Profile and Outcomes of Patients Presenting with Supraventricular Tachycardia to the Accident and Emergency Department of a Large Tertiary Hospital in Jamaica

Roshauna Ragbar, Camelia Thompson, Kenneth James, Hugh Wong, Shanni Mohan, Keri- Ann Buchanan- Peart, Tawanda Jones, Raja Boddepalli

Correspondence:
Dr. Roshauna Ragbar MPH
Kingston Public Hospital
North Street, Kingston, Jamaica, W.I.
Tel: 876-478-2086
Email: [email protected]

Camelia Thompson MPH
Department of Community Health and Psychiatry
The University of the West Indies, Mona, Jamaica
Email: [email protected]

Kenneth James MBBS
Department of Community Health and Psychiatry
The University of the West Indies, Mona, Jamaica
Email: [email protected]

Hugh Wong DM (Emergency Medicine)
Kingston Public Hospital
North Street, Kingston, Jamaica, W.I.
Email: [email protected]

Shanni Mohan MBBS
Kingston Public Hospital
North Street, Kingston, Jamaica, W.I.
Email: [email protected]

Keri- Ann Buchanan- Peart MBBS
Kingston Public Hospital
North Street, Kingston, Jamaica, W.I.
Email: [email protected]

Tawanda Jones MD
Kingston Public Hospital
North Street, Kingston, Jamaica, W.I.
Email: [email protected]

Raja Boddepalli MD
Kingston Public Hospital
North Street, Kingston, Jamaica, W.I.
Email: [email protected]

DOI:
DOAJ: 9218a1e22d084b269197ab9a1d7b5786

Copyright: This is an open-access article under the terms of the Creative Commons Attribution License which permits use, distribution, and reproduction in any medium, provided the original work is properly cited.

©2022 The Authors. Caribbean Medical Journal published by Trinidad & Tobago Medical Association.

Abstract

Objective:  To describe the profile and outcomes of patients presenting to the Accident and Emergency (A&E) department of a large tertiary hospital in Jamaica with Supraventricular Tachycardia (SVT) over a 28- month period.

Methods:  A cross-sectional study was done involving 130 patients presenting to the A&E department with an electrocardiogram (ECG) – confirmed diagnosis of SVT requiring medical therapy, over a 28- month period. Data relating to sociodemographic characteristics, presenting complaint, comorbidity and patient outcomes were obtained. Logistic and linear regressions were used to identify independent predictors of cardioversion in A&E, death on the ward, and length of hospital stay.

Results: Most (69.2%) patients were female. Number of chronic illnesses ranged from zero to three (median =1). The most common presenting complaint was palpitation (82.3%), and the majority (73.6%) of patients were treated with Adenosine. Approximately 89% of patients cardioverted in the A&E.  Almost all patients were admitted to the ward; Length of hospital stay ranged from 1-20 days (median = 3 days). ‘Palpitation’ was the only variable that independently predicted length of hospital stay (B= – 3.351, p=<0.001); those presenting with palpitation, spending less days in hospital. Compared to those who presented to the emergency room unresponsive, patients who presented to the emergency room responsive were almost 98% less likely to die on the ward (OR=0.022, 95% CI: 0.001-0.661, p= 0.028).

Conclusion: Established protocols, a multidisciplinary approach, advanced training and adequate resources are key in the management of SVT patients in order to improve outcome.

Key words: Supraventricular tachycardia; cardioverted; emergency room; Jamaica

Introduction/ Background

Supraventricular tachycardia (SVT) describes a group of arrythmias whose mechanism involves or is above the atrioventricular node and is defined by a narrow QRS complex (<120 milliseconds) on electrocardiogram (ECG) with a rate of greater than 100 beats per minute ⁽¹⁾. The QRS complex reflects the duration of depolarization of the right and left ventricles of the heart and associated contraction of the ventricular muscles. Atrioventricular nodal reentrant tachycardia (AVNRT), also known as paroxysmal supraventricular tachycardia (PSVT), is occasional SVT without provoking factors, and commonly presents with a ventricular rhythm of 160 beats per minute ⁽²⁾. Approximately 30% of SVTs are Atrioventricular reentrant tachycardia (AVRT) while  10% are atrial tachycardia ⁽³⁾.

Supraventricular tachycardia impacts quality of life. It affects personal relationships, self-esteem and may result in unemployment ⁽⁴⁾. In the United States, 50,000 people visit the emergency department per year for SVT, with an estimated cost of US$ 190 million per year for hospital admissions ⁽⁵⁾. Supraventricular tachycardia is also responsible for 5% of sudden cardiac deaths ⁽⁶⁾.

