Clinical presentation of sustained monomorphic ventricular tachycardia without cardiac arrest

BACKGROUND: “Palpitations” are one of the most common complaints prompting medical attention. Textbooks of medicine and cardiology as well as guideline documents and position papers describe palpitations as a common symptom of ventricular tachycardia (VT). However, data to support this description are lacking. The aim of our study was to evaluate the symptomatology of sustained monomorphic VT with emphasis on the prevalence of palpitations. METHODS AND RESULTS: Consecutive patients presenting to our center with a first event of a regular sustained monomorphic VT (n=59) or a regular supraventricular tachycardia (SVT; n=109) between January 2012 and September 2019 were interviewed regarding their symptoms during the arrhythmic event. We included only patients with a first arrhythmic event to avoid the influence of previous medical encounters on our patients’ terminology. As expected, patients with VT were older (age 68.8±13.6 versus 52.6±16.8 years; P<0.001), more often of male sex (94.9% versus 37.6%; P<0.001), had lower left ventricular ejection fraction (37±11% versus 59±2%, P<0.001) and more comorbidities (87.6% versus 40.5%; P<0.001) compared with patients with SVT. Importantly, even though the heart rate upon presentation did not differ between the 2 groups (165±26 beats/min during VT versus 171±32 beats/min during SVT; P=0.16), symptomatology differed significantly; specifically, palpitations were reported in only 8.8% of VT patients, compared with 90.7% of SVT patients (P<0.001). Common symptoms in the VT group included chest pain (64%), dyspnea (21%), and dizziness (26%). CONCLUSIONS: Despite similar heart rate, patients with VT rarely report having palpitations, whereas patients with SVT do so commonly. This finding may assist with decision making in patients reporting palpitations in whom an ECG tracing is not available.