Unrecognized Paroxysmal Supraventricular Tachycardia: Potential for Misdiagnosis as Panic Disorder
Abstract
BACKGROUND: 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. OBJECTIVE: To systematically evaluate the potential for PSVT to simulate panic disorder. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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Most common symptoms during sustained SVT may imitate panic disorders.
“Most common symptoms during sustained SVT imitating panic disorders.12”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [12]
In a study conducted on patients with documented supraventricular tachycardia, two-thirds had previously been wrongly diagnosed as suffering from panic attack disorder, and the diagnosed 'psychosomatic disease' could be cured by catheter ablation in most of these patients.
“Finally, in a study conducted on patients with documented supraventricular tachycardia, it was found that two-thirds had previously been wrongly diagnosed as suffering from panic attack disorder, and that the diagnosed 'psychosomatic disease' could be cured by catheter ablation in most of these patients.30”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [30]
In the absence of electrocardiographic recording during an episode of palpitations, only a presumed or probable diagnosis can be made.
“It should be underlined, however, that, in the absence of electrocardiographic recording during an episode of palpitations, only a presumed or probable diagnosis can be made.30”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [30]
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- Authors
- Lessmeier, T. J.
- Affiliations
- Wayne State University (US)
- Corresponding author
- Lessmeier, Timothy J.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1997-03-10
- Volume
- 157
- Issue
- 5
- Pages
- 537
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W1963700522
- Cited by
- 157
- References
- 40
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2023: 6 · 2022: 6 · 2021: 9 · 2020: 6 · 2019: 6 · 2018: 3 · 2017: 7 · 2016: 4 · 2015: 8 · 2014: 7 · 2013: 4 · 2012: 5
- FWCI
- 3.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- paroxysmal supraventricular tachycardia, panic disorder, misdiagnosis, preexcitation, reentrant tachycardia, event monitoring, Holter monitoring, catheter ablation, DSM-IV diagnostic criteria, sex differences in diagnosis
- MeSH terms
- Diagnosis, Differential, Diagnostic Errors, Female, Humans, Male, Retrospective Studies, Tachycardia, Paroxysmal, Tachycardia, Supraventricular, Electrocardiography, Ambulatory, Panic Disorder
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