higher than group 2 (776.07 ± 913.57 versus 93.72 ± 51.25 pg/mL, P < 0.001). Conclusions: Abdominal pain may be an initial presentation of PSVT in children, especially under 10 years old.

Supraventricular tachycardia diagnosed by smartphone ECG

Diagnosis of paroxysmal supraventricular tachycardia (PSVT) may be difficult due to its episodic nature, which can be brief and self-limited, limiting the ability for clinicians to diagnose the specific rhythm...

SUPRAVENTRICULAR TACHYCARDIA DIAGNOSED BY SMARTPHONE ELECTROCARDIOGRAPHY

Timely diagnosis of paroxysmal supraventricular tachycardia (PSVT) is difficult due to its episodic and unpredictable nature. Advances in smartphone technology have enabled wireless, single-lead, real-time electrocardiogram (ECG) recording without the need for traditional ECG monitors. We present

Electrophysiological study generally is negative in patients < 40 years suspected of supraventricular tachycardia but also complaining of chest pain and/or syncope

BackgroundThe diagnosis of paroxysmal supraventricular tachycardia (SVT) frequently is a dilemma. Electrophysiological study (EPS) is the only means to evaluate the nature of symptoms when noninvasive studies remain negative. Our objectives were to determine the clinical factors of negativity or positivity of (EPS) in patients suspected of SVT. MethodsEPS was performed in 2650 patients complaining of tachycardia and suspected of SVT. Transesophageal EPS consisted of programmed atrial stimulation in control state and after isoproterenol. Patients were followed from 1month to 18years (2.93±4years). ResultsSVT was induced in 1944 patients, age 48±19.5. EPS remained negative in 706 patients, age 34±17 (p<0.0001). Age <40years, feeling of dizziness/syncope or chest pain associated with tachycardia, the absence of heart disease or short PR interval was more frequent in patients with negative EPS (respectively 64, 42, 26, 96, 88.5%) than in patients with induced SVT (34, 14, 4, 88, 59%) (p<0.0001).The positive predictive value for the prediction of a negative EPS of age <40, chest pain, syncope or their association was 63.5, 42, 26.5, 11% and negative predictive value was 66, 86, 94.5, 99.5%. At multivariate analysis, age <40 (0.000, OR 2.79), the presence of syncope associated with tachycardia (0.000, OR 5.075) or chest pain (0.000, OR 17.923) was an independent factor of negative EPS. ConclusionsAmong patients complaining of nondocumented tachycardia, suspected of SVT, the association of tachycardia with chest pain and/or syncope and age <40years generally was correlated with a negative EPS and did not indicate initially invasive studies. In the remaining patients transesophageal EPS is indicated.

Abstract 17883: Racial and Insurance disparities in Paroxysmal Supraventricular Tachycardia Ablation

Objective: To identify racial and/or health insurance disparities in the population undergoing ablation for paroxysmal supraventricular tachycardia(PSVT). Method: We identified adult patients (pts) admitted with principle diagnosis of PSVT by ICD 9 code 427.0 who had catheter ablation (ICD 9 code - 37.34), using the Nationwide Inpatient Sample (2000-2011). We stratified patients by race (White, Black, Hispanic, and other minority racial groups)and insurance status, and a hierarchical mixed effect multivariate model was created to identify independent predictors of PSVT ablation. Results: 64,564(20.2%) patients underwent ablation out of 319,579 patients admitted for PSVT during the period of 2000-2011. In absolute numbers, the majority of ablations were performed in Whites (58.7%) and patients with Medicare (56.3%) or private insurance (30.1%). After adjusting for confounding factors, the odds of having ablation were lower in Black pts (compare to White), and Medicare, Medicaid, and Uninsured pts (compare to private insurance) (see table). Other predictors of lower rate of ablations were: older age and female patients while odds of receiving ablation were higher for elective admissions and in teaching hospitals (p&lt;0.001 for all comparisons). Conclusion: In a population of pts admitted for PSVT, those without private insurance and Black pts were less like to be treated with catheter ablation; and, this disparity persisted from 2000-2011. Since catheter ablation for PSVT is generally considered a curative procedure, future studies are needed to identify the factors that lead to these disparities of care.

