EP study/arrhythmia questions

[janet]

1. How successful are EP studies is detecting the source of an arrhythmia? Are they the most conclusive test?

2. If they cannot stir up the problem, does that mean that you are in the clear?  Can they fail to detect a problem?  If so, how frequently does that happen?

3. Are EPS results generally provide more definitive results in younger people (teens, 20s, and 30s) opposed to older people (40s and up)?

4. Is it common for an aberrant heart beat to manifest itself many times over a few days and then not happen again for a couple of weeks?

5. At what point would you recommend going to the emergency room when experiencing an improper heart beat?   After a few minutes? After a few hours? (My last episode of IST/palpitations last about 3 hours.  Should I have gone to the ER?)

Thanks.

[Cleveland Clinic, MD]

1. How successful are EP studies is detecting the source of an arrhythmia? Are they the most conclusive test?
A: Electrophysiology (EP) studies are useful tests after other forms of diagnostic monitoring have failed.  Most doctors will try things like "loop recorders' or 'event monitors' before EP testing.  These devices can be worn for weeks at a time and are quite good in helping to diagnosis the source of arrhythmias. If these fail then  EP testing is the next step.

     2. If they cannot stir up the problem, does that mean that you are in the clear? Can they fail to detect a problem? If so, how frequently does that happen?
A: Not necessarily.  It is possible that you can have an arrhythmia that EP testing will fail to 'stir up'.  However, in the majority of cases the arrhythmia can be induced and often times treated at the same time.

     3. Are EPS results generally provide more definitive results in younger people (teens, 20s, and 30s) opposed to older people (40s and up)?
A: There is no age differences that I am aware of.

     4. Is it common for an aberrant heart beat to manifest itself many times over a few days and then not happen again for a couple of weeks?
A: This is not uncommon.  There are many different factors that create arrhythmias and not all of these may be present at any given time.

     5. At what point would you recommend going to the emergency room when experiencing an improper heart beat? After a few minutes? After a few hours? (My last episode of IST/palpitations last about 3 hours. Should I have gone to the ER?)
A: It depends.  If a diagnosis has never been made I would get to the ER right away so it can be recorded.  If the arrhythmia is known and you are working with your doctor using medication to control it, you may not need to go at all.  Of course if you are having significant symptoms you should go right away.  If you are having palpitations this severe and medication is not working for you then EP testing with possible ablation may be the best recommendation for you.

[JENNY]

Not meaning to be rude, but if you have to ask if you should have gone to the Emergency Room, then your answer is obviously no. Believe me, after 20 years of suffering from arrhythmias you will know when it is time to go to the hospital. If your arrhythmia is determined to be non life threatening and you DO NOT experience any distress or symptoms, many times no treatment is required, especially if it not sustained for a long period of time. Of course everyone reacts differently to these events and every event is not always the same. Just go with your gut instinct. You will know if and when to call for help. Good luck and stop worrying so much. Anxiety will only work against you.

[Mommydee]

While you wait for the doctor to answer, I found it interesting that I just read how women so often delay treatment for heart attacks.  Even doctors and emergency rooms sometimes treat women with heart disease with less urgency, both because the symptoms can present differently....and whereas a man will go to the ER and tell them he thinks he's having a heart attack, a woman is more likely to wait longer at home, not have an ambulance transport, tell the ER she is not sure what is wrong, and sometimes even apologize for going in!  If the arrhythmia has not yet been diagnosed as benign, and you are worried, then you should probably err on the side of caution, at least until your doctor has told you not to worry.  When my arrhythmia first presented, I was not aware I was having symptoms...I was tired and feeling generally lousy, went to a walk in clinic asking them to test my thyroid and blood count to see if I was anemic because I was so tired....next thing I knew people were flying around me, monitors were being placed and I had an IV drip of lidocaine with the doctors telling me I'd feel much better once the heartbeat was controlled.  They were talking intensive care and all I had wanted was to see if I should take some vitamins!  Anyway, in the end it all worked out, there were a lot of components to my problem including some medication reactions and an infection, but it took a long time and a lot of tests to determine why.  I would not believe it could be serious, and I had to babies to take care of (one was an infant), and so I refused hospitalization against doctor's advice....I figured after all I was a young woman so there was no chance of a heart problem.  MOst of the the time arrhythmias are not serious.  I still have tons of premature ventricular contractions, but they are benign, and I have tachycardia but was given an exercise stress test with cardiolite to make sure my heart could handle how fast it gets, and everything checked out ok.  So now I know I can just deal with any episodes at home.  However, if things changed considerably, I would still not hesitate to use the ER or at least call the doctor to ask what to do.
Dee

