Skip to main content
SpringerLink
Log in

Is paroxysmal supraventricular tachycardia truly benign? Insightful association between PSVT and stroke from a National Inpatient Database Study

  • MULTIMEDIA REPORT
  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Atrial fibrillation and flutter are well-known causes of stroke. Whether other atrial arrhythmias categorized as paroxysmal supraventricular tachycardia (PSVT) are associated with stroke is less clear. We aimed to evaluate the association of PSVT with ischemic and embolic stroke and its impact on short-term outcomes in hospitalized stroke patients.

Methods

National Inpatient Sample database of the USA was used to assess the association of PSVT with ischemic stroke. Atrial fibrillation and flutter were excluded to minimize the confounding effects. The association of PSVT with stroke was evaluated using univariate and multivariate analysis. Subgroup analyses by gender, age, and stroke type were also performed.

Results

PSVT was associated with increased odds of overall ischemic stroke in univariate [OR 1.18 (95% CI 1.09–1.27) p < 0.001] analysis. No such association was observed in multivariate analysis (OR 1.06 (95% CI 0.98–1.14) p = 0.1) or with subgroup analysis by gender and age. However, PSVT was associated with embolic stroke in both univariate (OR 2.01 (95%CI 1.67–2.43, p < 0.001) and multivariate analysis (OR 1.7 (95%CI 1.4–2.14) p < 0.001) as well as in subgroup analyses by gender and age. Furthermore, the presence of PSVT was associated with increased mortality in embolic stroke (OR 4.11, CI 2.29 to 7.39, p < 0.001) and increased total hospital cost and length of hospital stay in all stroke types.

Conclusions

PSVT is independently associated with higher prevalence of embolic stroke but not with overall ischemic stroke. Patients with embolic stroke in the presence of PSVT have worse in-hospital outcomes with increased mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

PSVT:

Paroxysmal supraventricular tachycardia

AF:

Atrial fibrillation

AFl:

Atrial flutter

CI:

Confidence interval

OR:

Odds ratio

NIS:

National Inpatient Sample

ICD:

International Classification of Disease

References

  1. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Lond Engl. 2014;383:245–54.

    Article  Google Scholar 

  2. Demaerschalk BM, Hwang H-M, Leung G. US cost burden of ischemic stroke: a systematic literature review. Am J Manag Care. 2010;16:525–33.

    PubMed  Google Scholar 

  3. Ferro JM. Cardioembolic stroke: an update. Lancet Neurol. 2003;2:177–88.

    Article  Google Scholar 

  4. Binici Z, Intzilakis T, Nielsen OW, et al. Excessive supraventricular ectopic activity and increased risk of atrial fibrillation and stroke. Circulation. 2010;121:1904–11.

    Article  CAS  Google Scholar 

  5. Go AS, Hlatky MA, Liu TI, et al. Contemporary Burden and Correlates of Symptomatic Paroxysmal Supraventricular Tachycardia. J Am Heart Assoc 2018; 7.

  6. Miyamoto KJ, Tsuchihashi K, Uno K, Shimoshige SY, Yoshioka N, Doi A, et al. Studies on the prevalence of complicated atrial arrhythmias, flutter, and fibrillation in patients with reciprocating supraventricular tachycardia before and after successful catheter ablation. Pacing Clin Electrophysiol. 2001;24:969–78.

    Article  CAS  Google Scholar 

  7. Kamel H, Elkind MSV, Bhave PD, Navi BB, Okin PM, Iadecola C, et al. Paroxysmal supraventricular tachycardia and the risk of ischemic stroke. Stroke. 2013;44:1550–4.

    Article  CAS  Google Scholar 

  8. Chiang J-K, Kao H-H, Kao Y-H. Association of paroxysmal supraventricular tachycardia with ischemic stroke: a national case-control study. J Stroke Cerebrovasc Dis. 2017;26:1493–9.

    Article  Google Scholar 

  9. Anon. HCUP-US NIS Overview. Available at: https://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed June 9, 2018.

  10. Goldstein LB. Accuracy of ICD-9-CM coding for the identification of patients with acute ischemic stroke: effect of modifier codes. Stroke. 1998;29:1602–4.