In the United States, the prevalence of PSVT is approximately 0.2%, with an incidence of 1-3 cases per 1,000 patients; women being twice as likely to develop PSVT ⁽⁷⁾. Atrial fibrillation and atrial flutter are the most common subtypes of SVT and include, but is not limited to, atrioventricular nodal reentrant tachycardia (AVNRT), which accounts for majority (60%) of the remaining subtypes ⁽³⁾. Atrioventricular nodal reentrant tachycardia is typically seen in patients in their thirties and sixties, up to old age.

There are many factors that lead to supraventricular tachycardia. These include: myocardial infarction, structural heart disease, rheumatic heart disease, cardiomyopathy, pulmonary embolism, hyperthyroidism, caffeinated beverages and drugs such as salbutamol, cocaine and hydralazine ⁽⁷⁾. Extreme psychological stress and anxiety, low potassium and magnesium levels, family history of SVT and tobacco use can also result in supraventricular tachycardia ⁽⁸⁾.

Patients with SVT usually present with chest pain, palpitations, light-headedness, shortness of breath or syncope. An ECG is the initial test used to assess for SVT ⁽²⁾ (Figure 1). Laboratory and radiological investigations are also included in the management of these patients in the emergency department. Laboratory investigations include: magnesium, calcium, complete blood count, thyroid function, troponin and electrolytes. With regard to radiological investigations, a chest X-ray is usually done ⁽⁹⁾

Consistent with the Advanced Cardiovascular Life Support (ACLS) guidelines by the American Heart Association (AHA) (2016) for ‘Adult Patients with Tachycardia with a Pulse Algorithm,’ patients with persistent tachyarrhythmia (heart rate usually ≥ 150 beats per minute) may be either stable or unstable; stability determined by the signs and symptoms displayed ⁽¹⁰⁾.

Synchronized cardioversion should be done for unstable patients unless the rhythm is wide and irregular in which case defibrillation is required. Adenosine, antiarrhythmic infusion and expert consultation should be considered for haemodynamically stable patients with a wide QRS complex. Adenosine, beta blocker or calcium channel blocker and expert consultation should then be considered if  initial vagal or Valsalva manoeuvres are ineffective ⁽¹⁰⁾. Some patients may eventually require definitive radiofrequency ablation therapy ⁽²⁾.

There is good outcome with treatment in patients with paroxysmal SVT. However, if there is coexisting Wolff- Parkinson-White (WPW) syndrome on board, then there is a small risk of sudden cardiac death. If there are no structural defects of the heart, prognosis is excellent ⁽²⁾.

Admission rates vary for SVT, with one study in London reporting admission rate of 23.5% ⁽¹¹⁾, while another study in Sweden reports a rate of 15.1 admission per 100,000 person-years ⁽¹²⁾. A study done in Hong Kong revealed that patients with PSVT who successfully converted could be securely discharged from the emergency room after four hours of observation ⁽¹³⁾. Hospitalization for SVT is related to low systolic blood pressure, long duration of symptoms, structural heart disease, low serum sodium and potassium concentrations ⁽¹⁴⁾, and worsening of underlying conditions such as chronic obstructive pulmonary disease and myelodysplasia ⁽¹¹⁾. Sawhney et al., (2013) reported mean hospital stay of 2.3 days ⁽¹¹⁾.

There is currently no published data available on SVT outcomes in Jamaica.  This study sought to describe the profile and outcomes of patients presenting to the Accident and Emergency department of a large tertiary hospital in Jamaica with SVT over a 28- month period.

Methods

A cross sectional study was done over a 28- month period at a large tertiary care facility in Kingston and St. Andrew, Jamaica. A census of all records (n=130) of patients 12 years and older, who presented to the Accident and Emergency Department during the period September 2017- December 2019, with an ECG- confirmed diagnosis of supraventricular tachycardia, requiring medical therapy, was done. Patient records were retrospectively reviewed, and anonymized data relating to socio-demographic characteristics, presenting complaint, co-morbidity, treatment received, and patient outcomes (cardioverted in the A&E, admitted to ward, death on ward, and length of hospital stay) were extracted.

