Prevalence of stroke among patients with paroxysmal supraventricular tachycardia

To assess the prevalence of unexplained stroke in patients with paroxysmal supraventricular tachycardia (SVT). The risk of atrial fibrillation (AF) is well known and risk of stroke can be expected.

A total of 1,362 patients were referred for SVT, confirmed by electrophysiological study. Patients with anterograde conduction over accessory pathway (AP) were excluded. Clinical and electrophysiological data were collected.

Stroke was noted in 38 patients with a prevalence of 2.8%. Patients with stroke were older (62 ± 12 years vs 49 ± 19 years; P < 0.0001). Heart disease (34% vs 10%; P < 0.0001) and AF history (10.5% vs 2%; P < 0.001) were more frequent. Male gender was as frequent in patients with and without stroke (45% vs 39.5%; NS). SVT mechanism was similar: AV reentrant tachycardia over concealed AP was 10.5% in patients with stroke and 18.5% in other patients (NS). Atrioventricular node reentrant tachycardias represent other mechanisms. After 2.6 ± 2.5 years, SVT ablation was performed less frequently in patients with stroke (37% vs 63%; P < 0.001); three patients without previous stroke presented a stroke. AF and cardiovascular death were more frequent in patients with stroke (21% vs 4.6%; P < 0.000), (8% vs 2%; P < 0.008). Note that 7.6% of patients treated with ablation and 6% of patients without ablation had an event (stroke, AF, death; NS).

Unexplained stroke was rare in patients with SVT, noted in 2.8% of this population. Old age and AF history were the predictors of stroke. These patients had a risk of adverse events as AF or death. SVT ablation did not seem to reduce the risk of new stroke, AF or death.