Exercise induced SVT

[dzoo]

When I am running or biking my heart rate monitor will stick at  125 - 145 bpm, then I would tire rapidly. When I would stop to walk my HR would stay at the exact place for 3.5 min. then my HR would drop all at one time to approx. 90 bpm.

   I told my GP Doctor about this at a check up, he put me on a treadmill with an echo hooked up. Just like I told them at just over 1 mile their graph went crazy, after stopping, sure enough 3 min. and 20 sec. my hr dropped at once to 91, from 141. They sent me to EP Dr. and they did an EP study on me with the intent to ablate the extra pathway. They got the SVT to come in quickly but said that there 3D heart mapping was showing the pathway to be in the upper left side and that they couldn't ablate those because they are to risky.
  His diagnosis was Atrial Flutter and he wanted me to go to another Dr. that would do left side ablations at another hospital or to go on meds. I said I just wanted to live with it because I am not a racer and don't care if I have to rest and let my heart come down. He said that this condition won't hurt me but just be bothersome. The problem is, that now it is doing this SVT maybe 6 times in a 30 mile bike ride. But still only takes 3.5 min. to go away each time.
  1. My question is, how risky is this left side ablation?
  2. Is this problem I am having for sure not detrimental to my long term health?
  3. What would be my best course from here, meds? Go on like I am? Try another ablation?
  4. Would it be better to just quit exercising.
  I am 5' 11" male 46 years old, 178 lb

[Cleveland Clinic]

dzoo,

Thanks for the post.


1. My question is, how risky is this left side ablation?

It would depend on both the prcedure required and the experience of the operator. It would probably be worth seeking opinion at a high volume center.

2. Is this problem I am having for sure not detrimental to my long term health?

Sustained episodes of tachycardia can cause problems. However, from what you write, the most problematic issue for you will be trying to maintain a good quality of life in the setting of your frequent symptoms.

3. What would be my best course from here, meds? Go on like I am? Try another ablation?

Thats impossible for me to suggest. It really would be a matter of risk versus benefit. Some people font mind the episodes at all
while the others are driven crazy.

4. Would it be better to just quit exercising.

No.  If it comes to that, either you should try to think of a different exercise or medical regimen.  The long term benefits of a good exercise program are too important to give up.

good luck

[jdm]

Hi, I am 55 now and was once very active as you are.  In my mid to late 30's my heartrate stopped returning to normal after exercise.  It was appropriate during exercise but after would be 'stuck ' at 125 to 135 for literally hours.  Sinus rhythm and not erratic.  It was like my baseline pulse and would gradually come down to normal over as much as 10-12 hours if I had been on a long strenuous hike etc.  

The docs told me it was not dangerous......they told me to stop exercising and it would not happen any more ( exercise was my life or most of it ).  They told me it was all due to anxiety ( not true initially ).

I developed a severe anxiety reaction due to the IST.  My advice to you is to be aware of this monster lurking in the shadows.  Take care that anxiety reaction does not deveoped.  It's a very bad thing and nearly impossible to get rid of.  

Basically, I stopped exercising.  Now I'm 55, 195, 5'9" and on attenolol because I also started having tach after meals .  Rate goes from normal range to 100 or 110 after each meal. This is baseline for hours.  Docs said not dangerous.   Drives me nuts without the attenolol.  Cardiologists are not psychiatrists.  Some of they seem to try to understand how anxiety can get out of hand but I don't blame them.....the heart is complicated enough without having to understand the mind as well.  

good luck.  It's just a bad hand some of us get and we struggle to know how to play it.  It can be difficult.  If I had been a couch potato all my life I might have never noticed the tachycardia or cared.  Fat , dumb, and happy I might have been.  Now I'm just fat.

[WPWGuy]

Hi.  I had orthodromic AVRT with left sided pathway, that was exercise induced, and was "paroximal".  We ablated "trans aortically", i.e. entered into left ventrical via aortic bicuspid valve and ablated under mitral annulus, which fixed the original SVT. But unmasked another one (quite a bit less severe than the original one), probably situated in the left atria, which we could consider for a second ablation...

As I understand some of the risks on these left sided ablations.  There is greater risk of stroke since left side goes to brain.  Also, depending on accessibility, there may be need for trans sceptal procedure, which involves entry into the right atria from the left atria via a puncture. This, I think, is done under guidance of special echocardiogram, and is not necessarily that common at all hospitals. I am unclear on the risks, and will be interested in the reply to your question.

[dquenzer]

I had an ablation in both atriums at Mayo.  Their perception is that it wasn't that risky.  Mine was successful.  I had atrial flutter as well as AFIB.  I'm not sure how they do it, but I had catheters up both legs, not just one.  Plus I had catheter down the throat area to monitor for clots.  So I think they use more catheters than some.

If I were you I would probably go to a larger medical facility like Cleveland or Mayo and get another opinion.

[Boblan]

A related discussion, Exercised Induced SVT was started.