Troponin elevation in supraventricular tachycardia: A narrative review

Abstract

Supraventricular tachycardia (SVT) is a frequent cause of emergency presentations. Troponin elevation is common, but its clinical significance remains uncertain and may trigger unnecessary downstream testing. In this mini-review, we aimed to review the prevalence, mechanisms, prognostic relevance, and management of troponin elevation in adult paroxysmal SVT. A narrative review was conducted using PubMed and EMBASE (2000-2025) with MeSH terms related to SVT and troponin. Eligible studies included original research or registry analyses in adults with paroxysmal SVT. Pediatric and atrial fibrillation/flutter cohorts were excluded. Additional data were obtained from reference lists and expert commentaries. Troponin elevation occurs in approximately 30%-50% of adult SVT cases, primarily reflecting a tachycardia-induced supply-demand imbalance or myocardial stretch, rather than plaque rupture. Short-term registry data suggest potential prognostic associations, but long-term outcomes remain inconsistent and are largely determined by comorbidities and underlying coronary artery disease. Troponin-driven management often leads to increased admissions, consultations, and additional testing without a demonstrable benefit. Troponin elevation in SVT is frequent but usually benign. Routine measurement in all patients is not justified. A selective, risk-based approach – focused on ischemic symptoms, electrocardiogram changes, or high-risk clinical features – offers more appropriate, efficient, and patient-centered care.

Keywords: Acute coronary syndrome; Emergency service; Hospital; Risk assessment; Tachycardia; Supraventricular; Cardiac troponin

Core Tip: Supraventricular tachycardia (SVT) is a frequent emergency presentation where troponin elevation is common but often misinterpreted. This narrative review highlights that in adult patients with paroxysmal SVT, elevated troponin usually reflects supply-demand imbalance or myocardial stretch rather than plaque rupture. Although troponin testing may occasionally reveal underlying coronary artery disease or acute coronary syndrome, most elevations have limited prognostic value. Overuse of troponin can drive unnecessary admissions and procedures; therefore, selective, risk-based testing represents the most appropriate and patient-centered approach.