Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum. ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Heart Disease (Expert Forum)
Next steps for working with multiple arrhythmias.
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve, Pacemaker, PAD, Stenosis, Stress Tests
|
Next steps for working with multiple arrhythmias.
by Bromley, Jun 26, 2005 12:00AM
Hi. I experienced some extra arrhytmias after an ablation for WPW/Left free wall pathway. My questions:
What are the disadvantages and risks associated with a transaortic approach (vs transceptal) to ablating accessory pathway on left free wall?
What anatomical areas of the left atrium are only accessable using a transceptal approach?
During transaortic ablation of left free wall pathway, what sort of injuries can occur?
If I have short run narrow complex SVT (one or two ten beat strings a day) and occasional short run VT (10 beats once every 5 or six months as far as I know), is it worth worrying about it such that I limit exercise? I curently manage 6-8 miles of running regularly with no problems other than achy joints and a couple of thumps here and there.
Subjectively speaking, can you tell me how well ablation works and whether an EP study or ablation would be a good application for the short run SVT and short run VT that I am experiencing?
I should mention that an echo is normal, stress test is normal, cath shows no blockage. I am 45 yo male, 145lbs, use small amounts of toprol only when things get hectic. Tendency to feel ventricular runs seems to be diminishing with increased aerobic capacity, but I might just be getting accustomed to it.
Thanks.
What are the disadvantages and risks associated with a transaortic approach (vs transceptal) to ablating accessory pathway on left free wall?
What anatomical areas of the left atrium are only accessable using a transceptal approach?
During transaortic ablation of left free wall pathway, what sort of injuries can occur?
If I have short run narrow complex SVT (one or two ten beat strings a day) and occasional short run VT (10 beats once every 5 or six months as far as I know), is it worth worrying about it such that I limit exercise? I curently manage 6-8 miles of running regularly with no problems other than achy joints and a couple of thumps here and there.
Subjectively speaking, can you tell me how well ablation works and whether an EP study or ablation would be a good application for the short run SVT and short run VT that I am experiencing?
I should mention that an echo is normal, stress test is normal, cath shows no blockage. I am 45 yo male, 145lbs, use small amounts of toprol only when things get hectic. Tendency to feel ventricular runs seems to be diminishing with increased aerobic capacity, but I might just be getting accustomed to it.
Thanks.
Doctor's Answer
by CCF-M.D.-MJM, Jun 26, 2005 12:00AM
Hi Bromley,
What are the disadvantages and risks associated with a transaortic approach (vs transceptal) to ablating accessory pathway on left free wall?
The risks of transortic approach is an increased risk of stroke from the catheter bumping the aortic wall, although this risk is still low. Most people with WPW are young and do not have much aortic plaque. The trans septal approach is also very safe. The major risks are bleeding, blood or fluid around the heart causing hemodynamic instability -- again this risk is low, about 1%.
What anatomical areas of the left atrium are only accessable using a transceptal approach?
This is a tricky question. It depends on the patients individual anatomy and the size of the left atrium. The approach is usually individualized to each case and if one doesn't work we change to the other.
During transaortic ablation of left free wall pathway, what sort of injuries can occur?
You always risk perforation of the free wall and bleeding around the heart. This is risk is low, about 1%.
If I have short run narrow complex SVT (one or two ten beat strings a day) and occasional short run VT (10 beats once every 5 or six months as far as I know), is it worth worrying about it such that I limit exercise? I curently manage 6-8 miles of running regularly with no problems other than achy joints and a couple of thumps here and there.
We often put people on a treadmill and ask them to do a maximum exertion. If the exercise doesn't stimulate any severe arrhythmias and if the holter monitor isn't significant, exercise should be fine.
Subjectively speaking, can you tell me how well ablation works and whether an EP study or ablation would be a good application for the short run SVT and short run VT that I am experiencing?
If it is symptom limiting, I would consider trying something invasive. If the symptoms are rare and pose no significant threat, we would treat with medications. It is all about risk benefit ratios.
