Inappropriate Sinus Tachycardia

I am a 27yo female who has been recently diagnosed w/ IST.  I had a sinus node modification and partial ablation in mid-August.  The ablation was unsuccessful and my heart rate began to rapidly (150-160) accelerate again with minimal exertion.  I become symptomatic with high rates, with dizziness, sob, and extreme weakness.  My cardiologist started me back on flecainide 100mg bid, lopressor 50 mg bid and cardizem 30 mg tid.  Meds make me feel terrible.  They are really tough to tolerate.  I used to be active and with no health problems whatsoever.  I work as a nurse on a heart and lung floor and usually my heart rate on the floor, while walking around, is always 140-160.  This condition has completely destroyed me and decreased my quality of life in a big way.  EP MD's give me 3 choices-1) Stay on meds(can't get pregnant on these), 2)Try for another sinus node modification with increased chance of pacemaker, 3)AV node ablation with perm. pacer.  Questions-1)What is quality of life like for someone with a pacer who is as young as I am?  2)Would you suggest sticking it out on meds for a while.(Meds are keeping my rate down, but the last time I had an EKG, I was very close to a 1st degree AV block-PR was .20) 3)Does this condition ever just spontaneosly go away?
Thank you very much for your time.

[Cleveland Clinic]

KAD,

thanks for the question.

1)What is quality of life like for someone with a pacer who is as young as I am?

Generally unchanged. However, they have a finite life so you most likely would need to have another procedure in the future. There is also some risk of complicationslike infection associated with implants. But it sounds as if life is pretty miserable now.  You need to balance the two.

2)Would you suggest sticking it out on meds for a while.(Meds are keeping my rate down, but the last time I had an EKG, I was very close to a 1st degree AV block-PR was .20)

I always think the best option is the least invasive as long as it doesnt increase your risk and you can live with the symptoms you have. I would need more information to comment specifically on your best option. It may be beneficial to get a second opinion so you are comfortable with whatever choice you make.

3)Does this condition ever just spontaneosly go away?

No generally.


good luck

3)Does this condition ever just spontaneosly go away?

[gleni]

Dear Kad,
I am 42 years old and also have IST.  I know that's quite a bit older than you...but I'm a young 42 :) Like you, my quality of life was horrible because of it. It's still a problem.  I was (and now am) a very active person who loves the outdoors and it became an effort to just walk the mall let alone ride my bike or hike. My heart rate would be 180+ just going up the stairs and would often be 120 at rest.  

I was on high doses of beta blockers and was tried on many other antiarrhythmics with little success.  The side effects of many of the meds outweighed the benefits. My day to day life was really horrible.  I had two ablations.  The first one was unsuccessful.  The second one resulted in having a resting heart rate of 30 with off and on episodes of tachycardia.  I ended up with a pacemaker in 2002.  Tachy episodes again became a problem after a year when I exercised or was biking. I had an ablation this past February.  Improvement and almost medication free for over six months and now again I'm having some problems with tachy episodes again when I exercise.  I have a feeling this is not going to ever go away entirely. My cardiologist said they can go in again with very little additional risk because I have the pacemaker now...but I'm actually not sure what is best.  I may go for a second opinion.  

I think I made the right decision for me. Having a pacer has it's own problems but like I said, my quality of life has improved greatly.  I do know that I was unprepared for some of the changes the pacemaker brought me and my support network was a club I found online.  It's not a medical site..it's a support site. If you want opinions thoughts and support of other young people who have pacemakers, visit www.pacemakerclub.com  

Good Luck Kad.

[starion]

HI!  I'm 47 & have "probable" mild chronic IST as well.  At this point, it doesn't interfere with my life as much as it does for you and Gleni, but my docs have presented the same options which both of you have mentioned--various meds can be tried, a sinus node modification which MAY make things worse or perhaps better (maybe temporarily), and possibly kill the sinus node & implant a pacemaker.

I agree that a second opinion would be a good idea, particularly if you could go to a large teaching hospital with a great cardiology program for the opinion.  These choices are always tough, especially when they are invasive and have permanent consequences.  Gathering info by having an independing second opinion could only help provide you with a sounder basis for making the best possible decision for YOU.

Good luck!
Starion

[Leslie8]

Hello My name is Leslie, I have been dealing with IST as long as I can remember.  I am a 43 year old. I have seen a cardiologist about IST and an electrophysiologist. I had an ablation July 19, 2004. I was so excited that maybe this was the answer to my resting HR of 120bpm-140 all the time, rarely under 100bpm with medication, clonidine, verapamil, nadolol. The side effects of these meds are not good, weight gain being the worse for me and tiredness.

    Just recently I have been told after the 60 burns done to my heart, still the fast HR has come back. My electrophysiologist wants to try again. Right now I don't have any other choice but to try again. I am not functioning well the way I am. I also have a high BP problem.  I have asked about a pacemarker but they tell me that would be the last resort. They want to do the ablation again. Pacemaker sounds better than living with a HR that makes it very hard to any activity. Cardiologist and electrophysiologist say I am too young for a pacemaker. Well Oct. 25th I am scheduled for the procedure again. Hopefully this time it will work.

      I just had to write to all of you that are going through this same thing. You are not alone and some day there will be a quick cure for IST.

Leslie

[Ally Rhea]

Hey Everyone! I am a 22 year old female dealing with IST. I have had heart problems for the past 5 years, but recently it has gotten a lot worse. For the past year I have been taking Toprol XL 200mg(beta-blocker) and Verepamil ER 160mg (calcium-channel blocker). I have been in and out of hospitals because my heart will beat fast and I have chest pain. Everytime I go the the hospital my pulse is over 150. My doctor says it should be around 60 because of all the medicines I am on. This problem has really negatively effected my life. I am a senior college student and I have to miss alot of classes becasue I am either in the ER or at the doctor. My doctor told me that he was setting me up to get an EPS (heart cath) with possible abblation. When I found out what that meant I totaly freaked out. My parents are worried and so they made me an appt. with another specialist. I just know he is going to say the same thing. I am really scared. I am too young. They have mentioned a pacemaker too. That just really scares me. I go to the new doc in a couple of days. Can anyone help me understand why my meds never worked and what causes this kind of problem in a heathy 22 year old. I am so scared.