Aloraini Nawaf Y, Alowaidi Anas M, Alqarni Usamah I, Suliman Ihab, Alanazi Haitham A
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.
Cardiology, King Abdulaziz Medical City, King Abdulaziz Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, SAU.
Cureus. 2025 May 4;17(5):e83456. doi: 10.7759/cureus.83456. eCollection 2025 May.
Supraventricular tachycardia (SVT) is a common arrhythmia, often responsive to pharmacologic intervention or electrical cardioversion. Resistance to direct current cardioversion (DCCV) is uncommon and can be clinically challenging. Lifestyle factors, including dietary stimulant intake, may influence arrhythmia dynamics and treatment responsiveness. We present a case of a 26-year-old female known to have SVT, who presented with six hours of palpitations, with a past medical history of successful cryoablation performed in 2021 for atrial tachycardia originating from tissue near the atrioventricular bundle. Her maintenance therapy included bisoprolol 2.5 mg. Notably, the patient reported regular and excessive consumption of energy drinks, averaging multiple servings daily. The pharmacological intervention failed to achieve rhythm control, necessitating DCCV. Despite appropriate sedation and energy dosing, initial cardioversion attempts were unsuccessful. Subsequent higher-energy shocks ultimately restored sinus rhythm. This case underscores an unusual presentation of cardioversion-resistant SVT in a young adult with prior ablation. The patient's habitual intake of energy drinks raises concern for potential pro-arrhythmic and electrophysiologic alterations induced by high caffeine and other stimulant content. While caffeine's arrhythmogenic potential is recognized, its role in altering myocardial excitability and threshold for cardioversion is not well established. This case adds to the limited literature suggesting that excessive stimulant use may contribute to treatment-resistant arrhythmic episodes. Clinicians should be aware of dietary and lifestyle factors, such as energy drink consumption, which may influence the efficacy of electrical cardioversion. Further research is warranted to elucidate the mechanisms by which stimulants impact cardioversion outcomes in patients with SVT.
室上性心动过速（SVT）是一种常见的心律失常，通常对药物干预或电复律有反应。对直流电复律（DCCV）产生抵抗并不常见，且在临床上可能具有挑战性。生活方式因素，包括饮食中刺激物的摄入，可能会影响心律失常的动态变化和治疗反应性。我们报告一例26岁已知患有SVT的女性病例，她因心悸6小时前来就诊，既往有2021年因起源于房室束附近组织的房性心动过速成功进行冷冻消融的病史。她的维持治疗包括比索洛尔2.5毫克。值得注意的是，该患者报告经常且过量饮用能量饮料，平均每天饮用多份。药物干预未能实现节律控制，因此需要进行DCCV。尽管给予了适当的镇静和能量剂量，但最初的复律尝试未成功。随后更高能量的电击最终恢复了窦性心律。该病例强调了一名有既往消融史的年轻成年人中出现的对复律抵抗的SVT的不寻常表现。患者习惯性饮用能量饮料引发了对高咖啡因和其他刺激物含量导致潜在促心律失常和电生理改变的担忧。虽然咖啡因的致心律失常潜力已得到认可，但其在改变心肌兴奋性和复律阈值方面的作用尚未明确确立。该病例补充了有限的文献资料，提示过度使用刺激物可能导致难治性心律失常发作。临床医生应意识到饮食和生活方式因素，如饮用能量饮料，可能会影响电复律的疗效。有必要进行进一步研究以阐明刺激物影响SVT患者复律结果的机制。