Termination of paroxysmal supraventricular tachycardia with P6 acupressure

To the Editor: Paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia characterized with sudden onset of regular and narrow QRS complex tachycardia. P6 (Neiguan) is a well-known acupoint lessening postoperative nausea and vomiting (PONV) [1]. Here, we present a case of PSVT successfully terminated by P6 acupressure during anesthesia. A 51-year-old woman underwent titanium plate removal surgery with spinal anesthesia. Preoperative 12-lead electrocardiogram (ECG) showed sinus rhythm and normal heart rate (Supplementary Fig. 1). Spinal anesthesia was performed with ropivacaine 15 mg, and adequate anesthesia was controlled at the L1 level. When the supine posture was changed to Trendelenburg position, she complained of chest tightness. Her BP was 131/84 mmHg. The ECG showed a narrow complex tachycardia with heart rate of 138–160 beats per minute and absence of P waves. ST depression with 3 mm is also noted in lead II (Supplementary Fig. 2). A diagnosis of PSVT was made. Immediate management included changing to supine posture, carotid sinus massage, and slight ocular compression, but these interventions failed. Just before adenosine (50 lg/kg) was given intravenously, P6 acupressure was suggested. Obtaining the patient’s permission, P6 acupressure was performed with the thumb for continuous compression at the acupoint. To our surprise, her heart rate dropped to 76 bpm in 5 s, and the ECG converted to sinus rhythm from then on (Supplementary Fig. 3). No further episodes of PSVT occurred, and she was discharged home 5 days later. P6 stimulation was reported to reduce heart rate through increasing vagal modulation [2]. Compared with vagal stimulation maneuvers and anti-arrhythmic drugs, P6 acupressure is relative safe and easy to perform. Further confirmation should include randomized controlled clinical studies.

Stroke : Highlights of Selected Articles

HomeStrokeVol. 44, No. 6Stroke: Highlights of Selected Articles Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBStroke: Highlights of Selected Articles Scott B. Silverman, MD Scott B. SilvermanScott B. Silverman Search for more papers by this author Originally published1 Jun 2013https://doi.org/10.1161/STROKEAHA.113.002000Stroke. 2013;44:1499Paroxysmal Supraventricular Tachycardia and the Risk of Ischemic StrokeAtrial fibrillation and atrial flutter are currently the only cardiac arrhythmias known to be risk factors for ischemic stroke. Patients with cardioembolic-appearing stroke have supraventricular arrhythmias more often than patients with other types of stroke. Multiple studies have also shown a link between frequent supraventricular ectopy and stroke in the absence of atrial fibrillation. Paroxysmal supraventricular tachycardia (PSVT) affects mostly older patients who have a high burden of cardiovascular disease. Atrial fibrillation is associated with PSVT. The current retrospective study by Kamel et al sought to demonstrate a possible association between PSVT and stroke. They reviewed ≈4.8 million patients from emergency room visits and hospitalizations at California’s nonfederal acute care hospitals in 2009. Of these patients, >14 000 (0.29%) were diagnosed with PSVT, and >14 000 (0.30%) had a diagnosis of ischemic stroke. Patients with PSVT were older and had significantly more cardiovascular risk factors than patients without PSVT. The cumulative stroke rate after the diagnosis of PSVT (0.94%) significantly exceeded the rate among patients without PSVT (0.21%; P<0.001). Stroke occurred a median of 70 days after index visit. PSVT was independently associated with a higher risk of subsequent stroke (hazard ratio, 2.10). An age cutoff existed such that PSVT was associated with a higher risk of stroke in patients ≥65 years old. This is an important work, for PSVT may be an independent risk factor for ischemic stroke and thus accounts for a proportion of stroke currently classified as cryptogenic. Further prospective studies are needed. See p 1550.Incidence and Predictors of Late Seizures in Intracerebral HemorrhagesThe Prognosis of InTra-Cerebral Hemorrhage cohort is an observational cohort at the Lille University Hospital in France. Early seizures were classified as ≤7 days and late seizures (LSs) as >7 days after stroke onset. The authors previously reported an early seizure incidence of 14%. Early seizures in this cohort were associated with cortical intracerebral hemorrhage and did not influence in-hospital mortality or 6-month outcome. The current study population consisted of 324 patients. During 778 person-years of follow-up, 31 patients developed ≥1 LS, resulting in an incidence rate of 4 new cases/100 person-years. Nine months were the median delay between intracerebral hemorrhage and LS. Cortical involvement of the intracerebral hemorrhage was the only factor independently associated with LS. Lobar microbleeds were predictors of LS as well. Early seizures were not predictive of LSs. Interestingly, LSs were associated with a worse functional outcome after 3 years of follow-up. Further prospective studies are needed to confirm these findings. It would be interesting to know as well whether location of the cortical hemorrhage and microbleed differed significantly with the risk of LS. See p 1723. Previous Back to top Next FiguresReferencesRelatedDetails June 2013Vol 44, Issue 6 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.113.002000 Originally publishedJune 1, 2013 PDF download Advertisement

