Paroxysmal supraventricular tachycardia and risk of ischemic stroke: A systematic review and meta‐analysis

Abstract

Background Paroxysmal supraventricular tachycardia (PSVT) has been traditionally considered as a benign rhythm disorder. However, recent studies have suggested that patients with PSVT may have a higher risk of ischemic stroke although the data are limited and inconclusive. The current systematic review and meta‐analysis was conducted with the aims to identify all available studies and summarize their results together to better characterize the risk of ischemic stroke among patients with PSVT. Methods A comprehensive literature review was conducted by searching for published articles indexed in MEDLINE and EMBASE databases from inception through November 11, 2018 to identify all observational studies that compared the risk of ischemic stroke between patients with PSVT and individuals without PSVT. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random‐effect, generic inverse variance method of DerSimonian and Laird. Results A total 5 studies (4 cohort studies and 1 case‐control study) with 4 886 977 participants met the eligibility criteria and were included into the meta‐analysis. The risk of ischemic stroke among patients with PSVT was significantly higher than individuals without PSVT with the pooled RR of 2.03 (95% CI, 1.22‐3.38, I 2 = 89%). Conclusion This study found that PSVT is associated with a higher risk of ischemic stroke. Whether this association is causal and how it should be addressed in clinical practice require further investigations.

Supraventricular Tachycardia (SVT) and Stroke: Should We Pump the Brakes on Cardioversion?

“…This process can cause apoptosis of myocardial cells and fibrosis, resulting in enduring structural alterations within the atria. Among these alterations, left atrial enlargement emerges as a prevalent sequela, which can induce blood flow stagnation and escalate the likelihood of thrombus formation [11][12][13]. The second rationale lies in the heightened susceptibility for subsequent atrial fibrillation as atrial fibrosis and left atrial enlargement act as pivotal catalysts in the onset of atrial fibrillation [11,17].…”

“…Cardioembolic stroke has primarily been associated with atrial fibrillation; however, the recognition of PSVT as a potential etiology for cardioembolic strokes has been relatively understated [10]. Recent studies are shedding light on this connection, revealing a substantial increase in the risk of ischemic stroke among patients with PSVT compared to those without [10][11][12]. The current nascent understanding is that PSVT could be an unrecognized stroke risk factor, potentially explaining a portion of strokes currently labeled as cryptogenic [13].…”

Infant Stroke Associated With Left Atrial Thrombus and Supraventricular Tachycardia

“…3 SVT is a risk factor for AIS in adults, although the incidence remains largely unknown. 5 In the pediatric population, AIS is a rare complication of SVT with only a few cases reported in the literature. Children were less than 5 years of age at time of diagnosis of SVT and stroke.…”

“…[9][10][11][12] The proposed mechanism of thrombosis is stasis of blood flow in the setting of poor contractility or enlargement of the left atrium or ventricle. 5,9,10 Aside from the patient with left ICA narrowing, all children with SVT and subsequent stroke had atrial enlargement and/or ventricular dysfunction on echocardiogram. [6][7][8] These findings suggest an increased risk for intracardiac thrombus formation.…”