PAT since age 11

[laurahs]

I am a 41 year old woman and I have had Paroxysmal Atrial Tachycardia since I was 11.  It was confirmed by EKG when I was 19.

I discovered very early on that I could control it by suddenly lying down from an upright position.  Sometimes I am awakened from sleep with it and I have to stand up for a few seconds and then lie down quickly on the floor.  If it doesn't work the first time, I just repeat until I get a normal rhythm.  It rarely lasts longer than a minute.  It occurs every two weeks or so, sometimes more, sometimes less.  Usually it will happen a few times for a few days in a row then nothing for a little while.  I haven't ever used any medication.

My question is this.  I've recently read about heart rate variability and heart coherence (basically how much variability there is in heart rhythm which is a good thing and how smooth the changes are) and how this affects physical and psychological health and I'm wondering if PAT and other arrythmias are just a heart that is far out of coherance.  I know it is supposed to be an electrical malfunction but I am now thinking it may have an emotional genesis.  Is anyone aware of any research into the possibility that heart arrythmias such as PAT could be sometimes be caused by psychological issues?

Thanks!
-Laura

[Forum-M.D.-MJM]

Hi Lauara,
I know it is supposed to be an electrical malfunction but I am now thinking it may have an emotional genesis. Is anyone aware of any research into the possibility that heart arrythmias such as PAT could be sometimes be caused by psychological issues?

Stress causes changes in your body like increased cortisol, increased adrenaline, etc.  These emotional factors contribute to your bodies regulation and certainly can cause you to go into arrhythmias more frequently. A beta blocker may help decrease these episodes.  If you haven't seen an electrophysiologist yet, an ablation procedure would probably cure you of these tachycardias with a very high success rate.

I hope this helps.  Thanks for posting.

[laurahs]

Is it reasonable to expect that I can control this indefinately since I've managed it just fine for 30 years?  I was always told that it wasn't harmful but now people are having this ablation surgery to stop the problem.  I really don't like the idea of risking surgery.
-Laura

[ireneo]

I haven't seen any studies about PAT/PSVT being linked to psychological issues. Then again, I haven't seen a lot of things LOL. I know PVC's can be triggered by stress. Just read the support board.
Like you, I've had PSVT pretty much all my life (I'm 54 now). About 7 years ago a doctor told me the tachy wouldn't kill me but they could do an ablation to fix it. I thought he was weird - why poke around in my heart to fix something benign? But mine was pretty frequent and lasted long enough to bother me (30-45 mins). I went ahead with the ablation. It wasn't so much a "surgery" as a procedure. No general anesthesia, just happy meds that sent me into a fog. It wasn't bad at all, some tenderness in the groin with bruises but a quick recovery (a couple days of fatigue). Whether to have one or not is between you and your doctor. Each person is different. As for me controlling the tachy times - I like valsalva: take a breath, hold it and push like having a bowel movement. Sometimes it takes more than once but it typically breaks the tachy. Ahhhh.

[frs87]

Have you never used ANY medications? Wow. I wish I could face it so well as you do. You're sounding like you go "Oh well, here's the arrhythmia again, let my lay down and then go to sleep". When I had a crises, even if it lasted five seconds, I usually had an panic attack, lol.

Anyway...

1) I'm not a doctor BUT from what I've heared from my own doc, if you have a normal structured heart, you could probably live with a PAT forever. Of course, you would have to say how many beats per minute etc. A 90 years old heart isn't as strong as a 20 years old one.

2) I find it highly implausible that your crises are being triggered by psychological issues. Specially because you have them since so young. But the doc here will have the right answer to you.

3) I had an ablation for Atrial Flutter. It's a very safe procedure, but there are aways some risks. Particularly, I would recommend it for everyone who doesn't tolerate the symptoms - which doesn't seem to be your case.  You have to balance and see what is better for you. Maybe meds will give you some pacer sleeps. Why haven't you ever take anyone? I'm just curious.

[frs87]

It is not a question about risk of life, but quality of life. Even if you could live with the tachycardia forever, it would probably perturb your life. Sometimes there's a little risk of syncope, which can be dangerous depending where you are.

[laurahs]

Nope, never taken meds.  I am always concerned about side effects and avoid most medications.  They were offered to me long ago and I just refused.

I *am* pretty casual about the arrythmia but I think it's because I feel that I can control it and it started so young.  I don't lie down and go to sleep but it is pretty much, "oh there's that arrythmia, again" and I plop down and jump back up repeatedly until I make it stop.  It is a little disconcerting for others if it happens in public but I can usually find a private place to lie down.

It really doesn't interfere with my life too much.  I am very active.  It's more an annoyance than anything.  Can you tell me what is syncope?

[laurahs]

Thank-you for describing the ablation procedure and what you do to control the tachycardia.  I've tried that maneuver after it was explained to me but it doesn't work for me.  Lying down very fast works great but looks kind of funny.  I've also heard of plunging your face into ice water but that sound very not fun!

I think I would consider an ablation if my PAT ever got out of control but not sure it is worth the small but real risks in my case.

-Laura

[frs87]

Syncope is when you lose your conscience for a few seconds. This absolutely doesn't seem your case, I was just commenting ireneo's post.

