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.