Data were analyzed using the Statistical Package for the Social Sciences Version 21. Descriptive statistics, including frequencies and measures of central tendency were used to describe participants’ profile. We examined differences in the distribution of age, sex, diagnosis (hypertension, asthma, cardiovascular disease, diabetes mellitus, and ‘other’), presenting complaints (palpitation, chest pain, SOB, syncope, unresponsiveness), and total number of symptoms by death on ward and cardioversion in the A&E. The Chi Square, Fisher’s exact test were used to categorical variables and the Mann-Whitney U Test (Wilcoxon Sum Rank Test) for continuous variables. Correlational analyses (Spearman’s Rho) were also done to examine the relationship between the primary outcome variables of interest (death on ward, cardioversion in A&E, and length of hospital stay). Correlational coefficients with associated p-values of <0.05 were deemed statistically significant. Subsequently, a binary logistic regression model was developed to determine the independent predictors of death on the ward, and cardioversion in A&E. A Linear regression model was used to determine the variables that independently predicted length of stay on the ward. Variables entered in both the logistic and linear regression models respectively, were those with p-values of <0.10 in bivariate analyses.  A significance level of p <0.05 was applied.

Ethical approval was obtained from Mona Campus Research Ethics Committee (ECP 219, 19/20). Confidentiality and anonymity of patient records were maintained throughout the study.

Results

Socio-Demographic and Health-Related Characteristics of Participants

The majority of participants were female (69.2%, n=90). Patients’ age ranged from 12-93 years with a median age of 59 years (IQR= 23 years). The number of chronic illnesses ranged from zero to three with a median of one chronic illness (IQR=1). As seen in Figure 2, approximately 73% of cases reported having hypertension, while 33.7% had other cardiovascular-related diseases (congestive cardiac failure, coronary artery disease, congenital heart disease, rheumatic heart disease). Almost 20% had other diseases which included neurofibromatosis, end stage renal disease, chronic obstructive pulmonary disease, systemic lupus erythematosus, human immunodeficiency virus (HIV), hyperthyroidism and rheumatoid arthritis.

Presenting Complaints and Management

Presenting Complaints

On presentation, patients’ heart rate ranged from 138- 238 with a median heart rate of 174.5 (IQR=30). Patients presented with 1-4 symptoms with a median of two symptoms (IQR=1). The most common presenting complaint was palpitation (82.3%) followed by shortness of breath which was reported among 47.7% of cases. Approximately 5% of cases were unresponsive on presentation (Table 1).

Table 1: The distribution of symptoms and treatment of patients with SVT

Management

Almost 74% of cases received adenosine for the management of SVT, followed by Amiodarone which was used among 23.3% of cases presenting with SVT. Only 7.8% of cases were cardioverted electrically. Digoxin was the least frequently used drug; used among 0.8% of cases.

Outcomes

Among the patients requiring medical management for their SVTs, 89.2% cardioverted in the emergency room. Almost all (99.2%) were admitted to the ward, except one who was discharged to home. Of the patients who were admitted, 6.2% died on the ward (Figure 3). The length of hospital stay ranged from 1-20 days with a median stay of 3 days (IQR=3).

Independent Predictors of ‘Cardioverted in A&E’

There was a statistically significant difference in the proportion of those who ‘cardioverted in A&E’ based on the presenting complaint of unresponsiveness (p= 0.027). Among those who were responsive on presentation (n=123), 91.1% (n=112) were converted in A&E, while among those who presented unresponsive (n=7), 57.1% (n=4) were cardioverted in A&E. There were no other significant differences in clinical or demographic factors by cardioversion in the A&E status.  The final adjusted logistic regression model to identify predictors of ‘cardioverted in A&E’ was adjusted for total number of symptoms (p=0.067) and unresponsiveness (p=0.027). Unresponsiveness was the only independent predictor of ‘cardioverted in A&E’ (OR = 0.182; 95% CI: 0.034-0.968). Compared to those who were responsive on presentation, those who were unresponsive were 81.8% less likely to be cardioverted in A&E.”

Association between Length of Stay and Select Variables

The association between length of stay on the ward and the variables age, sex, diagnoses (hypertension, asthma, cardiovascular disease, diabetes mellitus, and ‘other’), presenting complaints (palpitation, chest pain, SOB, syncope, unresponsiveness), and total number of symptoms were examined. Length of stay on the ward was significantly associated with age, sex, as well as presenting complaint of palpitations (Table 2).

Table 2: Association between select variables and length of hospital stay

Predictors – Length of Hospital Stay

A linear regression was performed to determine if the variable age, sex and presenting complaints SOB and palpitations independently predicted length of hospital stay.  ‘Palpitation’ was the only variable that independently predicted length of hospital stay (B = – 3.351, p=<0.001); those presenting with palpitation, spending approximately three days less in hospital, than those who did not present with palpitations.

