PSVT Treatment: beta-blockers, ablation, or nothing

[beagle70]

Hello, I am an otherwise healthy 38 year old female. I experienced an episode of PSVT with sustained HR of 180's-190's for 2 hours and was administered adenosine IV.  My heart rythm converted back to a NSR and then I felt perfect. This is the 2nd time that this has occurred in about 12 months with the same character of symptoms requiring the same course of treatment.  I am an active duty service member. I think that the ER doctors acted in a very conservative manner and held me overnight in a monitored bed for observation.  I have an appointment to see a cardiologist next week to follow up.  My doctor wanted to put me on a beta-blocker until the follow up apt.  I was able to disuade him from the medication because I was concerned that a beta-blocker would lower my blood pressure and make me feel poorly. I assurred him that if I felt a rate change that I would immediately seek medical attention. He stated that I would probably end up requiring a cardiac cath and an ablation procedure. They did an echo that found my heart function to be normal except for a "mild" mitral valve regurgitation.  I am physically fit and have never had any indication of a problem except for the two episodes of PSVT.  All my labs are wnl to include the thyroid levels.  I am wondering if no treatment other than follow up at regular intervals would be sound treatment option. I am worried about undergoing an invasive procedure and the whole risk vs benifit thing. As well, I am worried about using medication to treat 2 isolated incidences of PSVT. Any general thoughts on this would be apprecitated!

[CCF-M.D.-MJM]

Hello,
Sorry to hear about your PSVT.  There are generally 3 options for treating PSVT.

1. Medical management with an antiarrhythmic medications like a beta blocker, calcium channel blocker, flecainide, propafenone, or procainamide.

2.  do nothing and try vagal maneuvers to break the psvt when it does happen.

3. ablation

Any of these options are indicated and they each have their own risks and benefits depending on the presumed mechanism are.

I would see an electrophysiologist to discuss treatment options.  The option of ablation is very low risk, but there is not treatment that carries no risk.   Before seeing the electrophysiologist, try to acquire your ER EKGs of the tachycardia before, during and after the EKGs.  

I do not think you need an ischemic work up for someone your age (no stress test or heart cath).

I hope this answers your questions.  Good luck and thanks for posting.

[anacyde]

I also suffer from PSVT.  My episodes typically last under a minute and break with vagal maneuvers (a hard cough) or cold water to the face.  I've had these episodes since I was 16 (I'm now 28) though they come in spells.  I've had about five or six episodes of it during the past 7 months, but they're not doing anything about it for now since I can break it.  It is a really unpleasant sensation.  All of my episodes are triggered at higher heart rates (140+) by a PAC that occurs during vigorous exercise. The PSVT typically puts me around 180-190 bpm until it breaks and I abruptly drop below 120.  My cardiologist tells me what I have isn't uncommon.

I hope you get the answers you're looking for.  I understand your worries, my blood pressure runs 90/55-110/65 without medications, though most people tolerate Beta Blockers pretty well.  My father has similar low blood pressure and he takes them with little change in his numbers.

Good luck to you :)

[CollegeGirl143]

Depending on what type of svt you have, there is a 98% success rate reguarding ablation, and less than 1% chance of complications. So the risk to benefit ratio is out of this world for going on with the procedure. I had an ablation for psvt myself and it was the best thing ive ever done for myself.

   You also have to consider your future when deciding what treatment to use now. SVT is not life threatening in a normal heart, but it will become a significant problem if you ever develope CAD. If i where you ide get the ablation done now considering it will be that much easier when you're young and healthy. Beta Blockers can help, but should not be considered a cure as you can still have breakthrough episodes and the effects can deminish over time, and you're right, you can experience unpleasent side effects. You should see an EP doctor if you already arent and discuss this with him/her.. Good luck and god bless..

[momto3girls]

Hi,

I am also a fellow sufferer of psvt.  Unfortunately mine occurs pretty frequently but doesn't go too high (only 140's).  I suppose that's a mixed blessing (:  Anyhow, I think your question is a great one...what to do.  Of course every cardiologist I've ever seen has assured me time and again that svt is not life threatening.  Nice to hear but I'm thinking long term like you are.  

My dad had a really bad case of svt, going over 220bpm and numerous times had to be converted to a normal rhythm.  Last December he had an ablation...turns out he had 3 different foci that were causing the svt.  Now he is svt free and loving it, no more medicine and no more trips to the ER 3 times a year.  

I understand your thoughts and reservations on ablation.  It is an invasive procedure even though there's minimal risk.  I know my dad was pretty nervous (he's a worry-wart) and he sailed through the procedure.  It will most likely be my like that the EP doctor I'm due to see will suggest it for me!  

