title: Paroxysmal supraventricular tachycardia and the risk of ischemic stroke.
abstract: OBJECTIVE
  It is unknown whether supraventricular arrhythmias other than atrial fibrillation or flutter are associated with stroke.
  
  
  METHODS
  To examine the association between paroxysmal supraventricular tachycardia (PSVT) and stroke, we performed a retrospective cohort study using administrative claims data from all emergency department encounters and hospitalizations at California's nonfederal acute care hospitals in 2009. Our cohort comprised all adult patients with ≥ 1 emergency department visit or hospitalization from which they were discharged alive and without a diagnosis of stroke. Our primary exposure was a diagnosis of PSVT recorded at an encounter before stroke or documented as present-on-admission at the time of stroke. To reduce confounding, we excluded patients with diagnoses of atrial fibrillation. We defined PSVT, stroke, and atrial fibrillation using International Classification of Diseases, Ninth Revision, Clinical Modification codes previously validated by detailed chart review.
  
  
  RESULTS
  Of 4 806 830 eligible patients, 14 121 (0.29%) were diagnosed with PSVT and 14 402 (0.30%) experienced a stroke. The cumulative rate of stroke after PSVT diagnosis (0.94%; 95% confidence interval, 0.76%-1.16%) significantly exceeded the rate among patients without a diagnosis of PSVT (0.21%; 95% confidence interval, 0.21%-0.22%). In Cox proportional hazards analysis controlling for demographic characteristics and potential confounders, PSVT was independently associated with a higher risk of subsequent stroke (hazard ratio, 2.10; 95% confidence interval, 1.69-2.62).
  
  
  CONCLUSIONS
  In a large and demographically diverse sample of patients, we found an independent association between PSVT and ischemic stroke. PSVT seems to be a novel risk factor that may account for some proportion of strokes that are currently classified as cryptogenic.
authors: Department of Neurology, Weill Cornell Medical College, 525 E 68th St, F610, New York, NY 10065, USA. hok9010@med.cornell.edu
authors: Hooman
authors: H
authors: Kamel
authors: Mitchell S V
authors: MS
authors: Elkind
authors: Prashant D
authors: PD
authors: Bhave
authors: Babak B
authors: BB
authors: Navi
authors: Peter M
authors: PM
authors: Okin
authors: Costantino
authors: C
authors: Iadecola
authors: Richard B
authors: RB
authors: Devereux
authors: Matthew E
authors: ME
authors: Fink
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D013614:Tachycardia, Paroxysmal / Q000150:complications*; D013617:Tachycardia, Supraventricular / Q000150:complications*
keywords: arrhythmia; embolism; epidemiology; fibrillation; risk factors; stroke; tachycardia
references: Circulation. 2010 May 4;121(17):1904-11
references: 20404258
references: Stroke. 2002 Oct;33(10):2465-70
references: 12364739
references: Stroke. 2010 Aug;41(8):1579-86
references: 20595675
references: Europace. 2012 Jul;14(7):942-7
references: 22183750
references: Stroke. 2007 Aug;38(8):2292-4
references: 17585079
references: Stroke. 1991 Aug;22(8):983-8
references: 1866765
references: Ann Neurol. 2006 Apr;59(4):691-9
references: 16566012
references: Stroke. 2010 Nov;41(11):2596-600
references: 20947860
references: Stroke. 2000 Dec;31(12):2925-9
references: 11108750
references: J Am Coll Cardiol. 1998 Jan;31(1):150-7
references: 9426034
references: Circulation. 2002 Oct 8;106(15):1962-7
references: 12370220
references: Heart Rhythm. 2004 Oct;1(4):393-6
references: 15851189
references: Stroke. 1997 Sep;28(9):1702-9
references: 9303012
references: Stroke. 1998 Aug;29(8):1602-4
references: 9707200
references: Chest. 2005 Oct;128(4):2068-75
references: 16236856
references: J Am Coll Cardiol. 2012 Aug 7;60(6):531-8
references: 22858289
references: Circulation. 2001 Dec 11;104(24):2886-91
references: 11739301
references: J Am Coll Cardiol. 1995 Apr;25(5):984-8
references: 7897142
references: Health Serv Res. 2011 Dec;46(6pt1):1946-62
references: 22092023
references: Neurology. 2006 May 9;66(9):1330-4
references: 16682662
references: Circulation. 2013 Jan 1;127(1):e6-e245
references: 23239837
references: N Engl J Med. 1995 Jan 19;332(3):162-73
references: 7800009
references: JAMA. 2011 Nov 23;306(20):2248-54
references: 22081378
references: Arch Intern Med. 2007 Feb 12;167(3):246-52
references: 17296879
references: Neurology. 2008 Nov 18;71(21):1696-701
references: 18815386
references: Chest. 2004 Sep;126(3):687-92
references: 15364743
references: N Engl J Med. 2012 Jan 12;366(2):120-9
references: 22236222
references: Stroke. 2013 Feb;44(2):528-30
references: 23192756
references: Stroke. 2012 Aug;43(8):2048-54
references: 22618379
references: Ann Intern Med. 1998 Apr 15;128(8):630-8
references: 9537936
references: Stroke. 2011 Jan;42(1):227-76
references: 20966421
references: Eur Neurol. 2009;61(5):285-8
references: 19295215
references: Ann Neurol. 1989 Apr;25(4):382-90
references: 2712533