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PVCs triggering SVT in a concealed pathway
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PVCs triggering SVT in a concealed pathway


Thanks again for taking another question.

   It is my understanding that PVCs trigger SVTs in concealed accessory pathyways, usually only identified in an EP study.
   I have PVCs that sometimes trigger a fast heartrate of about 140-170 bpm with PVCs occuring during the tachycardia, most of the times PVCs trigger no tachcardia. I had this documented on an ECG as PVCs with sinus tachycardia. I wondering if it is possible that I may actually have some sort of concealed pathway that can only be identified with an EP study. The attacks are few and far between , but anxiety can trigger them.
   Sometime a PVC will trigger the tachycardia with no PVCs occuring during the tachycardia , at other time times they will occur with the tachycardia, no trigger of tachycardia while taking atenolol, only the odd the pVC now and then.
   Would I be right to assume that PVCs that trigger SVT in a concealed pathway would not be as dangerous as in true WPW, even though it is referred to as concealed WPW, as they only conduct retrograde, or would risk of sudden death be the same in a concealed pathway as in WPW?
   I have a normal perfect ECG with no suggestions of ventricular preexcitation whatsoever?

   Thanks in advance.
          Hank.

  
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Avatar_n_tn
Hank,

Thanks for the post.

PVCs can indeed trigger SVT.  However, it would be unusual for you to have PVCs during the SVT.  What makes more sense is that you (1) develop PVCs, then (2) develop anxiety, and then (3) develop sinus tach with continued PVCs.

PVCs, nor PACs, are known to be "dangerous" in patients with WPW or a concealed pathway.  Afib can be dangerous in patients with WPW due to the potential for the afib to conduct 1:1 to the ventricles.

Also, the risk of sudden death from AVRT is very, very low in patients with AVRT over the age of 35.

Hope that helps.

6 Comments
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Avatar_n_tn
I have PVCs that sometimes trigger a fast heartrate of about 140-170 bpm with PVCs occuring during the tachycardia.

Hank, how long did your heart stay elevated after the pvc's triggered the fast rate?

The reason i ask is because pac's in my case used to do a similar thing to me(although i used to get an attack a day)..I felt a funny beat(or some weird pause..squeeze maybe)and then off my heart went between 140-168..I had my exercise heart monitor watch on to catch the speed so i saw exactly what was happening..I sometimes had some funny beats during the tachycardia as well(the odd pause here and there).

In my case it only lasted for 15-20 secs everytime(i still don't understand why it was so consistant..it was ALWAYS 15-20 secs).

I never had the attack on the event monitor..all they found was pac's.

Since i started beta blockers(about 6 months ago)i've not had a single attack..so i've stopped worrying about it.

I still think it was pac's triggering brief spurts of psvt or something like that..it started and stopped suddenly every time.
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Avatar_n_tn
>>>I still think it was pac's triggering brief spurts of psvt or something like that..it started and stopped suddenly every time.<<


That's exactly what my most recent event monitor showed -- usually pacs ( rarely, pvcs).. one would pop up and then I'd have a run of 3 to 15 or so atrial tachycardia beats... then it would be over , until next time. -- Lynn
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Avatar_n_tn
>>
Do these run of pacs happen just occasionally throughtout day, very frequently during the day or every couple of days?

I wonder if your AVRNT ablation was truly a success or just has a bit left hanging by a thread that gets revived up, but can't seem to take off at the rapids rates as before.

I am starting to wonder if another ablation would put this out of its misery and save you some "misery" yourself.<<

The runs are atrial beats preceded, usually, by a PAC that triggers them... sometimes I also have PACs and PVCs. They happen very frequently throughout the day... sometimes throughout the minute, the hour.

No, my cardiologist, an EP doc he talked to in the hall ( with me listening up against the door..hahahahahaha.. when I had a "funky" EKG recently.. )), the doc who did the AVRNT AND my NEW EP doc alls say the AVRNT is gone... that one was ablated successfully.What I have now is from some other place in the atrium.. seems to be mono-form, not uni-form but could be too close to the sinus node to ablate.  THIS one causes tachycardia at not a very fast rate ( 120 - 150) and only lasts for seconds... the hope was the atenolol would calm down this irritated focus.. hasn't worked so far . might if i could take more, but I wouldn't be able to walk, I'm afraid, with it dropping my BP so low.

L
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Avatar_n_tn
Great questions HS.

I too get short runs of arrythmia (never caught on a Holter) similar to that you and others here on this thread describe.

In my own case, the arrythmia appears once or twice most days - sometimes none for a week or two, and sometimes as often as 4 times in a day. (I also get quite a few single PACs and PVCs every day - as few as 10 (good day) up to as many as a couple of hundred (bad day).) It typically appears as a fluttery arrythmia lasting from 2/3 secs up to 15 secs. It varies as to speed and regularity/irregularity - it can feel very slow and 'plunging' with longish pauses, it can feel fast and quite regular, it can feel just a little quicker than NSR but distinctly heavy, and it can feel fast and irregular. In other words, a LOT of variety. It can terminate with a long pause and a thump, and it can also equally often terminate very gently with little in the way of a noticable transition. Wierd. It most often feels lumpy and a bit uncomfortable and frightening.

I should add that I have also had 5 AF episodes during the last 5 years (all early AM whilst asleep and self-converting after 3-4 hours). I am on no meds. I am 42 yr old healthy male with no structural or other heart disease. I am in great shape if a little O/W (6'4" 220Ibs). I have had ectopy for 20 years. I have GERD and have been diagnosed and treated for Generalised Anxiety Disorder, OCD, and mild depression. (Traumatic and very violent childhood.) Educated to PhD level.

I really do wonder what the short bursts of arrythmia which I dascribe above are.... ANd I do know they're not AF cos I know what THAT feels like!

Any views or opinions would be MOST appreciated.

BM.
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Avatar_n_tn
Thanks very much for the much-appreciated input. It's strange but quite wonderful how the Internet allows one the privelege of 'meeting' and conversing with good folks such as yourself.

Yes, my childhood was rough - I 'grew up' as an only child (left by my abused and long-suffering adoptive mother when I was 14) on a fairly isolated farm (in NE England, UK) with a mentally ill adoptive father. Poor guy, he was such a unhappy and tortured individual - life was quite hellish for the both of us (and my mother while she was there) one way or another. He's at rest now - don't think he ever was in his life..... Anyway, life with him up until age 17 sure left me with a few issues! I am currently having psychotherapy to try to rid me of some of my more self-destructive belief systems inadvertantly acquired from my father. Long hard road...... hardest part is actually becoming mature enough to realise that it's a journey you need to take (-:

Best wishes HS

BM
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