Ablation Created a New Tachycardia

I posted before about all of my post ablation problems in particular, sinus tachycardia. I am now 6 weeks post ablation. I was to my EP for a follow-up the other day.  I had worn a Loop monitor for 3 weeks prior.  My doc stated that I may now have Innappropriate Sinus Tachycardia as I had captured a 20 minute episode of 160bpm 2 weeks earlier of sinus tachy.  He feels it may be temporary or could end up being permanent.  I was burned three times near the mid and lower crista termanalis region and he pointed out that it was near the sinus node.  I was ablated for avnrt (240bpm), atrial tachycardia (140bpm) and extrasystolies.  All of the three problems ablated for were a success he stated. I am disappointed that I now have to be medicated for a new tachycardia as it causes me to be depressed and very tired which is why I had an ablation in the first place as I had been on Verapamil. I have only had the one episode but was put on Toprol XL (50 mg one per day)right after that episode which does help. My question: How often does IST happen after ablation?  What are my chances of it being post ablation irritation? Is there a possibility that my sinus nerve was damaged? Can I drink at least 1/2 cup of coffee per day or will that irritate the sinus tachy even on Toprol. I was able to drink coffee before the ablation without any problems. Also, what, if any, are the long term effects of Toprol? How long before I'll know if it is temporary or permanent?  Thanks for this forum and Happy Holidays!

[Cleveland Clinic]

glassheart,

Some of the side effects of ablation is the unmasking of other arrythmias and the creation of others. I'm not sure how often inappropriate sinus happens afte ablation, but its frequency is increased by manipulation around the crista terminalis.

The longer you go from your ablation the less likely your arrythmias are from irritation. One rule is that they should be occuring less frequently as time goes on.

The only way to tell if caffeine makes a difference is to try to go without it. 1/2 cup isn't too much, but if it triggers, then its too much.

Long term effects of toprol are just the side effects of the medication which some experience and some dont which will go away with stopping the medicine, mainly fatique.

good luck

[BlueHeron59]

I am anxious to hear a response to this.
I had a Isithmun flutter ablation done 7 weeks ago and
life has never been the same. I was put on Flecanide and Toprol
and since have had numerous tacycardia episodes with
extreme feelings of blacking out. After numerous ER visits
and back to the cardiologist, noone has any answers.
We caught it on an event monitor and it was simus tachyacrdia and not flutter or afib again.

So now they have me off the Flecanide and almost
off Toprol to see if the medications are causing it.

Being 44 I am still wondering if this is hormone related and
HRT might help.??

[DottyCece]

I had an atrial flutter ablation attempt im August but it failed.  For a two month period of time, I was AV paced or V paced for the most part.  Then I developed atrial flutter again and have been cardioverted three times since Sept.  Even though they were unsuccessful with the Atrial Flutter ablation, my electrophysiologist said that I may stay out of flutter since he cust many of the pathways..thought I may just develop other flutter origins.  I have had periods of atrial fibrillation since the ablation attempt.  Bottom line, I really expect to have a number or arrhythmias in the future.  Nothing is absolute and we are all so different in response to interventions.  I was taking amiodarone and have quit on my own. It has made no difference one way or another and with all the side effects, I really felt that nothing is better.  If I take anything in the future, I may ask to go back on a low dose of sotolol since I have the pacemaker so the rate wouldn't be a big issue.  I did well with sotolol and had no arrhythmias during the time I took that drug.  

Yes, this is all very frustrating and I wouldn't wish this on anyone.  No matter what they say, one never feels right with all the drugs etc. etc.

[bama jane]

I will be very intersted in hearing what the doctor says as well.  I had an ablation attempt 4 years ago and it failed. I have numerous atrial arrhythmias and it really affects the quality of my life as it does everyones.  I have not heard of too many successful ablations on the internet, but as my husband says if you were fixed or controlled you wouldn't still be on the internet looking for things to help your condition because it would be over and you would want to forget about it and move on.  That is true but it would be nice to hear some success stories.  Everyone is different and I guess no one knows how burning a little place on your heart will affecct it until after it is done, but I have heard that it takes a while for your heart to settle down after this procedure. Good luck to everyone.