Paroxysmal Supraventricular Tachycardia and the Risk of Ischemic Stroke

It is unknown whether supraventricular arrhythmias other than atrial fibrillation or flutter are associated with stroke. To examine the association between paroxysmal supraventricular tachycardia (PSVT) and stroke, we performed a retrospective cohort study using administrative claims data from all emergency department encounters and hospitalizations at California's nonfederal acute care hospitals in 2009. Our cohort comprised all adult patients with ≥ 1 emergency department visit or hospitalization from which they were discharged alive and without a diagnosis of stroke. Our primary exposure was a diagnosis of PSVT recorded at an encounter before stroke or documented as present-on-admission at the time of stroke. To reduce confounding, we excluded patients with diagnoses of atrial fibrillation. We defined PSVT, stroke, and atrial fibrillation using International Classification of Diseases, Ninth Revision, Clinical Modification codes previously validated by detailed chart review. Of 4 806 830 eligible patients, 14 121 (0.29%) were diagnosed with PSVT and 14 402 (0.30%) experienced a stroke. The cumulative rate of stroke after PSVT diagnosis (0.94%; 95% confidence interval, 0.76%-1.16%) significantly exceeded the rate among patients without a diagnosis of PSVT (0.21%; 95% confidence interval, 0.21%-0.22%). In Cox proportional hazards analysis controlling for demographic characteristics and potential confounders, PSVT was independently associated with a higher risk of subsequent stroke (hazard ratio, 2.10; 95% confidence interval, 1.69-2.62). In a large and demographically diverse sample of patients, we found an independent association between PSVT and ischemic stroke. PSVT seems to be a novel risk factor that may account for some proportion of strokes that are currently classified as cryptogenic.

207 Incidence and clinical significance of the asssociation of paroxysmal supraventricular and ventricular tachycardia

Fine-QRS complex tachycardia alternating with wide-QRS complex tachycardia can lead to an erroneous diagnosis of paroxysmal supraventricular tachycardia (SVT) with or without aberrancy. The purpose of the study was to evaluate the incidence and the significance of the association of SVT and ventricular tachycardia (VT) in the same patient. 898 patients aged from 11 to 88 years were consecutively admitted for a sustained VT; 818 patients had associated heart disease (history of myocardial infarction 374, idiopathic dilated cardiomyopathy 69, arrhythmogenic right ventricular dysplasia 86, miscellaneous 289) and 80 had no apparent heart disease. Electrophysiological study including programmed atrial and ventricular stimulation, 2D cardiac echocardiography, coronary angiography in patients older than 40 years, right ventricular angiography and cardiac RMI since 2002, were performed in these patients. Fifteen patients presented (2%) with either SVT or VT. All SVT's were related to an atrioventricular node reentrant tachycardia (AVNRT). The association of SVT and VT was significantly more frequent in patients without heart disease and with verapamil-sensitive VT (n=6/80, 7.5%)(<0.001), arrhythmogenic heart disease (n=4/86, 5%)(0.05) than in those with myocardial infarction (n=4/374, 0.1%) or dilated cardiomyopathy (n=0). Among 692 patients with AVNRT, 39 had associated heart disease and only 5 have both tachycardias. Radiofrequency ablation of AVNRT performed in all patients did not change the recurrence of VT which required ablation in 3 patients and the implantation of antitachycardia device with defibrillator in 2 patients. The association of SVT and VT is rare in patients with heart disease except in those with arrhythmogenic right ventricular dysplasia. The association is more frequent in patients without heart disease diagnosis and could be underestimated; fine QRS complex tachycardia alternating with wide QRS complex tachycardia leads generally to the erroneous diagnosis of SVT with or without aberrancy.

