AVNRT Ablation questions

[mattpp]

Hi
I'm a 27 year old male with AVNRT.I have attacks about 5x a year with hr up to 280 bpm lasting from 5 mins to 1 hour max.I occasionally have skipped beats which I'm assuming are pacs/pvcs.

I'm due for an ablation on 22 Jan and still have a few things i'm not sure about.

Firstly i'm worried about the proarrhythmic side effects of the procedure - pac's, pvc's,atrial flutter etc. Judging by the posts on this forum,it appears that very few patients undergoing the procedure come away completely cured(although I imagine those who are fully cured would be less likely to post).Specifically I was wondering what percentage of patients come away completely cured and what percentage come away experiencing new arrhythmias caused by ablation lesions.Also, would these new problems have already been present before and would I be less likely to be affected as I only present avnrt symptoms?

Secondly my electrophysiologist also performs cryoablation. I met with him last week and we discussed both cryo and rf. He performs both but has only undertaken a handful of cryoablations compared with 40 rf ablations for avnrt a year.He hasn't had an occurence of permanent heart block for 7 years so I have every faith in him.My question is whether cryoablation carries less risk of the above side effects (new arrhythmias) compared with rf ablation? Also, what is the death rate of ablations? At the moment I am erring on the side of rf because I do not want my avnrt to return and my electrophysiologist appears more comfortable with this, although he is fully prepared to go either way.
Many thanks, Ma

[CCF-M.D.-MJM]

Hi Ma,

The success rate for RF AVNRT ablations is about 98% with low recurrence rates.  Success for cryo ablation is about 94%.  I think there is only one report of complete heart block with cryo, but the trade off is a lower initial success rate.  RF is very safe and the risk of complete heart block from is low, generally quoted as between 1-2%.  Even under perfect conditions, heart block can occur.  The catheter can move and it only takes about 2 seconds of ablation in the wrong spot to cause heart block.  You should be comforted that the incidence of complete heart block is low, but never zero even in the very best hands.

Developing other arrhythmias as a result of an AVNRT ablation would be very rare.  You do see selection bias on this forum.  In general, most people are cured without complication.

In general, we use RF for 95% of cases.  The death rate from an AVNRT ablation is about very low -- probably less than 1 in 1000.

If you have PACs/PVCs, the ablation will not help them.   They are a different entity.

Good luck with your procedure.  Thanks for posting.

[CollegeGirl143]

i had an ablation for avnrt, it was successful, and i noticed a decrease in the sensation of the pvc's, i cant say it was the ablation, but i can say the change happend at the same time.. Unfortunatly, pvc ablation is a last resort and alot of doctors just wont do it unless the pvc's are lowering the EF.

[ivy123]

Would like to know who the doctor was.  My daughter has had 4 ablations over the last 5 years to no avail.  Three months after the procedure her heart begins having VT once again.

[CollegeGirl143]

ivy, the doctor was talking about ablations for avnrt, which is a type of svt.. Success rates vary depending on what type of arrhythmia you are trying to ablate, im sorry about your daughter! have you taken her to a major medical clinic yet?

[ivy123]

She is being treated at Ochsner Hospital in New Orleans.  They told us they have never seen this in a child so young therefore there are no text books to go by.  It seems as they are using her as genie pig.  All the meds.  At one point they had her on 2 different  meds to lower her blood pressure, thank goodness my pharmasist caught it.  I don't know where to get a second opion.  I have totally lost faith in the doctor she is seeing now.  I tried to look online but keep hitting dead ends.  She has upper left venticular tachycardia.  Her HR has gotten to 198.  She's always pale and has passed out a number of times.  Once we had to call 911 and the medics freaked out on her saying they have never seen anything like this in a person so young.  When she saw her doctor in the ER he told her next time just go home and lay down.  I have given up on him.  If anyone could suggest a doctor it would be greatly appriciated.

