(Summary based on an article by Timothy J. Lessmeier, MD; Deborah Gamperling, LPN; Vicki Johnson-Liddon, C-CVT; Barbara S. Fromm, MA; Russell T. Steinman, MD; Marc D. Meissner, MD; Michael H. Lehmann, MD originally published in Archives of Internal Medicine, March 10, 1997, pages 537-543.)

Symptoms commonly associated with paroxysmal supraventricular tachycardia (PSVT) are also shared and sometimes mistaken for another condition: panic disorder. Palpitations, dizziness, shortness of breath, sweats, and chest pain are all symptomatic of both PSVT and panic disorder and, combined with less sensitive rhythm detection techniques (Holter instead of event monitoring), may contribute to mistakenly attributing PSVT symptoms to a panic attack.

In this retrospective survey, investigators identified 107 consecutive patients with documented PSVT (patients were confirmed electro-physiologically to have atrioventricular nodal reentrant tachycardia [AVNRT] or accessory pathway-associated reciprocating tachycardia), then systematically evaluated the potential for PSVT to simulate panic disorder. These investigators made both objective and subjective assessments of PSVT symptomatology, including the application of the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV).

Results showed that 67% (72/107) of patients studied reported symptoms that fulfilled the criteria for panic disorder, and that 55% (59/107) had suffered from unrecognized PSVT despite initial medical evaluation. In the latter group, physicians (nonpsychiatrists) attributed the aforementioned symptoms to panic, anxiety or stress in 54% (32/59), and 12% (7/59) sought mental health care. Of interest, women were more likely than men to be diagnosed with panic disorder (without regard to PSVT) -- thereby delaying diagnosis and PSVT treatment. For all patients, median time from initial presentation to diagnosis of PSVT was 3.3 years.

These investigators also stated that heart rhythm documentation during symptoms appears critical to distinguishing PSVT from panic disorder. In this study, detection of PSVT was significantly more accurate for patients who underwent event monitoring compared to Holter monitoring (47% [8/17] vs. 9% [6/64], respectively,
[p < 0.001]), suggesting that PSVT diagnosis may be delayed by less sensitive rhythm detection techniques (e.g., Holter).

Follow-up data (median 20 months) revealed that electrophysiologically guided therapy resulted in symptom resolution in 86% (92/107). Overall, only 4% (4/107) of patients continued to meet DSM-IV panic disorder criteria without evidence of PSVT.

These data demonstrate that PSVT symptoms may often fulfill the criteria for panic disorder and that, in fact, PSVT detection may be delayed for years due to inaccurate diagnoses. As determined by the investigators, "The clinical characteristics of patients with PSVT referred for electrophysiologically guided therapy can mimic panic disorder," and that "...misdiagnosis could result in the administration of inappropriate therapies."