[mairey]

I am sorry I just have to write this. Actually no I am not sorry. If you wern't meaning to be rude why were you?  Your comment was presumptuous, overbearing and condescending not to mention just downright dangerous. You state you have had these symptoms for 20 years, well good for you. Think back to when they first started were you so blase' about it, do you sometimes still not get a little scared? It is much better to go to the ER if you are not sure even if it does mean enduring just the same attitude you display in your message. As the other message said  many women are hesitant to go, apoligize and are misdiagnosed just for this reason. We certainly don't need that type of remark on a page where support is the main concern. I too have had PVC's for 20 years and have made 3 trips to the ER in the last 2 months, the result they have at last been able to catch something on an EKG and prescribe appropriate medication. My message would be the opposite if you are not sure GO TO THE ER. Whats the best that can happen they tell you you are OK, what's the worst well we all know what that is but apart from that being made to feel like a time waster.  I would rather be a time waster than have my family cope with me being dead. Jenny if my message upsets you, or anybody else would like to discuss PVC's etc, my e mail is ***@****. Love, peace and health. Mary

[JENNY]

I sincerely apologize to anyone if you may have perceived my comments to be presumptuous, overbearing, condescending and or dangerous. That was certainly not my intent, nor was it my intent to be rude. Maybe I did not make myself clear. I believe I stated that if your arrhythmia is deemed to be NON-LIFE THREATENING AND YOU ARE NOT IN ANY DISTRESS, NOR EXPERIENCING ANY SYMPTOMS, then in certain cases no treatment is needed. Never
did I once say to stay home and not go to the Emergency Room. I agree wholeheartedly with everyone that heart disease in women needs to be addressed and treated much more aggressively than our current standards of treatment. Within the 20 years that I have been ill, I have had 2 open heart surgeries, 10 EP studies,
6 ablations and eventually permanent pacemaker implantation. I am currently on my second pacemaker. I guess my response was based on my experiences over the years. With a heart rate of 260bpm, no one ever had to tell me that it was time to go to the hospital. So again, I apologize for my comment. Please never hesitate to go to the hospital. As the saying goes, DON'T GUESS
CALL EMS. Good luck!

[Just a comment about EP.]

Hi,

I too agree, that better to go to the ER then to the funeral home.  But, in time you do get used to the heart arrhythmia's and you will learn when you should and should not have to go.  I am on my 3rd pacer in 2-1/2 yrs, about 16 or more leads for them, and have had 11 surgeries due to pacer problems, open heart in Jan. of 99 and then 2 more pacer surgeries just after that in March and April.  I just had major vascualr surgery too in March.  BUT, I am also in the medical field with a cardio background, and I too was told by a cardio doc that my heart arryhthmia's were "normal" for a woman my age.  I was 40.  Two weeks later I passed out in the clinic in the hospital where I worked and fractured my skull.  Due to heart arrythmia's, still after 4 days of cardio work-ups nothing showed.  Then 1 yr later I had sinus arrest 2 times in the ER on monitor, when I complained LOUD enough that SOMETHING WAS WRONG !!  So, then I started the pacemaker stuff.

JUMP up and down and yell and scream until something is done if you feel sick enough to go to the ER. If it bothered you enough to go to the ER then make darn sure that something is done to figure things out !