[CCF-M.D.-MJM]

I see your point based on the way I phrased my reply.  A PVC ablation will/should reduce the incidence of PVCs and in some cases will reduce SVT as well.  It depends on the initiating factor for the SVT -- some SVTs can be initiated by PVCs and other can not.  I hope this clarifies your question.

[ivy123]

The doctors claim that the only way a child this young could have the condition is from either she was born that way or she had a disease to her heart which they have shown neither to happen.  I just need to find another doctor who can help us.  My daughter is so tired of going through this, she just wants to lead a normal teenage life.  We have to find a medicine or a doctor who can help.

[CollegeGirl143]

i dont know if you are able to travel, but the cleveland clinic in ohio would probably be the best place, that or the mayo clinic.. They've seen pretty much everything and would be able to help you considerably more than it seems you are now..

[momto3girls]

Hi there,

I just wanted to let you know I hope your daughter can find a good dr. and feel better soon.  Poor thing!  It must be very hard for her (and you) to deal with.  When you say she has upper left ventricular tachycardia, do you mean the atrial chambers?  I'm just curious because my little brother had tachycardia/vagal tone issues when he was a young teenager.  His heart would race really fast when he was standing and then he'd get very dizzy and nearly pass out.  The doctor said he had problems with his vasalvagal (sp.).  He was put on high fluid (gatorade and water) and high salt diet.  It hardly ever bothers him now but it was a problem when he was younger.  

I sure hope you can find a doctor to sort this out for her.  Goodness knows you both must be beyond frustrated.  Good luck to you!  Best wishes (:

momto3girls

[ivy123]

Thanks collegegirl & mom.  To mom I wasn't sure but after going over her med records I do see atrial.  It states she has left ventricular fascicular tachycardia.  In 2005 she one of her tilt test and they begin her on Atenolol 25mg & did tell us to increase her healthy salty snacks and fluid intake, none of which helped.

To collegegirl OH YES I am willing to travel.  I am willing to do just about anything at this point to try and fix this.  Thanks again!

[momto3girls]

You should try to post a question on the forum about your daughter.  Maybe they'll have a different approach or perspective on your daughter's symptoms.  Try posting early in the morning (8:00 am eastern time).  Good luck!

momto3girls

[Momto3]

The Cleveland Clinic also offers an "e opinion."  You can access information about this service at http://www.eclevelandclinic.org/

Maybe a second opinion from the Clinic will offer some guidance as to how to proceed.

I've had 2 successful ablations in Cleveland, but not at the Clinic.  I do have a cardio at the Clinic and I can tell you first hand this is a world class facility.  

Good luck!!  Keep us posted.

[m0rr0w]

Hi,

I had ablation about 5 years ago when I was 14 at the University of Pennsylvania. I was having episodes about once a week and my heart would beat faster each time. Eventually when they finally decided it would be best for me to go through with the procedure was when my heart rate hit 279 while playing volleyball in gym class. They then took me to the U of Penn where I was put in the hands of 2 of the best electrocardiologists in the country. They did the procedure and it took about 6 hours to complete. Mine was very difficult because it was right near one of my major pathways. The only scary thing about the whole procedure is when they have to speed up your heart in order to find the problem. I was awake though for the entire procedure. I am now 19 and havent had an episode since the procedure. The only problem is both of these doctors have left now and are at different hospitals. I still stay in touch with one of them and he is considered a master in electrophysiology. These 2 doctors got in alot of trouble when they performed this procedure on me because I was only 14 and was under the weight limit for having it performed at a major hospital. I was really supposed to have the procedure done at a childrens hospital but these 2 doctors at the time were the best and they decided that they wanted to take on the challenge and to this day I am very grateful and thank them both very much. If you can get your daughter to this doctor I can almost guarentee she will be in the best of hands because I had svnrt and mine was very close to my main pathway but they were still able to completely close the bad pathway shut. His name is John Beshai and he is now at the University of Chicago hospitals here is the link so you can get his email and phone number. If you decide to go with him keep me up to date because I would like to know how it goes. He is a very nice doctor and is wonderful with children.
http://www.uchospitals.edu/physicians/john-beshai.html

Zac