Paroxysmal supraventricular tachycardia: outcome after ED care

The objective of this study was to investigate the outcome and rate of symptomatic recurrence of paroxysmal supraventricular tachycardia (PSVT) in an emergency department (ED) patient population, after ED management and disposition. A retrospective descriptive review of ED records and state death registry was performed. The study took place at a University hospital ED with 60,000 annual patient volume. The subjects were all patients presenting to the ED in PSVT from January 1993 to December 1996. One hundred eleven patients met entry criteria. The mean age was 53 years, 49% were men, and 51% were women. EMS was used by 47 (42%) patients. Ten of these patients who used the EMS system had an unstable event in the prehospital setting. Eleven patients had unstable events once in the ED. ED therapy given (with number of successes in parentheses) included: Adenosine 48 (41), vagal maneuvers 44 (22), calcium channel blockers 22 (14), beta-blockers 10 (4), and electrical cardioversion 5 (1). Twenty-six patients (23%) spontaneously converted to normal sinus rhythm (NSR). Seventy-nine (71%) patients were discharged from the ED. Mean age for this group was 49 years, and the mean ED stay for this group was 3.8 hours. Three patients (4%) in this group had a recurrence of their SVT after discharge. These patients all had recurrence within 24 hours, and none had an unstable event associated with their recurrence. Thirty-two (29%) patients were admitted to the hospital, with 3 (9%) going to a monitored floor, and 29 (91%) going to an intensive care unit. Mean age for this group was 65 years. Twenty-one of these 32 admitted patients (65%) required continued in-hospital therapy once admitted for their arrhythmia. Six of the 32 admitted patients (19%) had recurrent PSVT in the hospital, with 1 episode of instability. Recurrence of PSVT was more likely to occur among those admitted (P <.05), in older patients (P<.01), and in those with a history of cardiovascular disease (P <.01). No deaths were recorded in either group. Most patients with PSVT can be safely discharged from the ED after short-term observation if therapy produces prompt conversion to NSR. PSVT recurrence is relatively uncommon and usually occurs within 24 hours of ED presentation. PSVT recurrence occurs more often in the elderly and in those with established cardiac disease.