Idiopathic Ventricular Tachycardia Ablation

[cookienkikin]

I'm a 25 yr old male with PVC's everyday.  I have been having left side chest pain for like 3 years now and skipped beats about the same amount of time.  My ekg's have been normal, normal stress test, normal stress echo, normal echo's, normal chest x-rays, normal Cardiac CT.  Only thing wrong was caught on event monitors and holter monitors, it was documented that I had PVC's, and two runs of Ventricular Tachycardia, 26 beat run at 127bpm.  And also a 25 beat run of v-tach at 127bpm.  The EP I saw said that he thought it do be benign and called it Idiopathic Ventricular Tachycardia.  I started asking him questions about it and I guess might have convinced him to go ahead with the EP study and possible ablation b/c he said he wanted to do that after I was asking all about Idiopathic Ventricular Tachycardia.  I've seen 2 other EP Dr's and they didnt think it was necessary right now to do the EP study and ablation.  My questions are   1. How dangerous is it to have an EP study and ablation for Idiopathic Ventricular Tachycardia?    2. Do the runs of V-Tach that was caught mean this could be deadly or do they seem benign (see above test results).  3. Could it have been SVT with wide abberant complexes?  4.  Whats the success rate for ablation of this sort?  5.  Could ablation make it worse later and hurt some of the foci in my heart and later cause problems or SCD or V-Fibb?  6. Whats the one MAJOR complication that could cause death that could occur during or after an EP study and ablation?  7.  Should I just go on about my bussiness and dont have this done since its thought to be benign, or could it progress to v-fibb and SCD?  8. Can they get me out of any abnormal dangerous rhythm?

Thanks so much!!!!   I'm SOOOOOOOOOOOOOOO scared to have this done, and also scared to not have it done.:(

I have a 10 week old son and just want to be there for him and one day have me some grandbabies!

[erijon]

I have to agree with the post above, it doesn't matter how many times you ask, you still get the same answer yet you ask over and over again. I think that's the issue you need to deal with, get some help with your anxiety.

I notice you did not bring up your binge drinking this time, I hope it's because you have it under control. Remember, this will affect your condition as well and may change the doctor's answer.

Good luck with the new son and congrats!

Jon

[is_something_wrong]

Hello.

I hope you see, this is beginning to go too far.

You've asked this question (variances of it) in the Expert forum, and in the Arrythmia community, more than a dozen times now. I know, health anxiety is not easy, and I've done my share "terrorizing" the doctors here with concerns about benign arrythmias, but the only way to get out of this situation, is to accept what the doctors tell you.

I'm not a doctor and my answers are a bit worthless. But it's important to know, I answered your question before it was answered here, and you can compare the answers. They are similar. A lot of others in the community have answered you, and the answers are basically similar.

What I think you need to realize:

1. Your arrhythmias are benign. The heart can't "stop" (or go into VF to use a correct terminology) if it's healthy and you're in the 20s. VF occurs with major heart damage, major electrolyte disturbances or in young people, congenital heart defects or genetic diseases that you have ruled out long ago.

2. The link between VT and VF is only relevant with severe heart disease, or if the VT is so fast that the heart can't handle it (the same can happen with A-fib in the setting of WPW or LGL syndrome). "Idiopathic" VF doesn't occur in healthy hearts!

3. You should seriously consider forbidding yourself to read more cardiology topics! You need to understand, it's your meaningless reading that causes all your problems. Not the VT!

You just got a son (congratulations!!) and he needs a father that takes good care of him! You should use this opportunity (many before you have) to get your attention to something else and more meaningful, being able to take good care of your son, and forget your heart rhythm. Leave that to your cardiologists, they are the expert on that. And you are the expert on being a good father.

Please, take my advice. Otherwise you'll ruin your life. Trust me!

[Bromley]

Hi. I may have mentioned to you once before that I went through this same decision making process, getting the same sort of seemingly inconsistent feedback from doctors that you are getting. However, all were consistent. None felt it was  mandatory to do this; all felt that it could be done with some risk. Among the risks, stroke, the need for a pacer, or a failed ablation that exacerbates what you have already.

I may do the ablation thing at some point, but am taking a wait and see approach for now. After my first one, I am not really in a rush to get back in there. So far, I have a limitation on running distances and a fair amount of annoyances, including a fairly unnerving string once in a while. I max out somewhere around 9 miles on a single run, or sometimes over numerous middle runs of say 6 miles each (done on several days over a week or two).

[Cleveland Clinic]

None of the findings that your are telling me about are concerning.  The runs of VT are non-sustained and very slow and very unlikely to cause any serious problems. Because your heart function is normal there really isn't any danger from having the VT runs.  The only thing worth assessing is the number of PVC's in a 24 hour period.  If it's greater than 15% of all the heart beats than there is a small risk of developing a PVC induced cardiomyopathy.  We typically don't ablate PVC's unless they are symptomatic (such as in your case) or if they are very numerous (great than 15%).  The VT isn't ablated unless it's sustained or very symptomatic with episodes of passing out or nearly passing out.  Sometimes it's difficult to induce the Vt in the lab but becasue the PVCs typically look like the VT we sometimes go after them.

To answer some of your questions:
1.  It's regarded as a very safe procedure with small risk of complicaitons.
2.  benign
3.  Difficult to say.  It it looks like the PVC's or looks very atypical in morphology than likely VT.
4.  Pretty high, on the order of about 90%.
5.  This would be very unlikely.
6.  Death is the worst possible compliation but it occurs as a result of cardiac perforation, large vascular complications or a massive stroke.  These are extremely rare.  Some of the  less severe complications, yet still important to know about are the possible need for a pacemaker.  
7.  This is very unlikley to progress to VF or SCD.  If the PVC's/NSVT is really bothering you then you should have it done to relieve your symptoms, not to prevent SCD or VF.
8.  Yes, we are very good at that.