In general, invasive procedures are reserved for significant symptoms and people that are risk. Nothing you mentioned above speaks to significant symptoms or risk. As always, the final decision is about to your doctor and yourself.
Good luck.
What are the disadvantages and risks associated with a transaortic approach (vs transceptal) to ablating accessory pathway on left free wall?
The risks of transortic approach is an increased risk of stroke from the catheter bumping the aortic wall, although this risk is still low. Most people with WPW are young and do not have much aortic plaque. The trans septal approach is also very safe. The major risks are bleeding, blood or fluid around the heart causing hemodynamic instability -- again this risk is low, about 1%.
What anatomical areas of the left atrium are only accessable using a transceptal approach?
This is a tricky question. It depends on the patients individual anatomy and the size of the left atrium. The approach is usually individualized to each case and if one doesn't work we change to the other.
During transaortic ablation of left free wall pathway, what sort of injuries can occur?
You always risk perforation of the free wall and bleeding around the heart. This is risk is low, about 1%.
If I have short run narrow complex SVT (one or two ten beat strings a day) and occasional short run VT (10 beats once every 5 or six months as far as I know), is it worth worrying about it such that I limit exercise? I curently manage 6-8 miles of running regularly with no problems other than achy joints and a couple of thumps here and there.
We often put people on a treadmill and ask them to do a maximum exertion. If the exercise doesn't stimulate any severe arrhythmias and if the holter monitor isn't significant, exercise should be fine.
Subjectively speaking, can you tell me how well ablation works and whether an EP study or ablation would be a good application for the short run SVT and short run VT that I am experiencing?
If it is symptom limiting, I would consider trying something invasive. If the symptoms are rare and pose no significant threat, we would treat with medications. It is all about risk benefit ratios.
In general, invasive procedures are reserved for significant symptoms and people that are risk. Nothing you mentioned above speaks to significant symptoms or risk. As always, the final decision is about to your doctor and yourself.
Good luck.
Does anyone know the success rate of ablation for ECG manifest WPW vs. concealed accessory pathway or also called concealed WPW?
I understand the success rate of ablation for manifest ECG WPW is around 95-98% at some hospitals. Thanks.
Been suffering from SVT for 3 years now. Had EP study done twice but it failed to locate the accessory pathways. Recently I was diagonised with H.Pycoli in the stomach (causes heart burn and acid reflux in stomach). Since my EP Stidy has twice failed to induce the SVT, could there be a link between SVT and H.Pycoli infection in the stomach? Any one experienced this?
What are approximate costs for carrying out EP Study and possibly catheter ablation in Cleveland Clinic?
owiny - I am not familiar with costs of procedures at CC. I did put up the capital for an airplane ride so that I could consult doctors there. The cost to benefit ratio for that was good. Of course, I saved myself some money by doing the entire visit in one day. Also, as you can see, this alternate opinion, like the one I got during the visit, is conservative, so the cost of a second ablation may not materialize. Not sure what would have happened if I had gotten my medical care somewhere else. I should think it could have tended to cost me more.
Ticker - unfortuately I am a specialist in my own problem and therefore have no clue what the sucess rate is for WPW you can see on an ECG vs concealed. I'd be willing to bet that the stats that are usually quoted apply to both forms lumped into one. That is a very good question you have there: you'd think that manifest WPW would have a higher success rate than the concealed right?
Pika & Jeff - I do feel the ventricular beats as a string of strong beats. It doesn't happen often, but it is very uncomfortable when it does. My best guess about this is that the heart is beating very mightily, but no blood is flowing in or out of it, because it is not pumping efficiently. Like a waterballoon, as you squeeze it the fluid inside shifts and stretches the balloon, but does not flow out of the balloon. Sorry for the description, but that's about how it feels to me. The heart feels like it is being stretched as it pumps without achieving any flow, almost like all of the valves are shut, but heart rate is 180-200+.
I do hope you come to a decision on your arrythmias. Once they make you change the way you live it is time to take action.
Kathy