André Zimerman, M.D., and Andre d’Avila, M.D., Ph.D.
A 58-year-old man presented to the emergency department with a 1-month history of intermittent dizziness and palpitations that occurred when he spoke. Continuous electrocardiographic monitoring revealed atrial premature beats when he was speaking isolated words (Panel A) and sustained atrial tachycardia up to 167 beats per minute when he was speaking full sentences (Panel B). The arrhythmias promptly subsided when he stopped talking (Panel C). Arrhythmias were reproducibly triggered by any spoken syllable but not by soundless mouth movement, deep breathing, or an inspiratory breath hold. A transthoracic echocardiogram showed a structurally normal heart, and findings on computed tomography of the chest were unremarkable. Speech-induced atrial tachycardia may represent transient aberrant vagal stimulation from the recurrent laryngeal nerve to the atrial autonomic ganglia, resulting in abnormal automaticity or triggered activity. The patient’s symptoms resolved promptly with oral metoprolol treatment, which was continued for 3 months. The symptoms did not recur, and no catheter ablation was performed. At 3 years of follow-up, the patient remained asymptomatic.
May 29, 2021