Next steps for working with multiple arrhythmias.

[Bromley]

Hi. I experienced some extra arrhytmias after an ablation for WPW/Left free wall pathway. My questions:

What are the disadvantages and risks associated with a transaortic approach (vs transceptal) to ablating accessory pathway on left free wall?

What anatomical areas of the left atrium are only accessable using a transceptal approach?

During transaortic ablation of left free wall pathway, what sort of injuries can occur?

If I have short run narrow complex SVT (one or two ten beat strings a day) and occasional short run VT (10 beats once every 5 or six months as far as I know), is it worth worrying about it such that I limit exercise? I curently manage 6-8 miles of running regularly with no problems other than achy joints and a couple of thumps here and there.

Subjectively speaking, can you tell me how well ablation works and whether an EP study or ablation would be a good application for the short run SVT and short run VT that I am experiencing?

I should mention that an echo is normal, stress test is normal, cath shows no blockage. I am 45 yo male, 145lbs, use small amounts of toprol only when things get hectic. Tendency to feel ventricular runs seems to be diminishing with increased aerobic capacity, but I might just be getting accustomed to it.

Thanks.

[CCF-M.D.-MJM]

Hi Bromley,

What are the disadvantages and risks associated with a transaortic approach (vs transceptal) to ablating accessory pathway on left free wall?

The risks of transortic approach is an increased risk of stroke from the catheter bumping the aortic wall, although this risk is still low.  Most people with WPW are young and do not have much aortic plaque.  The trans septal approach is also very safe.  The major risks are bleeding, blood or fluid around the heart causing hemodynamic instability -- again this risk is low, about 1%.

What anatomical areas of the left atrium are only accessable using a transceptal approach?

This is a tricky question.  It depends on the patients individual anatomy and the size of the left atrium.  The approach is usually individualized to each case and if one doesn't work we change to the other.

During transaortic ablation of left free wall pathway, what sort of injuries can occur?

You always risk perforation of the free wall and bleeding around the heart.  This is risk is low, about 1%.


If I have short run narrow complex SVT (one or two ten beat strings a day) and occasional short run VT (10 beats once every 5 or six months as far as I know), is it worth worrying about it such that I limit exercise? I curently manage 6-8 miles of running regularly with no problems other than achy joints and a couple of thumps here and there.

We often put people on a treadmill and ask them to do a maximum exertion.  If the exercise doesn't stimulate any severe arrhythmias and if the holter monitor isn't significant, exercise should be fine.

Subjectively speaking, can you tell me how well ablation works and whether an EP study or ablation would be a good application for the short run SVT and short run VT that I am experiencing?

If it is symptom limiting, I would consider trying something invasive.  If the symptoms are rare and pose no significant threat, we would treat with medications.  It is all about risk benefit ratios.

In general, invasive procedures are reserved for significant symptoms and people that are risk.  Nothing you mentioned above speaks to significant symptoms or risk.  As always, the final decision is about to your doctor and yourself.

Good luck.

[Jeff-67]

How do you tell the difference between your VTs and SVTs?

[tickertock]

Does anyone know the success rate of ablation for ECG manifest WPW vs. concealed accessory pathway or also called concealed WPW?

I understand the success rate of ablation for manifest ECG WPW is around 95-98% at some hospitals. Thanks.

[owiny]

Hi..
Been suffering from SVT for 3 years now. Had EP study done twice but it failed to locate the accessory pathways. Recently I was diagonised with H.Pycoli in the stomach (causes heart burn and acid reflux in stomach). Since my EP Stidy has twice failed to induce the SVT, could there be a link between SVT and H.Pycoli infection in the stomach? Any one experienced this?

What are approximate costs for carrying out EP Study and possibly catheter ablation in Cleveland Clinic?

[Bromley]

Hi.  I experience the SVT as a series of light palpitations; The short string of VT feels stronger, and comes with some real discomfort.

[KAEB]

I had an ablation of the AV node that was on the left side just tow weeks ago.  Done by mini thoracotomy incision--no node but did document wolff Parkinson White syndrome and Mahaim fiber

[PikaPika88]

Hi, See many WPW turn up in this topic. I've been complainted Strong beat is chasing the light beats.  Many people taught I'm joking.  Actually my Cardio said is (copy from the letter)"The pacemaker changes its mode of pacing from DDDR to DDIR, it is not enough to stop her from experiencing short bouts of A FIB with increae in ventricular rate." Does it means the strong beat is the pacemaker kick or mode switching? The light beats are A FIB? Right or Wrong? Can someone explain, please? You all take care, Pika.

[Bromley]

KAEB - Boy that sounds like a long story. When are they going to fix you?

owiny - I am not familiar with costs of procedures at CC. I did put up the capital for an airplane ride so that I could consult doctors there. The cost to benefit ratio for that was good. Of course, I saved myself some money by doing the entire visit in one day. Also, as you can see, this alternate opinion, like the one I got during the visit, is conservative, so the cost of a second ablation may not materialize.  Not sure what would have happened if I had gotten my medical care somewhere else. I should think it could have tended to cost me more.

Ticker - unfortuately I am a specialist in my own problem and therefore have no clue what the sucess rate is for WPW you can see on an ECG vs concealed.  I'd be willing to bet that the stats that are usually quoted apply to both forms lumped into one. That is a very good question you have there:  you'd think that manifest WPW would have a higher success rate than the concealed right?

