UNRECOGNIZED PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA - POTENTIAL FOR MISDIAGNOSIS AS PANIC DISORDER

Background: The diagnostic criteria for panic disorder include symptom s commonly experienced by patients with paroxysmal supraventricular ta chycardia (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 d isorder. Methods: A retrospective survey of 107 consecutive patients w ith reentrant PSVT was conducted. Objective and subjective assessments of PSVT symptomatology were made, including the application of the Di agnostic and Statistical Manual of Mental Disorders, Fourth Edition (D SM-IV), panic disorder criteria. Results: The criteria for panic disor der according to DSM-IV were fulfilled by 67% of patients. Paroxysmal supraventricular tachycardia was unrecognized after initial medical ev aluation in 59 patients (55%), including 13 (41%) of 32 patients with ventricular preexcitation by electrocardiogram, and remained unrecogni zed for a median of 3.3 years. Prior to eventual identification of PSV T, 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 psychia tric origins (65% vs 32%, respectively; P<.04). Paroxysmal supraventri cular tachycardia was detected in only 6 (9%) of 64 patients undergoin g Holter monitoring vs 8 (47%) of 17 patients who wore an event monito r (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 charac teristics of patients with PSVT referred for electrophysiologically gu ided therapy can mimic panic disorder. Diagnosis of PSVT is often dela yed by inappropriate rhythm detection techniques (Holter instead of ev ent monitoring) and failure to recognize ventricular preexcitation on the sinus electrocardiogram; symptoms due to unrecognized PSVT are oft en ascribed to psychiatric conditions.