[glassheart46]

I agree with you totally Hank.  I only wish I'd have know about the possibility of new arrhythmias before I was ablated.  I have myself to blame as I did not do much research prior to ablation.  I think If I had looked into it further and asked my EP more questions, I may have choosen not to be ablated.  It is too late now and I cannot look back.  I only hope that my situation will aide someone else.  I, like a lot of people, stupidly think that doctors know everything. They are only human like the rest of us but I think we loose site of that fact when we are ill.   I trusted my cardiologist.  After all, HE IS A HEART SPECIALIST!  Well, I have learned a valuable lesson.  We are our own advocates of our health and must rely upon ourselves to figure out what is best for us and use our doctors as a means of making an informed decision.  I think individuals with an arrhythmia should do their homework before jumping into the frying pan.

[Momto3]

It does seem as though we only get to hear the bad stuff on these boards...Thought I'd let others know, when ablations are recommended, they can be very successful! HERE HERE!! For those of you who have pvcs and/or pacs, have the standard tests to rule out anything serious, and trust the good doctors. If you cannot talk with your doctor, find another one...There are MANY, MANY wonderful doctors out there.

Just thought people should know that there are success stories out here :)

Happy Holidays everyone!

[Momto3]

Hank,

Boy, you got that right!! I couldn't agree more. To anyone facing the possibility of a cardiac ablation, do your homework and be sure it is being done for the right reasons!! In my case, it was done for medical reasons, NOT for symptomatic relief. In fact, when I first broached the subject of an ablation for symptomatic relief of my pvcs(years ago), I was told it was "not necessary". AND, I was having bizillions of pvcs/day...Learning to "live with it" was the best decision I ever made :)

Hey Hank, send some of that sunshine up here to Cleveland! It's getting chilly....Happy Holidays!
connie

[Scientist]

I too have had a failed ablation (for flutter, which got worse afterward -- does anyone know the statistics for this, other than "rare"?), but I have some hope, as I have looked into a comment by my EPS about a complete cure of one patient through Chinese medicine.  It turns out that Chinese physicians and some alternative western doctors both believe that many arrhythmias are caused by a chronic viral infection (I have Epstein Barr).  While mainstream physicians know that some arrhythmias are caused by a viral infection, I understand that they do not tend to follow this path for other cases (but rather treat the symptom only).

Because I've learned about antivirals (not pharmaceuticals, but rather certain herbs and particularly ionized silver  -- it's easy to find claims about them on the web, and not only by commercial interests) and because of their relative safety, I have been experimenting.  The jury is still out, but I suspect I'm improving.  Progress is very slow; I've been working on it for one and a half years (I also have chronic fatigue and was initially limited by the strong Herxheimer reaction).  The CRS is better.  But it's very tricky to assess results, because improvement is preceeded by worse arrhythmia.  Moreover, I have discovered the need for other supplements such as cysteine and magnesium.  I am not a physician, so this information is only information, and not to be trusted for personal use.

[Scientist]

I think it's important to contact professionals from varying backgrounds or somehow to learn about different approaches to health.  I've found both wonderful help and also great deficiencies in every area.  I'm grateful to my mainstream EP/cardiologist for his knowledge, and Norpace keeps me out of flutter.  Yet (for example) the mainstream doctors I've seem less aware of magnesium as a natural calcium channel blocker, than the nutritionists who studied its effects decades ago.  The person who probably helped me most was not a mainstream doctor (tens of whom had failed to diagonose my chronic problem), but someone who had studied with a Chinese physician (after examining me, she simply stated "You have an active virus" -- that was later confirmed by standard tests).

