Ablation/Medication question

[tricializ]

Hi all.  I had an ablation attempt at the end of April that was unsuccessful.  The EP has tried a bunch of drugs are varying levels to control the arrhythmia with no real results.  I decided to do a very intense fitness camp for the last 4 weeks to see if exercise, some weight loss etc. might help.  (it didn't...look better though.  :)  Anyway, my next step is either another ablation attempt or another medication. I believe they would try norpace or betapace (can't remember) but I would have to be admitted to the hospital for 3 days.  My question is, what would make me believe that a second ablation attempt would be any more successful than the first?  And second question is, do you think that they would go for this?  

Go into the hospital for the ablation attempt. If successful than whoo hoo and go home the following day.  If not successful, then start the medication that requires hospitalization since I'm already there.  If you can't guess, I hate being a hospital patient and have been dreading and totally putting off this next step.  I am currently on 425mg 2 x/day of Rythmol and it is doing nothing.  I have been having a really bad day today with dizzyness at an all time high along with a weird pressure feeling in my upper mouth/throat/nose/cheeks area.  It's odd and comes and goes and only lasts a couple of seconds several times per hour.  Thoughts?  thanks.
Tricia

[sb786]

Whenever i have had an episode it has been as i was swallowing.  This could be the very first bite or the last and it has always lasted for about 10-30 mins. It doesn't happen all the time so i cannot reproduce it. I am 28 yrs old now and this has been happening since i was about 11 yrs old. I had no idea what it was. When i was younger i used to think it was because the food would get stuck in the food pipe!

[StephPT]

I never really had just PACs or PVCs, although from a morphology standpoint (meaning where they come from), i was told that each run of SVT started with a PAC (in my case).

There is a big difference between "swallowing induced" tachycardia and tachycardia that comes AFTER eating because of reflux.  Do your episodes happed during the meal, or after?  Do they happen with each bite, or when you are finished eating?  Mine was a few beats (2-20) with each bite, and it was caused by a change in vagal tone with swallowing (or burping).

Have you had a holter?  can you pinpoint when it starts?  And, is it so predictable that you could reproduce it by swallowing while having an EKG? (I could do that, and it was the deciding factor in letting me swallow sprite on the table to induce my own arrhythmia...they wouldn't let me do it unless i could consistently perform).

Just for the record, my arrhythmia specifically happened after each swallow...I would chew, swallow, and when i would inhale in (during normal respirations, or to take the next bite) it would kick off.  very predictable.

steph

[sb786]

Thank you for replying to my post! I am sure i have swallowing induced tachy as 99% of my svt episodes have been triggered by swallowing! The only difference between my episodes and yours is that mine only seem to happen when i ha ve very bad indigestion, stomach acid, bloating etc.
The EP told me that svts were triggered by pvcs and pacs and during the ablation attemt he triggered many pvcs and pacs but was unable to start the svt. Do you find that pvcs and pacs don't start the svt only swallowing does??
Thanks in advance xx

[StephPT]

My SVT occurred with every swallow of food or beverage, and every burp (reverse esophageal pressure).  It was 2-20 beats of a-flutter or other SVT in the range of 180-220.  I would also get blips of it now and again when i wasn't swallowing.  It was formally known as "swallowing-induced tachycardia", and if you google this, you will find a few (very few) research articles about it.  Pretty rare.

I say "occurred" because i have been arrhythmia free since 4/06!!  (woohoo!!).  I had 2 failed ablation attempts before we all figured out that they could try all they wanted while i was asleep, but if i wasn't swallowing, it wasn't happening.  So, i ended up at Oklahoma University Medical Center with Dr. Jackman...he is one of the best in the world, and only accepts cases that have failed somewhere else.  He was willing to let me stay awake and drink sprite during the study to induce my own arrhythmia.  Even he was skeptical until he saw me do it on EKG (it was like a bad party trick!)  We had to try twice (6 month apart...that is the longest day of one's life, being awake, and having them in your heart, and then the bedrest to follow...start to finish, about 16 hours flat on your back.), and the second time, he ended up doing a pulmonary vein isolation around 2 of the 4 pulm. veins, and some ganglionated nerve plexus ablations (something he is developing for the treatment of A-fib...my arrhythmia was treated very much like a vagally mediated a-fib, as the swallowing definitely had to do with the vagus nerve), and it worked.

as for medication, nothing touched it, and some (like beta blockers...the standard treatment for SVT and PVCs) made it worse...i was on toprol with and without digoxin, verapamil, norpace, rhythmol, flecanide...nothing worked.  i refused betapace (for obvious reasons...it's got a beta blocker in it) and amiodorone (didn't want a blue nose or thyrotoxicosis).

