Electrophysiology Study Questions

I'm a 54 yo female who needed a pacemaker 10 years ago due to idiopathic 3rd degree heart block, I take no medications for my heart.  My battery (now 10 years old) needs replacing.  I've had 4 episodes of 5 second or less V-tach (according to the pacemakers computer) in the last 18 months and the doctors are wanting to do an Electrophysiology study to see if they can find out why I've had these episodes, since the echo and nuclear stress test preformed last week, were all normal.  They want to determine if they should put a defibrillator/pacemaker in me instead of just replacing my existing pacemakers battery.

This procedure scares the heck out of me and I'd rather NOT do this test or get a defibrillator if at all possible. Is there anything I should ask the doctor or know before I make my decision to go through with the EP study? Can we try medications and do more frequent pacemaker checks to see if these episodes can be controlled by medications?  TX

[CCF HeartMD6]

If your device interrogations truly show that you have been having ventricular events, an EP study is not an unreasonable approach for further evaluation.  Having a ventricular arrhythmia can put you at risk for sudden cardiac death which can be mitigated by implantation of a defibrillator.  Treatment of such an arrhythmia depends on the cause (ischemia, scar, idiopathic). There are medications that can be used to suppress ventricular ectopy such as a beta blocker, but the decision to utilize this approach should really be in the hands of an electrophysiologist. However, an important factor is how often these arrhtymias are occurring, how long the episodes are, and if you are symptomatic from them.  

[pinehaven]

Thank you doctor for your reply.

I am asymptomatic to the episodes, no fainting, shortness of breath or chest pain.  I am very aware of my heart beat, I know when I feel a PVC and I know when my pacemaker is pacing.

In an 18 month period, there were 4 episodes with the longest of the 4 VT runs lasting 5 seconds.  One of the 4 episodes was caused by being awakened during the night by a scary dream, I gave the nurse the exact day and time it happened.

So could the other 3 episodes in the last 18 months, have been caused by a sudden scare? Could that be my trigger? And is 4 episodes of 5 seconds or less VT in an 18 month period considered a lot?