Pika & Jeff - I do feel the ventricular beats as a string of strong beats. It doesn't happen often, but it is very uncomfortable when it does. My best guess about this is that the heart is beating very mightily, but no blood is flowing in or out of it, because it is not pumping efficiently. Like a waterballoon, as you squeeze it the fluid inside shifts and stretches the balloon, but does not flow out of the balloon.  Sorry for the description, but that's about how it feels to me. The heart feels like it is being stretched as it pumps without achieving any flow, almost like all of the valves are shut, but heart rate is 180-200+.

[KAEB]

I did have the ablation two weeks ago.  They were able to cut the Mahaim fiber which had taken over for the av node.  The pacemaker is now working for me 100% and I have not had the afibs or the tackys since the procedure.  It was quite invasive and would never suggest it unless you are totally symptomatic and very limited with daily living.  This was the fourth attempt to try to find the problem.  Finding the Mahaim fiber and WPW Syndrome was a surprise to everyone but in the end I am pleased we kept trying.  No one should live with afibs for years and years.

[Bromley]

That sounds like a fantastic development for you.  You must be ecstatic about it.  Did you have this done at the cleveland clinic?

[KAEB]

I along with my doctors are all estatic.  I understand the nurse came out after finding the problem and told my family the entire OR was having a celebration.  This was five hours into the surgery.  While taking the probe out and deciding to go back in the next day the probe hit on the Mahaim fiber.  I have had 26 years of heart problems beginning when I was 29 years old.  If I knew then what I know now,,,,,I have done all my sugeries and procedures at Abbott Northwestern Hospital in Mpls, MN.  I have a wonderful relationship with my doctors and they treat me very special.  
I do hope you come to a decision on your arrythmias.  Once they make you change the way you live it is time to take action.
Kathy

[roxie1161]

I'm sorry to post onto someone else's message with question, but do any of you with heart arrhythmias and/or PSVT wear a medic alert ID, or should we?
Thanks

[Bromley]

Hi Kathy. Not sure about the medic ID. I dont wear one, but it sounds like it could be a good idea to wear one, if your arrythmia is a safety concern?  I'd get clarification from your doctor on whether you have a safety issue.  Then decide how the ID fits in with your overall strategy for staying safe.

Kathy, it is great to hear from someone who has a success story.  These posts are at times overfull of some troubling stories by people who feel things have gone wrong. Congrats on receiving a new heart; god bless you and your family.

Take care all, Bromley.

[salina]

Hello, i am a 24 year old pregnant female and am experiencing daily pain radiating down my left arm and into my hand and jaw.  also alot of chest discomfort and irregular palpitations.  sometimes it feels like my heart is really struggling to keep going and it trembles.  i have had a few episodes of svt where my heartbeat was around 170.  this has actually been going on for about 3 years.  i've been to emerg at least 20 times.  no one can give me any answers  they all say it's just stress or nothing serious.  i'm getting so depressed that this is consuming all my thoughts.  i feel so hopeless and like i've tryed all my sources.

[roxie1161]

Salina - Can you see someone for your depression?  I had SVT while I was pregnant with my son, and my OB/GYN actually told me it was panic/anxiety attacks!  I got depressed also so I started seeing a therapist and though I still had the "attacks" I felt better.  I have since found out that it isn't panic/anxiety attacks I was having, it's SVT/PSVT and pregnancy definitely makes it worse due to the extra stress on your heart.

See if your OB/GYN will refer you to a cardiologist.  Though I haven't had much luck getting myself referred to a cardiologist.
Anyway, on a happier note, my baby and I both made it through the pregnancy, labor, and delivery in fine shape.

I hope you can begin to feel better soon.  Pregnancy is hard enough without being depressed on top of it all.

God Bless you and Good Luck!

[seska]

hi

I am 29 and have a pacemaker and have had ablations for IST, Focal Atrial Tachy, Atrial Flutter and AVNRT. I also get non-sustained VT and paroxysmal AF (PAF). I think multiple arrhythmias are not so uncommon, but possibly less so in younger people. I know that in my own case, having Sinus Node Disease (Tachy-Brady-Syndrome in my case) makes multiple arrhythmias the norm in this instance, although the VT was a bit of a strange surprise (not a pleasant one!). My worst episodes were the AVNRT which gave me heart rates of 280bpm for extended periods before I had that ablated.

My current EP's opinion is that my non-sustained VT does not need treating (although the rate is 220bpm, the runs are so short that the symptoms are very short lived) and the same goes for my A-Fib - I take junior aspirin each day, plus take a beta blocker during long runs - but having had multiple ablations I am not in a hurry to get any more right now.

I hope you can get the answers and treatment you need

take care,
Seska x

[Bromley]

Hi Seska.  

As far as I know, I dont have Sinus Node disease. And I never had any runs of anything but AVRT prior to ablation. So the docs say that these "new" arrhythmias were not really new, but latent ---as though dormant or growing in the shadow of the more dominant AVRT.

I recognize that they are probably right.  But I had to ask the question about potential modes of injury because of the way things played out.

It sounds to me like you were faced with more difficult set of circumstances than me, and met with mixed successes. I dont think those things you mention are as easily cured as a left wall pathway.  Do you regret having gone ahead with your ablations in spite of the potential outcomes and risks?

regards,