Another ep study

[wmac]

I just had another ep study at the University of Utah on Sept.28. I had one back in Jan. of this year also and both times they could not induce my nsvt or my svt. I was wondering how can they really say that the nsvt is not life threating if they cannot induce it, dont they need to be able to see whats going on to say that? I tried meds in Jan. and it made the nsvt worse with three low doses of toprol xl. Although they did get some extra beats from my dual av node and he did go ahead and burn that. Will that help anything? They were hoping and so was I that the vt was actually svt with an abberency but dont know since they could not indcue either. I have had all the tests echo, stress, mri, single average, tilt table, two eps and my ef is 68-70. Why is it that I can just be sitting and have the runs of nsvt but in the ep they cannot induce it, it does not make any sense to me. I feel that I have no more options. They tell me not to worry and its not life threating but tell me that when I am having the episodes. Also when can I start exercising? I had no follow up appt. the doc said I didnt need one. It seems as though every time I get either nsvt or the svt its when sitting and watching tv or on the computer is there a connection? I just dont know what to do at this point. My longest run of nsvt is 26 beats at a rate of 187. I also have pacs, pvcs, and aivr & mvp. This has been controling my life for the last three and half years. The first eps they induced vfib with very aggressive stimulation. All tests show that my heart is good and strong. Thanks for your time
Wmac

[Bromley]

Hi Christy. I made a whirlwind decision on ablation for PSVT. I did it overnight. I do not recommend this; but my 6 minute episodes do not compare at all to your 4-8 hours. That is a  long time to have that arrhythmia, and may be a matter of greater urgency.

My understanding/suggestions.  Note: I am not a doctor, or a medical professional of any type.

1. not all hearts are qualified for ablation. Having a blockage or damage to the heart is a reason to consider NOT having an ablation.

2. ablation carries a significant risk of stroke, especially depending on what needs to be done, and who is doing it.

3. become familiar with the various ways the catheters are inserted into your heart, and the availability of the right technology for a transceptal approach if that becomes necessary.

4. some PSVT's are more hazardous than others.  For instance, accessory pathway combined with afib. Also, ablation carries more risk of needing a pacer if you have AVNRT, and need ablation near the AV node. become familiar with the terminology.

5. the standard of medical care is the same everywhere, but the results of ablation vary from institution to institution and from doctor to doctor.  More importantly, because of some problems with litigation, the availability of assistance/responsibility following an ablation procedure may be quite varied, especially if you need help as a result of the procedure.

6. this decision requires you to be very strong, to establish  high ethical standards and professional qualifications for your medical care, and to demand that they be fully met. Do not be afraid to conclude that a doctor may be unethical or manipulative.

7. Do not be afraid period. If you have questions or get bad vibes of any type, or even if you dont get bad vibes, consider seeking a second, third, or fourth opinion.

Good luck and God Bless.

[ChristyC]

Thanks for your comment...but "why" could not having the ablation done cause a MI, that is my question? All other diagnostics & labs reveal no other problems. Does having PSVT a potential for leathal arrythmias, and that would be the reason for a potential MI??

[wmac]

Your doc said you could have a MI (meaning heart attack) well I would certianly have it done then. But why would it cause a heart attack? Its a very safe procedure over all. If they can fix you it would be a very nice xmas gift. Dont worry if you doubt the ep doc get a second opinion, but if you trust him have it done. Good luck
wmac

[ChristyC]

Hi... I am a 55 yo female and have had two episodes of PSVT over the past seven years that required chemical conversion. The first time was 220/min (lasting 8 hrs till converted in ER) and last week was 156/min (lasting 4 hrs till converted in ER). I have now seen a cardio MD who immediately suggested ablation, and sent me to a EP who has it scheduled for Dec 5th....I felt this was a whilwind decision! I have taken Toporal XL-100mg for 6 years, and now vaguely recall some PSVT in my sleep that comes and goes. The Toporal XL has not bothered me in the least as a med.
I have no CAD, per diagnostics (echo,cath). I just feel very rushed about something so invasive for something w/o a specific etiology. This EP is good, studied at Univ. of MI. But not one can give me an etiology for PSVT.
  Any thoughts on forgoing this procedure for a while? He did tell me it is not a rush, but if I didn't have it I could have a MI (I am a Type 2 Diabetic, and obese. I have great A1C control and normal lipids)......feeling very anxious about the ablation.
It is okay to wait for another episode I cannot stop????
Please comments???

[PikaPika88]

Hi,

Someone told me in another forum, SVT patients can not take blood thinner.  Her cardio told her.  Let me find out where is the web page....
It is in Yahoo Group : WPW

[mika_k]

there is a new ep doc in provo.  Name is Robert Lemery.  You could look into him if you need a second opinion.  I think the u of u and provo are your only options if you stay in utah for your doctor.

