Complicated heart rhythm problem....Appreciate any help

Alright, let me start with the cardiac history and current diagnoses..my problems began when I was young.  When I was in school, about seventh grade; I started noticed my heart would suddenley take off and stop suddenley after about 20 minutes or so.  No major problems other than the fluttering in my chest, after years of this when I was about 16 my mom took me to my family doctor and I was reffered to a cardiologist here in Lubbock after wearing a holter monitor.  ...he gave me a event monitor in which I carried around and recorded these.  i was then sent to my EP doctor.  I had a EP study and RFA for a right anteroseptal pathway causing a 200bpm arrythmia, I Experienced syncope on one occasion before the ablation, and near-syncope many times.  2 days Before the ablation I had my first Echocardiogram in which they saw a significant case of MVP with only Mild-Moderate Regurgatation, and also have mild Tricuspid regurgatation. I now see Dr. Borno every 6 months for a check up on these.

I then had the ablation for the pathway, no complications, and it was sucessful as far as I know.   Yet, the Syncope still continued.  They had orginally belived the syncope had been due to a pause in the period between the arrythmia stopping and the sinus node regaining control of rhythm.  Since I was still experiencing syncope after the ablation I decided to get a second opion and saw a neurologist to rule out brain problems and then another EP who belived I MIGHT have orthostatic hypotension, and posturual orthostatic tachycardia (POT's) , and a pounding in the chest of usually near 200 bpm, but orthostatic hypo and POTS are still not my full diagnoses. So he ordered a tilt table to confirm, and nothing happened during the tilt, no symptoms, no signs of anything related to POTS or orthostatic hypotension, not even when medications were given through the IV.  So he then gave me a King of Hearts Express 2 monitor to 'catch' what was happening.

NOTE: I bought a home blood pressure monitor, it still has not registered a change in blood pressure with my diziness.  Nor has it shown any abnormally low blood pressure in me.

When i would record, It showed I had normal sinus rhythm for the 2 minutes up until the blackout and then my heart would jump into a 190-200 but in some occurences it has been clocked up to 220 bpm rate..usually in standing or walking(which still seems a little extreme of a jump for POT's to me).  That kind of rate didnt seem fast enough to make a person pass out by itself my EP doctor said.  A problem that came with this was I hear people with POTS experience a increase in heart rate around up to 120 or 130.  If the syncope happens to me during a standing position, it is not immediate, it takes about 10 seconds or so of the rapid heart beat before i start to get dizzy or gray out into the black out..I always thought people with orthostatic hypotension would stand and black out quickely ..?

Both doctors had before made it a clear point on saying that they could very well be wrong and the problem already at hand might not be POTS. This was because my rhythm strips were hard to read, but resembled a extreme burst of  only Sinus Tachycardia...seemed to stay in sinus rhythm, rather than a arrythmia from a pathway, but he said you never know.. I could possibly be wrong.  My rhythm strips are basically hard to go by.

And here is my other concern....

On this monitor the limits were set that if my BPM dropped below 40 bpm or if it would rise above 150 bpm it would begin to record on its own. And here is where my first concern begins....I would go to sleep at night and it would record many times in the night, when i played it back, it would soemtimes show a brief period of jump to 245-248 bpm in my sleep lasting around 10 seconds  (this obviously has nothing to do with the orthostatic hypotension or the POTS and this is my main concern in this post) Doctor did mention i could be at some very small risk or VT in a past appoitment.  Never asid anything else about it.

So My own first thought was maybe this is fast paced non-sustained Ventricular tachycardia.  But these rhythms never got sent in to the tecnician due to stupidity on my part because when I called they said they were having problems and would call me back...3 hours later..no call..and I had been forced to record over these rhythm disturbances with the syncope epsidoes; which seems to be a totally diffrent problem.  I never informed the doctors of this jump in heart rate in my sleep and daytime activities such as watching TV that lasted about 10 or 15 seconds. So they have no knowledge of that problem.

any opions so far?.....

My 4 questions are...

1)  Are these jumps in my sleep and day showing 248 bpm that my EP doc has no knowledge of.., possible non sustained V-tach or a other arrythmia; and should I call a doctor so i can get a montior to send these in for them to view?

2)  What kind of tests does it sound like I need to have done?

3)  Has Nonsustained V-tach in any case ever been a precursor that sustained V-tach might develop?

and finally...

4)  What do you think about this jump of heartbeat that they call POTS, I thinkt he 190-220 BPM seems a little 'too fast' to be POTS, and the strange ting is, I dont do this everytime I stand up like most people. It happens ocasionally. It seems that the faster it beats,the quicker I black out.  

Appreciate your feedback doc.

[CCF-M.D.-CRC]

Dear Blake,

You do have rather a complex problem and I certainly won't be able to untie the knot over the internet but perhaps I can give you my thoughts and some direction on which way to go.

In regard to the jumps in HR it is always useful to have rhythm strips so if you are still having rhythm disturbances I would get another event recorder.  Another possibility is an implantable event recorder called a Reveal monitor.   AS far as testing this would be up to your doctor.  Depending on what the event recorded showed you may benefit from another EP study.   I also think VT would be unlikely but this should be ruled-out.  As far as your last question I tend to agree with you. My guess is that this is a SVT, possibly some "remnant' of the accessory pathway or another type of SVT such as AV node reentry tachycardia or even afib.  The bottom line is to 'catch' the rhythm on a recording and then go from there.  Good luck.  If you wish to see a specialist in the area of fainting I would recommend the doctors here in our syncope clinic.

[steve111]

i have sinus bradycarida and i whould like tu know the long term effects im 21 and my heart rate is 46 -54

[Emmaj]

Hi Blake,

I was really interested in your post. I started having presyncope with tachycardia four years ago. The tachycardia is supra ventricular. It was happening anywhere - in the shower, as I started out the door to work, after running up a flight of stairs. I also have mitral valve prolapse with 2+ regurgition. I have never seen an ep, but my cardiologist has me taking Verapamil SR 120mg twice a day and Lopressor 50mg once a day. This controls all the arrythmia really well. I tried to cut back to Verapamil SR 120mg once a day - and it didn't work - within a short period, I again had an episode of nearly passing out with arrythmia - on that occasion I was riding an exercise bike. So I upped the Verapamil again, and I'm doing well again. Best of luck!

Emmaj