I also find I need to weigh the sometimes conflicting views of various professionals.  I've had to learn a lot.  It's been worth the constant uncertainty and pain.  I couldn't have come this far without the help of caring from experts several backgrounds, nor without my own judgment and wisdom.  I'm saying this because I'd like to encourage anyone who has health challenges to pursue her/his own path to health, relentlessly, with the belief that answers can be found.

[KarenSA]

I think it would help a lot of heart forum readers if there were more feedbacks from successful ablation patients.  I agree with the comments earlier in this thread that the successful ablations probably don't read this forum but this will be negatively skewing the results of a potentially lifestyle improving procedure.  Is there any chance of building a webpage like this one and asking successful ablation patients to post their stories on the site?

[Momto3]

Karen,

What a GREAT idea! When I was facing my first ablation, I also searched for "good" feedback....not much out there.  I reminded myself to return to the forum and post, especially if I had something good to share. Count me in among the lucky ablatees....have had two successful procedures this year...Keeping my fingers crossed.

Happy Holidays!!

Connie

[Momto3]

I was happy to read your post about the number of success stories.  I'm with you...If the doctor is not advocating strongly for an ablation, forget it! There are some risks with the procedures, but the decision for me was easy since the CM was a bigger risk...It was kindof good (in a weird way) because I have a hard time making decisions :)

I consider myself very lucky since an ablation was never really an option even will all those pvcs. However, when the story changed and my options came down to staying on the anti-arrythmics (YUK) for life or trying an ablation, I decided to give it a try. I asked the doctor what she would do, and she said she would have the ablation. That helped since she is very conservative and empathetic. I'm actually surprised at the number of people who want ablations for occasional pvcs, etc. Maybe they have pain or something, but I'm with you...not unless I needed one! For years, I was one of those patients who thought that the pvcs HAD to be doing some damage to my heart...they just had to be! How could anyone have an arrythmia that was considered benign? I just couldn't accept that until I found this new EP. She actually has pvcs so she GETS it! She understands what I am feeling and she convinced me that they truly are benign.

Thanks so much for your thoughtful and educational responses. As my uncle would always say, "You do good work!" lol...

Thanks for the sunshine! It's shining beautifully on the 6 inches of new snow : )
Connie

[12325Poohbear]

Hey, everyone.

I, too had an unsucessful ablation and was so discouraged. But I changed doctors and found one who was very capable and also listened to my concerns. My pathway was very near my A/V node and I was at risk for complication. But I needed the ablation (syncope) and went ahead. I am pleased to say that I am that success story you might be looking for. I had some PAC's for a few months after, and still have them if under a lot od stress or if I have too much caffiene, but my life is otherwise TOTALLY normal. No meds, good exercise tolerance and a cup of coffee whenever I want it! The medical motto is "do no harm" so if you don't have to have procedures avoid them. But if you require intervention, be proactive and seek the best care you can afford. Know your risks and what you (not your physician) are willing to risk. My first EP doc was very cavaleir about pacers-"no big deal" was his motto. I would rather try every medicine in the book before resorting to a pacer-especially since I'm only 40. My second physician understood that and assured me that he would back off if there was a chance of A/V node damage. Thankfully, he was able to fix my problem and did not cause any new ones! Thank God I can say all is well.

Good luck and keep the faith.

[Momto3]

Good morning,

I had a similar experience as you. My EP also went into the procedure with the plan of avoiding a pacer. She said if there was ANY chance of causing more harm than good, they were outta there....Plan was to be conservative, patient, and, respectful. I am 5 weeks post ablation, no meds, no longer winded after climbing a flight of stairs, and enjoying every morsel of chocolate I can get my hands on...

Thanks for sharing!
Happy Holidays!

[LynnSB]

Hank wrote:>>I certainly would definitely get an ablation if advised to do by a reputable EP doc if advised, that fact remains that most good EP doctors also advise their patients to try and tolerate their symptoms for as long as they can , epecially if the arrhythmia poses no threat to life and is very infrequent.<<

You know, I guess I'm involved with docs with really high standards or something but I have never , ever heard ( before reading this board!) that an ablation could be performed, would be performed, " just" for benigned skipped beats. Being " in there" doing an ablation for something else and also ablating areas of ectopy that could trigger more sustained rhythms is one thing -- but honestly, can people just decide they want an ablation for palpitations? I'm really shocked if that's the case.

