EP STUDY

[wmac]

I have had nsvt over a period of almost three years. I have also had many many test, which include, tilt table, several echos, treadmill, mri, single average ecg, which all have been normal. I have also wore king of hearts many many times, 24 hour monitor, and now I have a loop recorder implanted. In January of this year I had the worst run of nsvt 26 beats with h/r of 187. I had an ep study, the doc in Utah said 90% chance of me being fixed! HA! They did the ep study it took over three hours, they could not induce my vt! However they did with very aggressive stimulation induce vfib! My question is, If they would have induced vt then it could be life threating or even not life threating but be fixed, They tell me since they could not induce the vt that it means its benign, my chances of scd are the same as if I didn have it. But can the vt still be life threating even if its not induable? My ef is 70% They say I have a normal healtly heart and strong. Its just making me crazy that they say its not life threating now but they induce vfib in me. The h/r of 187 has me a bit concerned as well. Im not on any meds I had taken three low doses of torprol xl and thats when I had the 26 beat run. Each time I have nsvt its when sitting and relaxing so I think slower h/r does it for me. The meds they used in the ep study are Isuprel, and Esmolol with very aggressive stimulation. Do you think if I had another ep study they might get lucky and induce vt or do you think it would be a waste of money and time. I would be willing to do it again.Im just really confussed. Thank you Wmac

[CCF-M.D.-MJM]

WMAC,

That is a tough question.


1. If they would have induced vt then it could be life threating or even not life threating but be fixed?  

Inducing VT in the EP lab is a relatively safe procedure.  We do it every day and you are already situated for rapid defibrillation if you become "unstable."  Without inducing VT, it is very difficult to map and ablate.

2. But can the vt still be life threating even if its not induable?  The rule of thumb is that non sustained ventricular tachycardia (NSVT) and a normal ejection fraction is not a life threatening problem.   It is more likely that you will spend hours worrying about sudden cardiac death.  It sounds like they have captured the NSVT on monitor, meaning they should be relatively certain it is monomorphic -- this is believed to be a benign condiction.  They have done several other tests to rule out forms of structural heart disease the would put you in a higher risk group.

3. Do you think if I had another ep study they might get lucky and induce vt or do you think it would be a waste of money and time?

I am not sure where you had your test done, but if y ou choose to have another done, would consider a specialty center.  This is not to say there aren't great doctors in the community, it is just that academic centers may have more experience in dealing with difficult cases.  I would consider obtaining a second opinion and seeing what they think about repeating the test.  Some of this decision depends on whether you think you can live worrying about SCD -- although I agree that you should be low risk.  This being said, I have not seen your records and reports and am only going by what you wrote above.

DO NOT worry that they induced VF.  We can induce VF in almost anyone during an EP study if we are aggressive enough.

I hope this helps.

[wmac]

ALSO I  HAVE EVIDENCE FOR DUAL AV NODAL PHYSIOLOGY, BUT NO SVT WAS INDUCED.VT WAS NOT INDUCED EITHER.

[Neener44]

I've had two ep studies done by an ep doc in Utah. Both were for PSVT, but during the second ep study they "really pushed my heart" and ended up inducing VT in addition to the SVT. They were then able to ablate an area in my right ventricle which caused the VT. I still take sotalol (betapace) since the tachycardia returned after the ablation, however, my tachycardia is now better controlled with medication. Incidentally, before my first ep study I was also told that there was a 90 percent chance that they could completely fix the problem. My second ep study and ablation was done using the carto mapping system and was more sucessful. Take care.
Neener

[wmac]

who was your ep in utah and where was it done at?
wmac

[Neener44]

Dr. Chun Hwang, Utah Valley Regional Medical Center.