Introduction: Current guidelines recommend detailed symptom assessment in patients with supraventricular tachyarrhythmias. However, non-invasive differentiation of supraventricular tachyarrhythmias is challenging because of overlap in symptoms and sometimes equivocal ECG patterns. The aim of this investigation was to evaluate differences in triggers and symptoms for supraventricular tachyarrhythmias. 

Methods: All consecutive patients referred for an ablation of a supraventricular arrhythmia were screened for participation. If eligible, a structured questionnaire about triggers and symptoms, as well as two validated supraventricular tachyarrhythmia questionnaires (5Q-3L and ASTA) were answered by 326 participants before ablation. An electrophysiological study was performed in any participating patient; 111 participants with paroxysmal atrial fibrillation (par. AF), 128 participants with persistent atrial fibrillation or multiple heart rhythm disorders (pers. AF and/or multiple), 17 participants with typical right atrial flutter (AFL), 55 participants with atrioventricular-nodal-reentry-tachycardia (AVNRT), 11 participants with accessory pathway with AV-nodal-reentrant-tachycardia (AVRT) and 5 participants with ectopic atrial tachycardia (EAT).

Results: The patient collective has a mean age of 61 years, 59% is male and they have a  mean BMI of 28 kg/m2. 56% have also been diagnosed with hypertension, 12% of the patients with diabetes and 23% of the patients have a history of vascular disease as concomitant diagnoses. Defined triggers which start the arrhythmia could be identified which start the arrhythmia or reveal symptoms in most patients suffering of arrhythmia (65 %). Most frequent trigger factors for each arrhythmia are shown in Figure 1. Physical and mental stress was the most reported trigger factor overall. Bending over as a trigger factor was mostly reported in participants with AVNRT (29%). Caffeine and pain were seldom reported as risk factors in all groups. Sleeping on one side was a trigger for 10% of the participants with AF alone or multiple rhythm disorders, but rarely reported in the other groups.

Symptoms the subjects suffering of are palpitations across all arrhythmia groups. Anxiety was reported in 54% of the participants with AVNRT; 36% of the participants with AVRT, but only 29% in the participants with AF and AFL. 36% of the participants with AVNRT reported a severe limitation on daily life because of the rhythm disorder, 38% of the participants with AF and other rhythm disorders. In contrast to all other investigated arrhythmias, 82% of all the participants with AVRT reported no or only mild limitations on daily life.

Conclusions: Bending over was standing out as a trigger factor for AVNRT and anxiety is a predominant symptom for AVNRT and AVRT compared to the other groups. As a new diagnostic feature sleeping on one side to reveal palpations for AF and AFL may help to identify patients with asymptomatic arrhythmia episodes. The findings may help to diminish different types of supraventricular arrhythmia by taken history when ECG recording is not yet available.

Figure 1 Most frequent trigger factors for supraventricular arrhythmia in descending order