I couldn't even get an EP study until it was documented I had atrial tachycardia and it was believed (from event monitors)that I had so much ectopic activityfrom the pulmonary vein that I was at risk of developing a-fib. the EP study showed  what looked like the pulmonary vein focus on the monitor to be incorrect but the AVRNT was found -- and that also provided the explanation as to why my heart used to get "stuck" at 200 plus for hours on end while I sat quietly and tried to breathe calmly.

In other words, my cardiologist looked me right in the eye and said as relatively safe as EP studies -- and, if needed, most ablations are -- he would never recommend one without hard evidence of something serious or potentially serious that was documented.. and it took two months of the monitor to document the atrial tach!  No, atrial tach in itself isn't usually life threatening but when it makes you feel like you are passing out briefly it can sure be life threatening if it  puts you at risk for having a wreck, etc.

I'm still having palps -- was hoping I'd have less post-ablation but over all I'm glad i had it done and will do it again if the atrial tach is back and bothersome any time.

Maybe some day people can safely be ablated for plain old benign but aggravating skipped beats. Maybe some EP docs are doing that today! But I  would be shocked.. and I would worry about whether that's ethical at this point in the development of EP technology, fabulous as it is.  by the way -- for folks who have a-fib.. there's  new ablation technique  you might want to research( new in the sense the results of astudy showing it is much more effective and safer than olde technique came out at the recent AHA scientific sessions and more centers are doing it ... Angel Leon just did the first one in Georgia last week , for example) called left linear ablation.. looks like great news and better chance for a safe cure, actual CURE, of a-fib than ever before.

[parunuweap]

I had what was basically a successful ablation 2.5 years ago.  I used to get 2 different tachycardias.  One would be around 160 beats per minute and the other around 280.  I was told before the ablation that WPW was suspected and it was confirmed during the procedure.  I went to 3 hospitals before deciding on the one that I felt most comfortable with.  My doctor discussed potential problems and agreed to stop the ablation if ANY risk to an important pathway existed.  I was 30 so I wasn't interested in a pacemaker for the rest of my life.  The procedure went well but since then I have had an increase in PVC/PACs that do affect my life.  I have also had two instances of the 160 bpm tachycardia since the ablation.  Even so, that's alot better than the 2 or more a week I was getting.  Sometimes I'll get a REALLY hard beat when I'm exercising that my doctor explained is the heart wanting to go into it's old rythym but instead hitting the ablation.

[Vuce]

I am scheduled for an ablation soon - next month.  I have been diagnosed with a flutter and it really is not bad at all when I am on the meds (Toprol).  But when I was not on it I'd get palpitations every single morning.  I'm only 34 years young and in very good health.  I don't want to be on meds for the rest of my life and my EP says the younger you have the ablation done generally the better off you are.  His team has performed about 150 ablations per year for last 5 years or so with very good results.  Estimates for people like me with a flutter are in the 90% succes range.  My EP is optimistic that it'll work.  He says that there really is no need for me to be on this medication for the next 50 years if they can cure this.  Procedure takes about 2 to 3 hours and said I can watch it on the TV monitor if I want to.  I'll report back after it is done.

[psvt1948]

I'm ablation-shy and continue to sarch for a cardiologist who LISTENS. Have had 5 Adenosine treatments at the ER in one year.
A major inconvenience, but I tolerate the 155 to 167 heart rate well and don't have pain or dizziness. Fortunately I can continue most activities just feeling tired. SVT is new to me, started a year ago. Difficult to come to terms with not finding and treating the CAUSE prior to an invasive procedure.

