AV Nodal Re-entry or PAT

[mis123]

My electrophysiologist thinks I either have av nodal reentry
or pat from the heart monitor.  He's not sure which.
What is the difference and is one worse then the other?
Everything I've read said this is not life threatening.
He tried three medicines and I am currently on atenolol 25 mg
once a day.  None of the medicines seem to get rid of this
problem.  I just don't feel it as bad.  It's also not as long.
Usually if I take a deep breath and hold it a couple of times
it will go back into a normal rythem.  One time it felt like
my heart stopped and I almost fainted but since my palse is so
weak with the medicine I couldn't find it to see what was wrong.
Just when I thought I was gonna black out my heart started beating
again.  It probably wasn't as long as it felt but it was scary.
My heart still does the same rapid heart beat that it was doing without
medicine.  My last visit he recommended increasing the
atenolol to 35 mg a day but I wanted to wait.  Why doesn't
the medicine work?  He said he could go in a try to see
if he could zap it but wasn't ready for that either.  Is this serious or not?

[CCF-M.D.-RCJ]

111111,

Thanks for the post and multiple questions.

Paroxysmal Atrial Tachycardia (PAT) and AV-nodal re-entry tachycardia (AVNRT) are both causes of rapid heartbeats.  But asking which one is more serious is like asking: "which is darker, green or blue?"  The answer is: it depends.

It is reassuring that you are able to stop the fast heartbeat by holding your breath.  This maneuver is an example of a vagal maneuver.  Other examples include (1) bearing down like when you are moving your bowels, (2) immersing your head in cold water, or (3) hard repetitive coughing.

I think that you need to establih an alliance with your doctor to treat these palpitations.  On the one hand you ask why these medicines are not working, but on the other you would not accept your doctor's recommendation to increase the medicine dosage.  You are going to need to decide whether or not you trust him/her, and then act on his/her recommendations.

If you are becoming increasingly concerned about these palpitations, then it is probably time to become serious about making a diagnosis.  A diagnosis can usually be made by a holter or event monitor, but sometimes needs a long-term recorder.  Once you have a diagnosis, then more definitive therapy can be administered, such as an ablation procedure.

Both PAT and AVNRT can be serious in that they can adversely affect your quality of life by popping up at inopportune times, but it is unusual for someone to experience a life-threatening problem from either one of them.

Hope that helps, and good luck.

[Maria77]

Hi 111111.  I thought an electrophysiologist could tell which type of tachycardia it was by looking at the ECG.  I'm just learning about all of this myself, but when I had my last episode, I went to the ER, so they caught the arrhythmia on the ECG.  My cardiologist said that from looking at the printout, the electrophysiologist had determined that it was AVNRT.  

Here is an explanation I found on another site about how they differ:

"Tachycardias involving the AV node:

AV nodal reentrant tachycardia. An arrhythmia due to an extra conducting pathway within the AV node. This allows the heart’s electrical activity to “short circuit” itself (“reentry”). Episodes of this arrhythmia may be triggered by physical or emotional stress, caffeine or certain medications. AV nodal reentry can often be managed by medical therapy with beta blocker or calcium channel blocker medications, but can also be cured by catheter ablation of the extra pathway.


AV reentrant tachycardia using an accessory bypass connection. Similar to AV node reentry, this occurs when an extra conducting pathway allows the electrical impulse to “short circuit.” In contrast to AV node reentry, however, the extra pathway in this condition bypasses the AV node, directly linking the atria and ventricles. In most cases, this pathway can only conduct “backwards” — from ventricles to atria. This is called a “concealed accessory pathway” since it cannot be diagnosed from a regular electrocardiogram (EKG). These arrhythmias may be treated medically, but can also be cured by catheter ablation. Less often, the extra pathway is evident on the EKG, in which case the condition is called the Wolff-Parkinson-White syndrome (WPW). WPW syndrome may result in extremely rapid heartbeats and could potentially result in death. Symptomatic WPW syndrome generally requires catheter ablation."

"Atrial tachycardias may be focal (arising from only one place in one of the atria) or multifocal (arising from many different places in the atria).

Paroxysmal atrial tachycardia. A condition originating in the atria, in which the heartbeat increases for several minutes to a number of hours. Treatment may be necessary for short, sudden episodes that begin and end rapidly. Most people with this condition are young with normal hearts. The condition may be exacerbated by the use of even small amounts of caffeine or alcohol. This condition has also been associated with overly high levels of digitalis (a cardiotonic drug) in the bloodstream......"

I am not on medication and am on the list for the RF ablation procedure.

Marie

[cyn123]

Hi   i had avnode renetry and had a ablation done .  I had the condition for 13 yrs and it nearly brought me to the nut house.  I had the ablation done in may of 2000 and i have not had one episode of the tackycardia.  Please I cant stress it enough to go and get it done.   You go to sleep for  about 4 hours and they put 3 catherters in you   one in your neck and 2 in your groin.   I stay one night in the hosp.   Yale NewHaven was where i went and i would highly recommend it.   Good Luck