The combined use of esophageal electrocardiogram and multiple right parasternal chest leads in the diagnosis of PSVT and determination of accessory pathways involved: A new simple noninvasive approach

Introduction Paroxysmal Supraventricular Tachycardia (PSVT) resulting from any cause can at times lead to diagnostic difficulty mainly when due to AVNRT and AVRT. In this study we used a non-invasive approach using esophageal ECG (ECGe) and ECG derived from the various right parasternal chest leads (RPCL) to correctly diagnose the type of PSVT as well the accessory pathways involved in AVRT. Methods and results We studied a total of 161 patients (89 male) all having a history of palpitation. All the patients underwent routine 12 lead ECG, ECGe, RPCL and electrophysiologic study. With use of ECGe and RPCL, 71 (44.1%) were diagnosed as having AVNRT and 90 (55.9%) having AVRT with various accessory pathways compared to only 49 (30.4%) and 22 (13.7%) respectively with routine 12 lead ECG. With combined ECGe and RPCL, 80 (49.7%) showed accessory pathway in the left free wall, 4 (2.5%) showed in the right free wall, 6 (3.7%) septal accessory pathway, 60 (37.3%) in the anterior wall and 30 (18.6%) in the posterior wall. In comparison, EPS could show accessory pathways in the left free wall in 81 (50.3%), in the right free wall in 5 (3.1%), in the septum in 4 (2.5%), in the anterior wall in 53 (32.9%) and in the posterior wall in 37 (23.0%) out of the 161 patients. Conclusions ECGe + RPCL can be used as a reliable noninvasive diagnostic tool to identify the nature of tachycardia and the pathways involved in the reentrant ring of PSVT especially in those with multiple atrioventricular accessory pathways or a combination of atrioventricular accessory pathways and dual atrioventricular nodal pathway.

Unrecognized Paroxysmal Supraventricular Tachycardia

The diagnostic criteria for panic disorder include symptoms commonly experienced by patients with paroxysmal supraventricular tachycardia (PSVT). Since electrocardiographic documentation of PSVT can be elusive, symptoms may be ascribed to other conditions. To systematically evaluate the potential for PSVT to simulate panic disorder. A retrospective survey of 107 consecutive patients with reentrant PSVT was conducted. Objective and subjective assessments of PSVT symptomatology were made, including the application of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), panic disorder criteria. The criteria for panic disorder according to DSM-IV were fulfilled by 67% of patients. Paroxysmal supraventricular tachycardia was unrecognized after initial medical evaluation in 59 patients (55%), including 13 (41%) of 32 patients with ventricular preexcitation by electrocardiogram, and remained unrecognized for a median of 3.3 years. Prior to eventual identification of PSVT, physicians (nonpsychiatrists) attributed symptoms to panic, anxiety, or stress in 32 (54%) of the 59 patients. When PSVT was unrecognized, women were more likely than men to have symptoms ascribed to psychiatric origins (65% vs 32%, respectively; P < .04). Paroxysmal supraventricular tachycardia was detected in only 6 (9%) of 64 patients undergoing Holter monitoring vs 8 (47%) of 17 patients who wore an event monitor (P < .001). During a 20-month median follow-up, electrophysiologically guided therapy (ablation in 81% of patients) resolved symptoms in 86% of patients; only 4% continued to meet DSM-IV panic disorder criteria without evidence of PSVT recurrence. The clinical characteristics of patients with PSVT referred for electrophysiologically guided therapy can mimic panic disorder. Diagnosis of PSVT is often delayed by inappropriate rhythm detection techniques (Holter instead of event monitoring) and failure to recognize ventricular preexcitation on the sinus electrocardiogram; symptoms due to unrecognized PSVT are often ascribed to psychiatric conditions.

