Dual Av Nodal Physiology

[wmac]

I am having my second ep study this coming friday. I have pacs pvcs, aivr, vt and I found out I also have svt. I went to a new ep doc at the university of Utah last week, whick is where I had my ep in January as well. They could not induce my vt in the lab but did find the evidence of dual av node. This new ep doc says that it is very unlikely that one person have both svt and vt so he thinks it could be svt with an abberency. He said that this may fix everything by burning the dual av node. My question is how risky is it getting to the dual av node with out burning the wrong spot? Im just a bit concerned that by going in there again is too much of a risk, this is what I wanted but lately my heart has been behaving and im pretty nervous. My vt is non sustained vt with normal heart and ef of 68 had all the test. How often is it that the dual av node is resposible for svt with abberency (which is my understanding mimics vt on the ecgs strips)? After speaking with the Dr. Klein I told him I wanted his opinion on what I should and he said that I should try the ep again which this time there is no sedation.He said that he wont be as aggressive as they were last time. MY next question is, is it worth the risk of the ep to get the dual av node, do they just get worse or can they just kinda settle down on there own. Can dual av node be the problem behind pvcs as well. But when I do have the nonsustained vt runs they defintly feel different than the svt runs I have had. Can the same arrhythmia feel different or are they for sure two different ones.
Thanks for your time wmac

[CCF-M.D.-MJM]

Hi WMAC,

My question is how risky is it getting to the dual av node with out burning the wrong spot?

How often is it that the dual av node is resposible for svt with abberency (which is my understanding mimics vt on the ecgs strips)?

AVNRT (atrioventricular reentry tachycardia) accounts for 60% of reentry SVTs and requires dual AV node physiology.  It is fairly common.  Many people aberate at faster heart rates -- unfortunatley I can't quote you a precentage.  It is not uncommon though.

MY next question is, is it worth the risk of the ep to get the dual av node, do they just get worse or can they just kinda settle down on there own.

The risk is relatively low -- we quote a 1% risk of needing a pacemaker with a slow pathway ablation, although the risk here is actually much lower (0.3-.5%).  The risk benefit ratio depends on how often you are having symptoms.  If the symptoms of SVT are sigfinicant and frequent, I would say it is.  This is a subjective decision.


Can dual av node be the problem behind pvcs as well.

Not for PVCs.  You may get couplets or triplets that look and feel like PVCs but are actually a short run of AVNRT that didn't continue.  This is less likely.  If they are documented PVCs on holter or event monitor, they are probably just PVCs.

Can the same arrhythmia feel different or are they for sure two different ones.

The proof is in the pudding.  You need to capture the arrhythmia while you are having the symptoms.

I hope this helps and hope for a succesful procedure if you decide to go forward.

[kuc]

Hi,

I am one of those that has svt with abberancy and have been diagnosed through 2 ep studies.  Everytime I go to the ER with an episode, they think I'm having VT instead because of the wide qrs on the ekg.  When this happens, I have to become the doctor and tell them that it IS svt with abberancy, and I'm given adenosine.

As far as mine goes, I too have been diagnosed with AV Nodal Re-entry, but my problem is my extra wire is located so close to my normal pathway, they are afraid I might end up with a pacemaker if they ablate too much of it.  They were able to get some of the extra wire, but not all of it.  It's extremely frustrating, but hang in there, they might just be able to get you back to normal.  Good Luck!!

[wmac]

Thanks for your info. So do your rhythm feel differnt sometimes. I had a loop recorder implanted, and they have recorded svt and nsvt. But I do have dual av node. But my question to you do they feel different at times. Like when I have the so called svt (that shows up as svt on monitor) it feels like a sudden really fast heart rate. Then when I have the so called vt (that shows up as vt on monitor) it totally feels different it feels like my heart is rolling and thumping. But with the dual av node the ep thinks it could all be svt with abberency but I did forget to tell him that they feel different. What does your svt with abberncy feel like?
Thanks so much for your help
wmac

[Konopka1955]

Hi wmac,  Yes, I had avnrt and I had two different beats for the same tachy.. They both were rapid beats of 200 or better.  One felt like rapid butterflies - very soft beats - for 30 minutes or so.  I wasn't doing anything when they came  -  just sitting at my desk - talking to someone - or just sitting watching TV - whatever.   Then a year later I got rapid beats that were very hard beats.  My first thought was I got a new type of tachy - but in fact it was the same (anvrt).  

