What is the prevalence of palpitations in the general population?

Prevalence of Palpitations in the General Population

Palpitations are common in the general population, with a prevalence of approximately 16% among outpatients, though only about 15% of these cases correlate with actual cardiac arrhythmias. 1

Epidemiology of Palpitations

General Population

• Palpitations are widely diffused complaints in the general population 2
• The prevalence of supraventricular tachycardia (SVT), which can cause palpitations, is estimated at 2.29 per 1000 persons 3
• The incidence of paroxysmal supraventricular tachycardia (PSVT) is approximately 36 per 100,000 persons per year 3
• There are approximately 89,000 new cases of PSVT per year and 570,000 persons with PSVT in the US 3

Demographic Factors

Age-Related Patterns

• Individuals over 65 years of age have more than 5 times the risk of developing PSVT compared to younger persons 3
• The incidence of atrial flutter increases markedly with age, from 5 per 100,000 in those over 50 years to 587 per 100,000 in those over 80 years 3
• The mean age at PSVT onset is 57 years, with a range from infancy to over 90 years 3

Gender Differences

• Women have twice the risk of men of developing PSVT 3
• Female residents had a twofold greater relative risk of PSVT compared with males 3
• The frequency of atrioventricular nodal reentrant tachycardia (AVNRT) is greater in women than in men 3

Types and Causes of Palpitations

Clinical Classification

Palpitations can be divided into four clinical presentation groups 2:

• Extrasystolic
• Tachycardic
• Anxiety-related
• Intense

Etiological Classification

From an etiological perspective, palpitations may be caused by 2:

1. Arrhythmias
2. Structural heart disease (non-arrhythmic)
3. Psychiatric disease
4. Systemic non-cardiac disease
5. Drug or illicit substance use

Specific Arrhythmic Causes

• Premature ventricular complexes (PVCs) are common causes of palpitations 3
• Any arrhythmia can cause palpitations, including sinus tachycardia, atrial fibrillation, PVCs, or ventricular tachycardia 4
• In approximately 60% of atrial flutter cases, the condition occurs in association with specific precipitating events (major surgery, pneumonia, or acute myocardial infarction) 3

Special Populations

Pregnancy

• Palpitations are extremely common during pregnancy 3
• Several studies have shown an increase in the symptoms of SVT during pregnancy 3
• While most palpitations are benign during pregnancy, new-onset ventricular tachycardia is of concern 3

Athletes

• PVCs observed in conditioned athletes without heart disease may decrease with deconditioning and reappear with reconditioning 3
• This pattern does not indicate independently heightened risk in the absence of other risk markers 3

Clinical Significance

• Palpitations should be considered potentially more serious if associated with dizziness, near-syncope, or syncope 4
• In up to 16% of patients with palpitations, no cause can be found 4
• The significance of palpitations is related to the presence or absence of underlying cardiac disease, the clinical setting, and the characteristics and severity of symptoms 1
• Palpitations are a common reason for emergency department and primary care physician visits but are infrequently the primary reason for hospital admission 3

Diagnostic Approach

When evaluating patients with palpitations, clinicians should consider:

• Association with structural heart disease
• Presence of other symptoms (especially syncope or pre-syncope)
• Pattern and frequency of palpitations
• Response to exercise (PVCs that become more frequent or convert to runs of non-sustained VT during exercise should lead to further evaluation) 3

Ambulatory electrocardiographic monitoring is usually indicated if the etiology cannot be determined from history, physical examination, and resting ECG 4.