Is the Analysis of ST Segment and T Wave during Tachycardia Useful in the Differential Diagnosis of Paroxysmal Supraventricular Tachycardia

Is the Analysis of ST Segment and T Wave during Tachycardia Useful in the Differential Diagnosis of Paroxysmal Supraventricular Tachycardia

Intravenous adenosine as first-line prehospital management of narrow-complex tachycardias by EMS personnel without direct physician control

This study was conducted to evaluate the safety and efficacy of intravenous adenosine therapy for prehospital treatment of narrow-complex tachycardias with a presumptive field diagnosis of paroxysmal supraventricular tachycardia (PSVT) by paramedics without direct physician control. A ten-month prospective case series was designed in an urban EMS system that has paramedics operating under standing orders before physician radio contact. All patients with PSVT field diagnosis were included. Diagnosis of PSVT was made by regular, narrow-complex tachycardia with a heart rate greater than 160 beats/min by field ECG. Interpretation was performed solely by paramedics; ECG transmission was not available. In hemodynamically stable patients, vagal maneuvers were followed by intravenous placement and administration of adenosine was recommended by the manufacturer. If three adenosine boluses failed to convert the arrhythmia, patients were monitored and transported, with electrical cardioversion available. Data collection included demographic, history, medications, vital signs, and EGG tracings. Of 14 included patients, 31 were correctly diagnosed with PSVT (75.6%), with mean ventricular rate of 205 beats/min (SD 7 beats/min); one had sinus tachycardia; nine had atrial fibrillation (AF) (22%). Of the 31 cases correctly diagnosed as PSVT, 28 converted to sinus rhythm after adenosine (90.3%). Of those converted, 16 required a single dose (57.1%), nine required one additional dose (32.1%), and three required two additional doses (10.8%). None reverted to PSVT after adenosine conversion during the study period (conversion to arrival at emergency department). No significant difference in length of asystolic pause or in outcome was detected between the true PSVT cases and the AF cases receiving adenosine.(ABSTRACT TRUNCATED AT 250 WORDS)

Intravenous adenosine in the prehospital treatment of paroxysmal supraventricular tachycardia

Study objective: To determine the clinical efficacy and safety of IV adenosine administration in the field for the treatment of paroxysmal supraventricular tachycardia (PSVT). Design: Prospective, consecutive case series. Setting: An urban emergency medical services system. Participants: Thirty-seven adult patients in whom paramedics made the diagnosis of PSVT. Interventions: Six milligrams of adenosine was administered by rapid IV bolus. If there was no effect within two minutes, a 12-mg bolus was given. This dose was repeated once if necessary. If there still was no effect, the medical command physician was contacted for further management. Measurements: Vital signs, symptoms, and a single-channel ECG were recorded before, during, and after the administration of adenosine. Results: On review of the ECG tracings, 26 patients (70%) were in PSVT. Eleven had rhythms other than PSVT on review, including five with atrial fibrillation, four with sinus tachycardia, and two with ventricular tachycardia. Of the 26 patients with PSVT, 23 (88%) converted to sinus rhythm after adenosine administration. Eleven patients were hypotensive at presentation. Seven of these were in PSVT and became hemodynamically stable on conversion with adenosine. The four hypotensive patients with rhythms other than PSVT (two with atrial fibrillation and two with ventricular tachycardia) had no change in blood pressure after adenosine administration. Nine patients were subsequently found to have wide-complex tachycardia. None of these patients suffered hemodynamic compromise after adenosine administration, and side effects were infrequent, mild, and transient. Conclusion: Adenosine appears to be effective and safe for the prehospital treatment of PSVT.

Intracardiac stimulation for the diagnosis of arrhythmia.

Intracardiac stimulation (IS) has been widely used as the diagnostic method for various kinds of arrhythmias. Our results as to IS are as follows: 1) Since sinus recovery time (SNRT) closely correlated with basic cycle length (BCL) in 71 normal cases (r = 0.82, p less than 0.001), upper range of SNRT in normal was expressed as SNRT = 1.4BCL + 451 msec. 2) Paroxysmal supraventricular tachycardia (PSVT) induced by IS was fairly similar to the spontaneous PSVT (107 cases). Therefore, IS can be used to confirm the diagnosis of PSVT and also to evaluate the effectiveness of antiarrhythmic agents on PSVT. 3) Although induction or termination of ventricular tachycardia by IS may be useful in a general sense, dangerous tachyarrhythmias were sometimes provoked, indicating this test should be carried out under the utmost care.