My EP said I was born with a dual path av node - as I indicated they ablated one - and then all my avnrt tachy's were gone - I still had my pvc's and such.  Then the pvc's got longer in duration and I developed nonsustained and sustained vt's.  But its because I have heart disese.  Now, I have an ICD and I'm 100% pacer dependent in my ventricle and 22% pacer dependent in my atrial. But that's because I went into full heart block right after my open heart surgery for mitral valve replacement.  I'm scheduled to have an "AV stress echo Optimization" next month.  I guess ICD's come with a standard AV optimization program - but since my full heart block - I can't exercise well.  So, my EP thinks he can fine tune (optimization) my av with this echo stress test.  I'm hopeful that I'll be able to go back out and jog again.  :-)  I guess they can fine tune it for pacer dependent beats and non pacing dependency.  As 78% of the time - my av is on my own beats.  I'm just learning about all this.  I'm not sure I'm even explaining it right.  I just got scheduled for the test for next month.  I also have cardiomyopathy and will be seeing a CHF specialist after my ehco.  So, I have several problems going on.  Like I said - I have heart disease.  

When you say 'svt' - is that supra ventricle tachy?  I don't think I've ever been told I have that.  So for me I'm not sure how it feels.  My vt felt like rapid regular beats - just very rapid and it sucked the air out of my lungs when it happened.  My other tachy's had no side effects when they occured.  

I've had the rolling flopping beat feeling and was told those were my pvc's.. which I got them on my stress treadmill test years ago.  PVC's didn't take my breath away.  But it was a rolling kind of flip flop beat feeling.  

For ME, I would never allow an EP test or ablation while I'm 'awake'..  I've had 3 ablations one test.  My last ablation -I was on the table 10 hours and I felt like I had run a marathon afterwards.  It took nearly a week to get my strength back.  My EP doc said I had stayed in sustained vt for some time on that test.  They did a vt ablation and I think it improved the amount of vt's I had - but it wasn't 100%.  So I had to have an ICD. I never went into v-fib.  :-)  I guess these rhythms can be reproduced some days in the EP lab and not other days.  Its a hit or miss.  

Good Luck on your ablation.  I was very happy to get rid of that hard rapid avnrt rapid beat.  I would do it again in a flash.  But make sure you get a good doctor and hospital.  Check their credentials and make sure they have done lots of av ablations..  The more experienced they are the better your outcome.  But nothing is guaranteed and going into your hearts electrical system has risks.  For me I found - I just got rid of one tachy to end up developing another.  My electrical system is really bad since my heart attack and open heart surgery.  But I do wonderfully well overall.  The technology today is fantastic.  They can do so much today.  Some days I tell people - I'll never die - but I could 'rust' out.  :-)

Marilyn  (runner)

[wmac]

Thanks for your post. So you can have the rhythm and they can feel different. When recording the so called vt it felt like my heart rolling flopping but not as fast as the so called called svt. The svt just felt like my heart would take off racing. They both showed up different on the recordings, but this new ep doc said it could be svt with abberecy. I wonder now because the first ep study they couldnt induce the vt or even the svt last time. I was sedated the first time but this time I wont be that has me a bit nervous. Im glad to hear that they fixed yours. You did have a dual av node as well? And if so did they burn the bad one and you dont have a pacemaker right?
thanks Wmac

[Konopka1955]

Hi wmac,  I read your post to the CCF doc and it just reminded me of my situation about 6 years ago.  I to had pvc's and avnrt.  Had the EP study and they were able to induce it.  At that particular time my avnrt - felt like a fast (barely count) 200 bpm for approximately 30 minutes.  I had numerous events - but they didn't hurt - I could breath fine.  The only repercussions I had was that I felt like I had run a marathon after an event.  Well this went on for about a year - then all of sudden I got this other 'tachy' - only this was not a light flutter beat - it was just as fast - only a very hard beat.  It felt like my heart was going to come through my chest cavity.  Now the tachy itself didn't bother me - it was the feeling that surely beating this hard is not good for my heart.  I too thought this was probably a different tachy - but it turned out that it was the same tachy 'avnrt' only it had a different feeling.  Once confirmed - I decided to have it ablated.  My EP said this is the beat that everyone 'hates' - even though it was the same tachy.  So I had an ablation and it was 100% successful.  :-)  I still got my pvc's afterwards.  I also got non-sustained and sustained ventricular tachy's afterwards - but I have heart disease and my arrhythmia is caused from a scar from my heart attack - so its different in my case.  You probably don't have heart disease.  

Good Luck and
Best wishes
Konopka1955