Association between Death on Ward and Select Variables

The association between death on the ward and select variables was examined. There was no statistically significant association between death on the ward and age, asthma, cardiovascular disease, diabetes mellitus, length of stay in hospital and presenting complaints: shortness of breath, chest pain and syncope. As seen in Table 3, there was a statistically significant association between death on the ward and sex (p= 0.033), palpitations (p= 0.033), cardioverted in A&E (p= 0.041), ‘other diagnosis’ (p= 0.023) and presenting unresponsive (p=0.005).

Table 3: Association between death on the ward and variables

*P-values based on Fishers Exact Test

Independent Predictors of Death on Ward

As seen in Table 4, the variables that that were statistically significantly associated with death on the ward in bivariate analyses, as well as the variable ‘hypertension’ were entered in a logistic regression model to identify predictors of death on the ward. Sex, hypertension, symptom palpitation, cardioverted and other diagnosis did not emerge as significant predictors of death on the ward. Compared to those who presented to the emergency room unresponsive, patients who presented to the emergency room responsive were almost 98% less likely to die on the ward (OR=0.022, 95% CI: 0.001-0.661, p= 0.028).

Table 4: Predictors of death on the ward (logistic regression)

*Denotes statistical significance at alpha 0.05 level
Hosmer and Lemeshow Test significance = 0.394; Nagelkerke R Square = 0.427

Discussion

Supraventricular tachycardia is not an uncommon diagnosis seen in emergency departments ⁽⁷⁾. In this study, the majority of patients with SVT was female; consistent with findings in the literature ^(2,7,11,12). The typical age of patient with presenting with SVT was 59 years, similar to patients seen in the emergency room setting for SVT in Sweden and the United States ^(5,12). In contrast,  a slightly lower mean age (approximately 50 years) has been reported in a study of patients in United Kingdom ⁽¹¹⁾, but is still consistent with literature indicating the highest prevalence of SVTs being in the middle-age group ⁽²⁾. Understanding the profile of patients presenting with SVT is important, as studies have documented a tendency of providers to minimize symptoms among females ⁽⁴⁾. Hospitalization rates also tend to be greater for older persons ⁽¹²⁾. These observations argue for training and sensitization of staff regarding women presenting with SVT, and planning for admissions, taking into account the age-specific hospitalization rates.
Most patients had one chronic illness on average, with hypertension being the most commonly reported chronic illness. Rosengren et al. (2018), in examining paroxysmal supraventricular tachycardia hospitalizations, found that coronary heart disease and hypertension were the most common comorbidities seen among patients ⁽¹²⁾. Hypertension is a common cardiovascular risk. Hypertensive heart disease can manifest as cardiac arrhythmias, and SVT may occur especially in patient with  left ventricular hypertrophy ⁽¹⁵⁾. Some antihypertensive medications also causes electrolyte abnormalities, which may contribute to arrhythmias. It is therefore imperative that emergency physicians to refer these patients for specialty cardiology consultations to ensure that appropriate work-up and long-term management are done, utilizing established guidelines ⁽¹⁵⁾. With a high prevalence of hypertension (33.8%) in the Jamaican population greater than 15 years old ⁽¹⁶⁾, providers should pursue the optimal management of patients who have SVT and hypertension.

The most common treatment for SVT was adenosine; used among almost 74% of patients presenting with SVT. In other studies, Adenosine was used in lower proportions of patients; Murman et al (2007) – 26%, and Sawhney et al. (2013) – 55%.  The high proportion of patients receiving Adenosine in this study warrants further exploration. The discrepancy may be due to inappropriate/unnecessary use of Adenosine in our setting, and/or differences in treatment protocols/guidelines at the times when the studies were conducted.  There are indications that the former reason may be playing a role. For example, in this study, chest pain and unresponsiveness were reported among 26% and 5% of patients respectively, suggestive that many patients may have been ‘unstable.’ In such patients, synchronized cardioversion may be indicated, yet only 7.8% of patients received such intervention ⁽¹⁰⁾. Likely, the default mode of administering Adenosine was pursued, contributing to the high rates of Adenosine use. Adherence to established protocols may be improved by ensuring that emergency physicians are trained/certified in Advanced Cardiac Life Support, with subsequent refresher courses. The mounting of posters with treatment algorithms in the emergency room could also serve as reminder of the appropriate management protocol.