I hope this helps...let me know if you have more questions.

steph

[sb786]

My story seems very similar to yours. I had a failed ablation attempt in june. The EP tried to trigger the svt for almost 2 hours but with no success. How often are your svt episodes? Do you also get PVCs?

STEPH: My svts usually happen when i am eating and i believe that is why they couldn't start the svt. Do you also have the same problem? If so what medication are you on? How frequent are the svt episodes??

[Momto3]

I don't think you mentioned what type of arrythmia your ablation was for...I had 2 ablations in 2003 (3 months apart) to reduce the number of pvcs I was having.  Each procedure was considered successful, as it ablated a different foci.

Prior to the ablations, I was in the hospital to try flecainide, and it was fine.  I was hooked up to telemetry monitoring and just hanging around the hospital while they kept an eye on things.  The flecainide did a great job at lessening the # of pvcs, but didn't like the side effects.   Next, I was on rhythmol, and it also worked great, but less side effects.  In my case, the ablations were superior to both meds.  Good luck with your decision.  Hope you have a great outcome, regardless of what treatment you pursue.
connie

[jmpr]

I had an ablation in May of 2006. It got rid of my Atrial Flutter but then Atrial Fibrillation came out.

Anyway, I was told after my ablation that it would take up to 6 months for everything to heal...and that the circuits aren't stopped until after the healing. Apparently the burning leaves swelled tissue for a while and misfirings can come through that tissue until it scars up.

I'm surprised, I guess, that your EP would want to do another ablation so soon and not wait a while to see how things are once your heart has healed from the first attempt (I've heard that 2nd and 3rd ablations are very common). If taking the meds for just a temporary time would help while you were waiting for the 6 months to go by, then it would seem that it wouldn't be too bad because it would be short term.

I am on Amiodarone right now for my arrhythmias - it is a drug with nasty side effects but it does help a lot.

[ireneo]

I've gone in for 3 ablations. Not because I enjoy the experience but because my EP doc felt that was the best hope for some relief of my problems. Is my heart perfect? No, but it's greatly improved. Even at my old age (ha, over 50) I didn't want to play drug roulette, try this drug and that drug hoping for relief with minimal side effects. Plus, I understand that you can find the right med only to have it lose its effectiveness years down the road. No thanks. So now I'm drug free and living a pretty good life. That was my choice and my reasons for it.

[Sweetwaterguy]

Tricia,

    The questions you ask are certainly appropriate for discussion with your doctor.  Although my ablation in December appears to have been successful, I did discuss those "what if" questions with my EP during my last follow up visit.  I learned that second ablations are quite common, and hopefully if you choose to do so, you will get a better result.  
   I can understand the dread in being a hospital patient.   My choice to do an ablation as compared to try to manage with medicine was because I wanted to be aggressive in my approach to my a fib issues.  That was a more powerful motivation for me than my dislike of hospitals.  Reading between your lines suggests you, too, want to be aggressive about your medical care.  For people like us, waiting for things to happen or for answers is especially difficult.
   Just question your doctor until you have the answers to feel comfortable and confident in your health care.  The worst case scenario might be a pacemaker if ablation does not work.  My wife has had one for 10 years (she is 70) and she enjoys a very active and unrestricted life style.
   Best of luck to you.

[StephPT]

Are you still having the swallowing-induced problem?  If so (as i said before) another ablation won't help if you can't do some swallowing on the table.

As for other meds, I know how I felt about that (which was NO WAY).  Nothing had helped, and isn't likely to help (although I didn't try Betapace).

steph