Ventricular Tachycardia Does Not (Usually) Present as Palpitations

Background and aim: Palpitations are a common clinical symptom often attributed to cardiac arrhythmias, including ventricular tachycardia (VT). Furthermore, different medical documents describe palpitations as a common symptom during a VT event. Nevertheless, data to support this description lack.

The aim of this study was to evaluate the prevalence of palpitations in patients who suffered from a VT compared with a supraventricular tachycardia (SVT) event.

Methods and results: Patients who experienced a first event of a regular tachycardia, VT (n=54) or SVT (n=41), at our facility between 01/2012 and 12/2018 were included in the study. We included only patients with a first arrhythmia event to avoid the influence of previous medical encounters on our patients` terminology. The groups differed in baseline characteristics: mean age (68.8±13.6 vs 54.6±16.8 years, p<0.001), male sex (96.2% vs 31.7%, p<0.001), left ventricular ejection fraction (40%, IQR 30-45% vs 60%, IQR 60-60%, p<0.001) and comorbidities were found in 87.6% vs 40.5% (p<0.001) of the patients in the VT and SVT groups respectively. Importantly, heart rate upon presentation did not differ between the 2 groups (170, IQR 150-180 bpm and 170, IQR 160-190 bpm in the VT compared with the SVT group respectively, p=0.26) whereas symptomatology significantly differed: palpitations were reported by 9.2% compared with 90.2% of the patients in the VT compared with the SVT groups respectively (p<0.001). Common symptoms in the VT group included chest pain (44.2%), dyspnea (21%) and dizziness (26.9%).

Discussion and conclusion: Despite similar heart rate, patients with VT rarely report on palpitation whereas patients with SVT do so commonly. Possible explanations for this discrepancy might include background comorbidities, diverse myocardial O₂ consumption and the effect of atrio-ventricular dissociation.