Most patients were cardioverted in the emergency room. In the international setting, the majority of such patients are discharged from the emergency for follow-up and not admitted to hospital; admission rates being approximately 24% ^(5,11). Contrastingly, in our study, almost all were admitted to the ward. This high admission rate may be due to: an absence of protocol regarding disposal of patients with SVT after initial treatment in the emergency room; the lack of effective and timely cardiology consults stemming from a shortage of personnel; and the urgency to clear the emergency room and avoid overcrowding in the often limited physical emergency room space to cope with the continuous patient influx, and high demand for emergency care in the institution studied, may also be a contributor to the high admission rate.

The median length of hospital stay for SVT admission in this study was 3 days, a figure comparable to typical length of stay reported by Sawhney et al. (2013) of 2.3. The presenting complaint ‘palpitation’ was an independent predictor of length of hospital stay; those presenting with palpitation, spending less days in hospital. This finding might be explained by the greater likelihood of patient with palpitations seeking care early because of an increased sense of urgency. Prompt treatment arguably may lead to improved outcomes including shorter length of stay. None of the patients presenting with SVT died within the A&E setting, however 6.2% of those admitted to the ward died; records were not available to ascertain certified causes of death. Unresponsiveness in the A&E was an independent predictor of death on the ward, even after controlling for the presence of comorbidities. Although we found an association between death on the ward and unresponsiveness, we recognize that factors such as quality of monitoring, care and treatment on the wards may influence death as an outcome on the ward. Further investigations on the role of such factors is warranted. Additionally, with regard to treatment in A&E, unresponsiveness was a predictor of cardioversion in A&E; those presenting unresponsive less likely to be cardioverted in A&E. We note that even though numbers were small, the 95% CI for unresponsiveness is not extensively wide and is statistically significant. Small numbers can bias the association either towards or away from the null, and this is a limitation of the study. Future studies with larger numbers may be useful in further scrutiny of this finding to see if it consistently holds true.

Appropriate management of SVTs require a multidisciplinary healthcare team. Emergency room physicians, cardiologists, nurses, pharmacists and allied health professional have vital roles. Equally, patients should be educated about their condition and risks, as this may determine adherence to prescribed regimens and their health seeking behaviours, both of which may mitigate consequences of SVT and reduce emergency room visits. In our study setting, focus should therefore be on organizing and coordinating the care team, as well as individualized patient education. Treatment options including radiofrequency ablation merit consideration, although these can be costly.

This is a pioneer study in the Caribbean setting that describes the profile and outcomes of patients presenting with SVTs. The greater understanding obtained points to areas where actions might potentially enhance the management and outcome of patients. We acknowledge that we did not readily have access to details of medication history of the patients in the study, which may have contributed to a more nuanced understanding of their SVT profiles. Although this 28-month duration study was modest in size, and was conducted a large tertiary care facility, clinically and epidemiologically significant finding emerged that can help chart the way forward with the management of SVTs.

Conclusion

In the emergency room setting, females are more commonly seen for SVTs, and hypertension is a frequent comorbid condition. Adenosine is mainly used for the acute management of SVT. Unresponsiveness was an independent predictor of cardioversion in the emergency room, and of subsequent death on the ward. The presenting complaint ‘palpitation’ was associated with shorter length of hospital stay. A multidisciplinary approach, established protocols, adequate resources and advanced training are necessary to reduce the rate of admission, ensure successful cardioversion of patients in the A&E and improve the outcome of patients.

Acknowledgements: None

Ethical Approval: Ethical approval for the study was obtained from the University of the West Indies Mona Campus Research Ethics Committee (ECP 219, 19/20)

Funding: No funding was received for conducting this study.

Conflict of Interest : The authors declare no conflict of interest for this article.

Authors’ contributions:

Roshauna Ragbar MPH
Conceived the idea for the study, participated in data collection, data analysis and manuscript preparation

Camelia Thompson MPH
Participated in data collection, data analysis and manuscript preparation

Kenneth James MBBS
Participated in data collection, data analysis and manuscript preparation

Hugh Wong DM (Emergency Medicine)
Conceived the idea for the study, participated in data collection, data analysis and manuscript preparation

Shanni Mohan MBBS
Participated in data collection, data analysis and manuscript preparation

Keri- Ann Buchanan- Peart MBBS
Participated in data collection, data analysis and manuscript preparation

Tawanda Jones MD
Participated in data collection, data analysis and manuscript preparation

Raja Boddepalli MD
Participated in data collection, data analysis and manuscript preparation

