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.