OK, this will probably get me into to trouble for saying BUT I have been taking fish oil for the last couple of weeks and I've not had any tachycardia!  I have read that the fish oil calms tachycardias.  I've also been on a beta blocker for 18 months and it works some but I still have break-through tachycardia episodes.  Sometimes the vagal maneover works, other times not.  Anyhow, all of this to tell you that you are in good company.  I would definitely see an EP doctor, I have an appt. in 2 weeks with one.  Good luck and best wishes (:

[bama jane]

I have Psvt as well.  They some times call it atrial tachycardia as well. Is that the same thing?  Does anyone know.  I had an ep study 7 years ago and they could not reproduce it while I was in cath lab even though they had seen it numerous times before. I have lots of extra beats every day as well.  I am told there are different types of psvt.  Those of you that had successful ablations, do you know what kind of psvt you had?  Did the extra beats go away as well? I don't have it as often as I use to.  I do still have short runs of it just maybr 10 or 12 beats every couple of days,  but not the kind that is sustained for 30 minutes or more. I have that very seldom now.  I am on a small dose of atenenol, but I really avoid triggers. It is kind of a fragile way to lead your life. The highest my heart rate has been was 195 and that was only once it was awful.  It is usually about 160 when it happens. GOod luck to anyone dealing with this problem!

[Bromley]

Hi. I had the ablation for my PSVT. It worked pretty good, with only a couple of minor side effects.  I definitely recommend the ablation, if you qualify for it. You will be surprised at how easy the procedure is.

One thing though.  Be sure to do your homework on this, and choose a well qualified EP, one whose staff can support you after your procedure if you need it.  Mistakes are serious stuff, but are totally avoidable if you do your homework.

Good luck.

[Curmudgeon76]

Collegegirl,

Got my results via my primary care.  My e-mail is ***@****, don't want to take up valuable space on others' posts, so if you want to discuss it feel free to email me.

[KarenSA]

Hi.  I had an ablation for psvt in October 2005.  Best thing I ever did.  I cannot believe how quiet my heart is now.  I went in for an ablation of atypical or slow AVNRT.  This type of psvt occurs with a sudden onset and offset, no warm up in rhythm.  What I did not know before the procedure was that I also had Atrial Tach.  I knew my heart often ran at around 140 beats/minute during various times every day, but because I had lived with it for so long, I assumed it was normal and it did not concern me.  It usually coincided with rushing around etc, so I always put it down to activity levels.  The Doc did pick up on holter the 140 beats/minute and as I was not concerned about it, he did not pursue it and we stuck to the problems which did concern me - PVC's; PAC's and AVNRT.  Once they ablated the AVNRT in the lab, the Atrial Tach immediately presented itself and they ablated that too.  I am delighted.  Easy procedure, low risk and life changing benefits.  My confidence is gradually returning but for the pesky ectopics.  If you have an ablation for psvt, your ectopics will remain.  You need to have an ablation to specifically target these things to get rid of them, but that it not easy as they may not present in the lab and are hard to find.  
Regards Karen

[bama jane]

thank yuu for answering my question.  I am glad you are better

[micheller]

Hey, there, I was just curious what your Cardiologist says or said to you?  I am in the same boat.  I am a 35 yr female. My Dr. recorded 2 brief episodes of svt on a holter and is wanting to send me to a Cardio with an ep study and ablation. (I was having the holter because I have a history of pac's and pvc's and I am now having severe panic attacks and when I get them my heart skips.)
I am not ready for that, I have never had to go to the ER for this.  I'm curious to see how your doing.  I would try a med, but the invasive is too much for me right now.  My Dr. said they need to know what kind of SVT it is before doing a med, and the only way is by the EP study, but then I've been told that isn't true.  Wish I could get my question to the Dr. here.  Good luck to you, and let me know how you do. Michelle

[SNB3579]

I started having PSVT a few months after my mitral valve replacement in 1991.  It never occurred very often, but most of the time I could break it with the valsalva manuever.  I did have to go to the ER a total of 4 times over the last 15 years to have it broken with Adenosine.  I was never admitted for observation.  The last time I was in the ER for psvt was 7/26/06 and they wanted to admit me but I left the hospital AMA because I had never been admitted before, I knew the episode was completely stress related, and my last episode had been 3 years and 9 months before that date.  Quite frankly, I thought I had outgrown it since I hadn't had it for so long.  The first medication I was put on back in 1991 was Lanoxin but that never did anything.  I was on that for probably two years.  My wonder drug for psvt was Cardizem.  If I felt PVC's, I'd take one and my heart would return to a normal rhythm within a half hour.  I was able to discontinue the Cardizem this past March, but was put back on it for two months this past July.  I haven't had any problems since I went off the Cardizem in September.  I did see an EP doctor once, but I decided the svt wasn't happening often enough to warrant major surgery so I never had an ablation.  I would recommend that option for someone who is dealing with the svt on a regular basis.  It never hurts to see an EP and then get a second opinion.

Samantha

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