[StephPT]

For you folks that have had repeated EP studies that were unsuccessful at inducing the arrhythmia, were you asleep for the study?  I had two previously unsuccessful studies, and nothing could be induced under sedation.  I have a very rare form of swallowing-induced tachycardia (SVT), and just recently returned from what I think was at least a semi-successful ablation at Oklahoma University Medical Center.  The team there (headed by Sonny Jackman) was willing to keep me awake, because they said that some arrhythmias just go dormant under sedation.  Then, when they saw how easily my arrhythmia was reproduced by swallowing carbonated beverages, they actually let me induce it myself by drinking.  Being awake is by no means ideal, and it was the longest day of my life (9 hours on the table plus bedrest after the procedure equals one sore back!), but worth it if the end result is an improvement in the condition.  Just throwing a thought out there.  Good luck!

[PikaPika88]

I'm very hard to tell what kind of beat.  One common question that I'll ask is: "that kind of beat is come from my real heart or pacemaker?"  Another, AT or VT ; AF or VF all I can tell it makes me dizzy one is come from the bottom chamber.  Any one find out the different?  Can share?

VC, are you taking blood thinner for your A Fib?  Do your A Fib ever goes down to ventricle?

Pika

[VikingColumbus]

Hi, Pika

    I take an 80mg - baby aspirin - only.

VC

[wmac]

Actually I have seen many eps for this. I have seen Dr Marks in Boise, Idaho, I have seen Dr Freedman and Lund (lund is a resident) I seen Doc Wall who did the first ep, I have seen Doc Klein who did the second ep I have also seen his resident doc but cant remember his name. They have all said the same thing.
Its not life threating, but its really hard when im having an episode. Im just going to have to face the facts. I just wanted to be fixed is all. So I guess ive had many opinions.
wmac

[wmac]

Ya my first ep I was sedated with versed and was sleeping like a baby, the second one I was in and out alot. So see there is my point how can they say if its life threating or not without inducing and see whats going on? So if I was not sedated at all they maybe could of induced it and said oh look how about that it is bad. I just dont know it makes me crazy!
wmac

[vf15hammer]

I think the psychological aspect is the hardest part with SVT's.  I had them about once a week, and they would last for anywhere from 2 minutes to 2.5 hours and a trip to the emergency room!  I have had them since my surgery to repair my ASD in 1987.  But, last week I had that trouble spot ablated, and so far everything is okay.  Unlike you they were able to induce my SVT's though.
My doctor just told me today I had ~5000 PVC's on my last 24hr. holter monitor - wow.  And the palpitations definitely give me anxiety.  So that is my next thing to deal with.
The reason I say all this is - I understand that it is almost impossible to "accept" the diagnosis that you must live with your SVT's.  I had them for 17 years and they were starting to control my life.  I work outside, and if I had a spell of them I would have to stop what I was doing until they went away.  I definitely feel your pain and hope the best for you.

vf15hammer

[VikingColumbus]

Hi,

   You said " ...It seems as though every time I get either nsvt or the svt its when sitting and watching tv or on the computer is there a connection? ...." Well, funny thing but I as well experience bursts of SVT in the same circumstances in addition to other 'ctivities'

   I recently had the 30 day event monitor stuff and my Cardio
put me on Verapamil 180mg x 2 .  I asked an EPS Cardio who
'read' the events transmitted if I had NSVT and he said no.
Similiarly I asked if I had any 'Long-QT'. Again, no. I asked those questions as I 'feel' that my palpitations are changing in
character, but apparently it's age related as the heart does
gray with the rest of the body :)
  
   I also take Digoxin for Afib & Toprol XL100 for my SVT
tendencies.

   Been 'living' with SVTs for nigh on 30 years, on an off
for different intervals of time and frequency of occurences.
When in relaxed positions they - SVTs - are more prevalent for
me. I'd say up to 85% of the time.

   My EPS Cardio seems optimistic that an ablation can result
in a "99%" success of riding me of SVTs and the need for the
meds. I've got thinking to do on the potential adverse effects
which may attend to an ablation.

  
VC

[CCF-M.D.-MJM]

Hi WMAC,

Sounds like you have just about all the tests we have.  The reason they say that it isn't life threatening is because all the trials for ICDs have not shown a survival benefit for people with an EF of 40% -- yours is normal.  The treatment for NSVT with normal EF is a beta blocker or calcium channel blocker if the beta blocker is contraindicated.  They are telling you what is considered standard of care.

Will that help anything (burning the dual AV node)?

It will only help if this was AVNRT with aberrancy.  It will not help if the rhythm was VT.

Also when can I start exercising?

As soon as your doctor clears you.  Nothing that you mentioned above prohibits you from exercising now.


It seems as though every time I get either nsvt or the svt its when sitting and watching tv or on the computer is there a connection?

There is no connection that I know of.

"This has been controling my life for the last three and half years."

The doctors at U of Utah have told you that it isn't life threatening.  From my perspective I see two options.  One is obtain a second opinion and if that doctor agrees that it isn't life threatening, you need to move on. The other option is to accept it isn't life threatening and move on.  It sounds like they have done all the tests they have to prove that this condition is life threatening and haven't been able to do it.  The next step is the tough one -- that involves  you accepting the diagnosis and moving past it.  Psychologically, this is probably the toughest part.

I hope this helps and that you are able to move on.  Good luck and thanks for posting.