Speech-Induced Atrial Tachycardia

This image-based case report describes a 58-year-old man who experienced intermittent dizziness and palpitations exclusively while speaking. Continuous ECG monitoring revealed atrial premature beats during isolated word utterance and sustained atrial tachycardia up to 167 bpm when speaking full sentences, promptly resolving once speech ceased. The arrhythmia was reproducibly triggered by any spoken syllable but not by silent mouth movement, deep breathing, or inspiratory breath holding. Cardiac imaging revealed a structurally normal heart, and chest CT was unremarkable. The phenomenon may represent aberrant vagal stimulation via the recurrent laryngeal nerve to atrial autonomic ganglia, causing abnormal automaticity or triggered activity. The patient was treated with oral metoprolol for 3 months, with complete symptom resolution. No catheter ablation was required, and at 3-year follow-up, he remained asymptomatic.

This image-based case report describes a 58-year-old man who experienced intermittent dizziness and palpitations exclusively while speaking. Continuous ECG monitoring revealed atrial premature beats during isolated word utterance and sustained atrial tachycardia up to 167 bpm when speaking full sentences, promptly resolving once speech ceased. The arrhythmia was reproducibly triggered by any spoken syllable but not by silent mouth movement, deep breathing, or inspiratory breath holding. Cardiac imaging revealed a structurally normal heart, and chest CT was unremarkable. The phenomenon may represent aberrant vagal stimulation via the recurrent laryngeal nerve to atrial autonomic ganglia, causing abnormal automaticity or triggered activity. The patient was treated with oral metoprolol for 3 months, with complete symptom resolution. No catheter ablation was required, and at 3-year follow-up, he remained asymptomatic.