[Cathy7]

Has anyone heard of the "thoracoscopic Maze procedure"?  I have talked to two EP's and one recommended a cardiac surgeon who does this.  This procedure is an ablation done OUTSIDE the heart, so risk of clots and stroke are "practically zero" according to the surgeon.  They insert a 'scope and work the tools thru small incisions between the ribs.  Only about 50 have been done in the US within the last year, but I was told the success rate is higher than the usual ablation, with less risk.  I have near-syncopal episodes with my a. fib./tach and have had two fender benders when it happens - one with my grandkids in the car!  NOT good!

[SVT1979]

Okay well I have never had an Ablation.  I am scheduled for one this Friday and I think I am going to cancel until I feel more comfortable with the procedure.  Great EP and one of the best Cardiac hospitals however I am still very concerned.  I have had SVT that we know of since I was 8 years old.  I am no 25 years old.  I have had to go to the ER for fast acting medication twice in a 1 1/2.  I on the average have about 2 episodes a year.  Maybe 3.  I am usually able to stop these by standing on my head.  Before going to the ER 1 1/2 ago I hadn't been since I was 15.  So 8 years went by and I was sucessful stopping it myself.  I have a 5 year old daughter and I am just very unsure of taking the risk to do the EPS Study w/ Ablation as infrequent as these happen.  I have been fine so for in life.  HELP!  I am going to cancel this procedure for now.  Not enough time to think about it.  Any other comments are welcome please and anyone that has SVT as infrequent as I do???? Age wise have you noticed any further problems??  Let me know.  Thanks I enjoyed reading everyone's input.  Thanks

[SVT1979]

Okay well I have never had an Ablation.  I am scheduled for one this Friday and I think I am going to cancel until I feel more comfortable with the procedure.  Great EP and one of the best Cardiac hospitals however I am still very concerned.  I have had SVT that we know of since I was 8 years old.  I am no 25 years old.  I have had to go to the ER for fast acting medication twice in a 1 1/2.  I on the average have about 2 episodes a year.  Maybe 3.  I am usually able to stop these by standing on my head.  Before going to the ER 1 1/2 ago I hadn't been since I was 15.  So 8 years went by and I was sucessful stopping it myself.  I have a 5 year old daughter and I am just very unsure of taking the risk to do the EPS Study w/ Ablation as infrequent as these happen.  I have been fine so for in life.  HELP!  I am going to cancel this procedure for now.  Not enough time to think about it.  Any other comments are welcome please and anyone that has SVT as infrequent as I do???? Age wise have you noticed any further problems??  Let me know.  Thanks I enjoyed reading everyone's input.  Thanks

[Inspira8]

I have sort of a success story with ablations (although, success is all in how you perceive it):

I am a 25 y/o healthy female. I have always been extremely atheletic and have always had a fast heartrate and had trouble breathing as a child, but the drs attributed it to asthma. Turns out I do not have asthma. When I was 21, I finally saw an EP and a study was performed on me. Turned out I had beats up to 280 and he called it "Sinus Node Reentry". He ablated it and thought that he actually burned too much of my sinus node and that I would need a pacemaker. Turned out that I was fine & didn't need a pacer. However, 6 months later, my episodes came back... I underwent a 2nd ablation for the Sinus Node Reentry. It seemed to help for a few months, then it came back. I then underwent a 3rd ablation (this was all in a period of 2 1/2 years), and the EP found Atrial Flutter along with my IST (or sinus node reentry). He successfully ablated my flutter but my IST remained as he didn't want to burn too much in fear of giving me a pacer. However, my resting heartrate used to be as high as 150 + and I CONSTANTLY got attacks of flutter up to 250 bpm. After the ablation, my heart rate SIGNIFICANTLY went down and the flutter was cured! Although I still have a fast resting heartrate and still have IST, my flutter is gone and my heartrate never goes above 165bpm, even in a bad attack. So this is a successful ablation with respect to the flutter...now, my EP is talking about a 4th ablation for the IST with a significant pacemaker risk... Good luck to all of you :) Keep your hope and spirits up--it will get better :) :) :)