Complications after 3rd ablation for SVT

[outtarhythm]

DX w/PAT&SVT 8yrs ago. Was in afib w/rapid vent. response that required cardioversion 8 mo ago. I also have Junc. Escape,wandering atrial pacemaker, RBBB,MAT. Have since had 3 abaltions 2 of which did not work, unable to pinpoint the MAT. Since last ablation have. Loop monitor has shown Sinus tach at rest of 160 that required 2 rounds of adenosine and IV cardizem to slow, NCT, 2nd degree AV block, sinus bradycardia, Junc Escape, and lot's of PVC's. Have been on many different meds from Cardizem, Verap, Nadolol, DIgoxin, Flecainide. Unable to tolerate the BB's due to severe asthma. Last EKG showed NCT rate of 141, Left Axis Dev, LAFB, Right atrial enlargement, Late transition, Non Spec T abnorm, Anterosepatal MI-old. I was a tad concerend about the old MI! I am constanly fatigued, 1 brief syncopal episode and have near syncopal feelings everyday.
Dr. had mentioned putting in a pacer and I just want to make sure this is the route I should be taking. And as for the MI, what should I be doing about this? I have had chest pains but nothing that I would have thought that I was having a heart attack. Any advise you could offer would sure make me feel a little better.

[Forum-M.D.-MJM]

Hello,
This is sounds very complicated and could be many different things.  If the tachycardia only slowed and did not terminate with adenosine, the picture sounds like it could be inappropriate sinus tachycardia.  There are some rare people that have multiple morphologies of atrial tachycardia and PVCs.  We do not know what causes these episodes.

unable to pinpoint the MAT--

Multifocal atrial tachycardia would be near impossible to ablate.  The standard treatment for MAT is treating the underlying cause -- it is usually in patients with decompensated lung disease. You didn't mention COPD.


Sinus tach at rest of 160 that required 2 rounds of adenosine and IV cardizem to slow, NCT, 2nd degree AV block, sinus bradycardia, Junc Escape, and lot's of PVC's.

If the tachycardia did not terminate, only slow down, this is the usually response to adenosine to sinus tachycardia.

And as for the MI, what should I be doing about this?

EKGs are no perfect for diagnosing MI's.

At this point I would recommend a second opinion to try to put the picture together.  It is very possible that your doctor is correct and a pacemaker may be a good option.  Pacemakers are permanent and therefore I would want to make sure it is the only reasonable option before committing.

If you get a second opinion, try to gather all your old tachycardia EKG's including the response to adenosine, holters, echo's, EP studies.

I hope this helps.  Thanks for posting.

[outtarhythm]

THe ablations were for AVNRT. 3rd ablation was done at the Brigham&Woman's hosp.

[ireneo]

Wow! Got a lot going on in there. I've had 3 ablations to bring my PSVT under control. Ha, not under control but tolerable. MAT would be tough to map and zap. With everything going on, maybe it is time for a pacer. My cardio mentioned the possibility for me a few years ago and my heart is practically normal compared to all your goodies. Get your thoughts together - what will be the benefits and drawbacks if you get one, will they have to ablate the SA node, etc - and then have a good talk with your doctor about it. As for the previous MI, that's more of a plumbing problem and you probably are familiar with the changes you need to make in diet and activity. Ask about that too, if they can check via stress test or angio. Good luck with the decision.

[outtarhythm]

Thanks for your post...I put as much as they would allow in my previous post. I have alot more goodies than space would allow. I do not have any plumming issues. I had nuclear stess test done in Dec that showed no blockages only a mild anterior defect. As for lifestyle changes, I wish that were the issue. I have never smoked, I don't drink anything but water (no caffeine, alcohol etc.) I eat healthy and until this whole thing unfolded in Sept, exercised regularly. I am not overweight. I am just anxious to have resolution to all of this, whatever that may be. I work as an RN so I think I know what I should do but am just curious to hear what others, who may have similar issues, would do. I will be going back to the Brigham&Woman's next week and want to go to the appt. prepared to make my decision.

[onemotime]

I didn't realize that going back for ablation was a normal occurance, I am due for my second very soon.

[ireneo]

Appt. next week? Probably feels like forever. Sometimes our hearts are just very tempermental and it's not our fault. Like you, I don't live a risky lifestyle - no cigs, alcohol, drugs, not overweight, stay very active but. . . .my heart has a mind of its own. All we can do then is hope the docs can help us out a bit and then carry on. This forum is an "ask the doctor" type. You can do unlimited posts on the "support" forum. Might be good to ask your question over there as well. You'll get opinions, not necessarily facts, but sometimes it's good to share experiences. It would be interesting to hear what you decide. Take care.