I had a general anesthesia during ablation so I didn't feel absolutely nothing and everything were fine. I didn't felt pain on leg as much as on the neck, but quick recovery. I'm 100% OK now. If I have insomnia it is just because I'm too paranoid with the PACs and the possibility of a arrhythmia recurrence. :)

Ireneo: do you know why your tachy came back after ablation?

[Bromley]

For some of these arhythmias, I dont think its possible to fool yourself into it. You really have to have an abnormal electrical connection on your heart, even if its an intermittent one affected by stress or psychology.

PAT is old terminology, some words that probably reflect the common understanding of things when you were eleven.  I think the new terminalogy for PAT is PSVT. Things have changed alot in this area over the last 30 years.  

Yours doesn't sound too bad since it lasts only a minute.  However, if you saw a good electrophysiologist, he or she could probably rediagnose you in today's terms, assess your risk (I am not a doctor, but it doesn't sound like you are at much of a risk right now), and prescribe a low dose of beta blocker.  Then you could see if it improves your state of mind or reduces your anxieties knowing that you have your rhythmn under control.  I think it would be worth it.

[Bromley]

I almost forgot. Ablations carry some fairly hefty risks (e.g. stroke in 1-2% of cases).  There are many other things that can go wrong and cause death.  There is also a risk that an ablation will not kill you, but make your heart rhythmn worse, or require you to have a pace maker for the rest of your life.  The risks are really something to think about.

Without knowing much about you, I would suggest avoiding an ablation if you have your episodes for only a minute and have never blacked out.  And I would give low dose betas a chance.  But talk to a good electrophysiologist and be sure the two of you understand what is going on.  Good luck.

[laurahs]

Thanks for the information.  Interesting that there is new terminology.

The reason that mine only last a minute or so is that I know how to stop it.  If I do nothing, it goes on for a long time.  The only time I recall letting it go on was when I was on the way to a dr appt and that time it lasted over an hour because I wanted to catch it on an electro cardiogram.

Strange that I haven't ever heard of anyone doing what I do to stop the arrythmias.  I stumbled upon the method I use to sop the arrythmias when I was little.  None of the other vagal stimulation methods work for me.

I really don't want to use drugs.  I have it under control and I don't want to risk side effects.

-Laura

[laurahs]

Oh, and psychosomatic illness doesn't mean fooling yourself into reactions.  There is a theory of mind that strong emotions can be repressed and are translated into true physical reactions in order to distract the mind from acknowledging painful emotions.  It's not that things are, "all in your head" but that it is easier for a person to tolerate physical reactions than to deal with very strong emotions so the mind can cause very real physical responses.  I am beginning to wonder if my PAT or "SVT" is emotionally initiated.

-Laura

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I also have had pat for almost 8 years and mine use to last longer, but now it usually lasts a minute or less.  I tried an ablation and it did not work for me, all they could induce was sinus tach.  I am on a low dose beta blocker ( half of 25 milligrams) and the side effects are not too bad, but it can be a real quality of life issue with misbeats and short runs daily. It is a little like having a lion in the basement and not knowing when it may get out and how long it will hang around. Mine is usually about 160 but has been caught on a monitor at 200 or above but briefly at that rate, only a matter of beats. I do know bending over can cause misbeats or short runs and if I am having a lot of misbeats changing position will help. I can't sleep on my left side or I will get misbeats that wake me up.  I do take something to help me sleep because it does wake me up a lot.  Haven't slept through the night in 8 years, but having said all of that I have learned to deal with it much better than when I first got it. My father had pat then later chronic afib I wonder how much of this is genetic. Did either of your parents have heart rhythm problems?

[laurahs]

My father had an arrythmia (that wouldn't slow down even with drug therapy but it didn't start until he was 60.  Previously, he hadn't had any trouble at all.  He did have ablation and that was successful for him.  It was the first time I had heard about the procedure.

-Laura

[ireneo]

frs - risk to life or quality of life: that's what my first cardio told me. I was waffling about the procedure until he got frustrated and told me he wouldn't live like that. To me it was normal. Why did my tachy come back? I don't know. The first ablation they thought they got it. But it came back. The second time they knew they didn't get it. The third time, well, it was improved. I'm going to go with that. My EP cardio (the marvelous McAnulty whom I admire and adore) is a compassionate and gentle person but I'm done with trying to have a perfect heart. Yes, I have PAC's and PVC's and tachy times (150 -190 bpm, usually less than a minute, no longer than 15) but I can live with those. Shoot, Iived with worse for over 45 years so this is a piece of cake.
Laura - no drugs for me either. I tried Verapamil but the side effects were way worse than the tachy. I couldn't stand the shortness of breath, chest pain, etc. I agree with the psychosomatic issue. Like stress, it can cause definite chemical and physical changes. Like I said before, it would be interesting to see what you decide and how strongly your doc feels about pro-ablation in your case. Take care.

[Bromley]

One hour?  Yes, I think I would get that done.  Pick a good doctor and a good hospital and go for it.  You'll be surprised at how easy the procedure is.  Good luck.