    Article  CAS  Google Scholar 

  11. Alhadramy O, Jeerakathil TJ, Majumdar SR, Najjar E, Choy J, Saqqur M. Prevalence and predictors of paroxysmal atrial fibrillation on Holter monitor in patients with stroke or transient ischemic attack. Stroke. 2010;41:2596–600.

    Article  Google Scholar 

  12. Khachab H, Brembilla-Perrot B. Prevalence of atrial fibrillation in patients with history of paroxysmal supraventricular tachycardia. Int J Cardiol. 2013;166:221–4.

    Article  CAS  Google Scholar 

  13. Hamer ME, Wilkinson WE, Clair WK, Page RL, McCarthy E, Pritchett EL. Incidence of symptomatic atrial fibrillation in patients with paroxysmal supraventricular tachycardia. J Am Coll Cardiol. 1995;25:984–8.

    Article  CAS  Google Scholar 

  14. Healey JS, Connolly SJ, Gold MR, Israel CW, van Gelder I, Capucci A, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012;366:120–9.

    Article  CAS  Google Scholar 

  15. Meiltz A, Zimmermann M. Atrioventricular nodal reentrant tachycardia in the elderly: efficacy and safety of radiofrequency catheter ablation. Pacing Clin Electrophysiol. 2007;30(Suppl 1):S103–7.

    PubMed  Google Scholar 

  16. Kohsaka S, Sciacca RR, Sugioka K, Sacco RL, Homma S, di Tullio MR. Electrocardiographic left atrial abnormalities and risk of ischemic stroke. Stroke. 2005;36:2481–3.

    Article  Google Scholar 

  17. Katoh S, Honda S, Watanabe T, Suzuki S, Ishino M, Kitahara T, et al. Atrial endothelial impairment through Toll-like receptor 4 signaling causes atrial thrombogenesis. Heart Vessel. 2014;29:263–72.

    Article  Google Scholar 

  18. Kamel H, Okin PM, Longstreth WT, et al. Atrial cardiopathy: a broadened concept of left atrial thromboembolism beyond atrial fibrillation. Futur Cardiol. 2015;11:323–31.

    Article  CAS  Google Scholar 

  19. Sanna T, Diener H-C, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014;370:2478–86.

    Article  CAS  Google Scholar 

  20. Alkhouli M, Alqahtani F, Aljohani S, Alvi M, Holmes DR. Burden of Atrial Fibrillation-Associated Ischemic Stroke in the United States. JACC Clin Electrophysiol. 2018;4:618–25.

    Article  Google Scholar 

  21. Bybee KA, Prasad A. Stress-related cardiomyopathy syndromes. Circulation. 2008;118:397–409.

    Article  Google Scholar 

  22. Abboud H, Berroir S, Labreuche J, Orjuela K, Amarenco P, GENIC Investigators. Insular involvement in brain infarction increases risk for cardiac arrhythmia and death. Ann Neurol. 2006;59:691–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Garden City Hospital, Garden City, MI, USA

    Sharan Prakash Sharma & Ashok Kondur

  2. The Kansas City Heart Rhythm Institute, HCA MidWest Health, 12200 West 106th Street, Suite 320, Overland Park, KS, Overland Park, KS, 661215, USA

    Rakesh Gopinathannair & Dhanunjaya Lakkireddy

  3. Quivira Internal Medicine, Overland Park Regional Medical Center, Overland Park, KS, USA

    Timothy Kamerzell

  4. Section of Electrophysiology, Massachusetts General Hospital, Boston, MA, USA

    Moussa Mansour

  5. Abbott Laboratories, Minneapolis, MN, USA

    Srijoy Mahapatra

  6. Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland

    Krzysztof Bartus

Authors
  1. Sharan Prakash Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashok Kondur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rakesh Gopinathannair
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Timothy Kamerzell
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Moussa Mansour
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Srijoy Mahapatra
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Krzysztof Bartus
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dhanunjaya Lakkireddy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dhanunjaya Lakkireddy.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

Supplementary Appendix: ICD-9 codes used for identification of study population (DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharma, S.P., Kondur, A., Gopinathannair, R. et al. Is paroxysmal supraventricular tachycardia truly benign? Insightful association between PSVT and stroke from a National Inpatient Database Study. J Interv Card Electrophysiol 59, 35–41 (2020). https://doi.org/10.1007/s10840-019-00651-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-019-00651-7

Keywords

Search

Navigation