References

1. Patti L, Ashurst J V. Supraventricular Tachycardia [Internet]. StatPearls. StatPearls Publishing; 2020 [cited 2021 Jul 22]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441972/
2. Patti L, Gossman WG. Rhythm, Tachycardia, Supraventricular (SVT) [Internet]. StatPearls. StatPearls Publishing; 2018 [cited 2021 Apr 28]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28723001
3. Sohinki D, Obel OA. Current trends in supraventricular tachycardia management. Ochsner J [Internet]. 2014;14(4):586–95. Available from: https://pubmed.ncbi.nlm.nih.gov/25598724
4. Wood KA, Wiener CL, Kayser-Jones J. Supraventricular tachycardia and the struggle to be believed. Eur J Cardiovasc Nurs [Internet]. 2007/04/03. 2007 Dec;6(4):293–302. Available from: https://pubmed.ncbi.nlm.nih.gov/17409024
5. Murman DH, McDonald AJ, Pelletier AJ, Camargo Jr. CA. U.S. Emergency Department Visits for Supraventricular Tachycardia, 1993–2003. Acad Emerg Med [Internet]. 2007 Jun 1;14(6):578–81. Available from: https://doi.org/10.1197/j.aem.2007.01.013
6. Wang Y, Scheinman MM, Chien WW, Cohen TJ, Lesh MD, Griffin JC. Patients with supraventricular tachycardia presenting with aborted sudden death: Incidence, mechanism and long-term follow-up. J Am Coll Cardiol [Internet]. 1991;18(7):1711–9. Available from: https://www.sciencedirect.com/science/article/pii/0735109791905087
7. Hafeez Y, Grossman SA. Paroxysmal Supraventricular (PSVT) [Internet]. StatPearls. StatPearls Publishing; 2019 [cited 2021 Apr 28]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29939521
8. Terrie Y. Managing and Preventing Supraventricular Tachycardia. Pharm Times [Internet]. 2011 [cited 2021 Apr 28];77(12). Available from: https://www.pharmacytimes.com/view/managing-and-preventing-supraventricular-tachycardia
9. Ashok A, Cabalag M, Taylor DM. Usefulness of laboratory and radiological investigations in the management of supraventricular tachycardia. Emerg Med Australas [Internet]. 2017 Aug 1;29(4):394–9. Available from: https://doi.org/10.1111/1742-6723.12766
10. American Heart Association. Advanced Cardiovascular Life Support (ACLS) Provider Manual. Dallas, TX: American Heart Association; 2016.
11. Sawhney V, Corden B, Abdul-Mukith K, Harris T, Schilling RJ. Are patients admitted to emergency departments with regular supraventricular tachycardia (SVT) treated appropriately? Clin Med [Internet]. 2013 Apr;13(2):146–8. Available from: https://pubmed.ncbi.nlm.nih.gov/23681861
12. Rosengren P, Li X, Sundquist J, Sundquist K, Zöller B. Hospitalization rate of paroxysmal supraventricular tachycardia in Sweden. Ann Med [Internet]. 2018/10/15. 2018 Nov;50(7):556–64. Available from: https://pubmed.ncbi.nlm.nih.gov/30192639
13. Chan HY, Yuen WL. Outcomes of Patients with Successfully Converted Paroxysmal Supraventricular Tachycardia after Four Hours of Observation in an Emergency Department of a District Hospital in Hong Kong. Hong Kong J Emerg Med [Internet]. 2006 Jul 1;13(3):140–7. Available from: https://doi.org/10.1177/102490790601300303
14. Piyanuttapull, S Patarananakul P. Recurrence rate of PSVT (paroxysmal supraventricular tachycardia) in Rajavithi emergency department. J Med Assoc Thai [Internet]. 2013 [cited 2021 Apr 28];96(Suppl 3):S47-53. Available from: https://pubmed.ncbi.nlm.nih.gov/23682522/
15. Lip GYH, Coca A, Kahan T, Boriani G, Manolis AS, Olsen MH, et al. Hypertension and cardiac arrhythmias: A consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace [Internet]. 2017 Jun 1 [cited 2021 Apr 28];19(6):891–911. Available from: https://academic.oup.com/europace/article/19/6/891/3871445
16. Ministry of Health Jamaica. Jamaica Health and Lifestyle Survey III [Internet]. 2018. Available from: https://www.moh.gov.jm/wp-content/uploads/2018/09/Jamaica-Health-and-Lifestyle-Survey-III-2016-2017.pdf

Figure 1 – ECG showing SVT

Figure 2: The distribution of chronic illnesses of patients with SVT

Figure 3: Distribution of outcomes of patients with SVT