Post ablation loose ends.

[WPWGuy]

In 4/2004 I had an ablation for a hidden accessory pathway/left free wall form of WPW. The EP study found sustained orthodromic AV reentry. The ablation eliminated the original tachy, but seemed create occasional small bursts of VT and SVT, which were not present before ablation. My questions: 1. The prodedure note states that the team "did transiently eliminate conduction with the catheter ontop of the distal poles of the coronary sinus" using a retrograde aortic approach, with the catheter introduced into the left atrium and then advanced to the mitral annulus. What conduction was eliminated and why was it eliminated? 2. Ulitmately, the catheter was introduced in a retrograde fashion with the catheter underneath the mitral annulus. What complications can arise when ablating tissue in this area? 3. I have had a few recorded incidences of a short run of what appears to be VT (10 beats ~200bpm or less) since the ablation. I also have occassional short run SVT ~180bpm or less. These arrhythmias can occur at rest or while exercising. My original arrhythmia occurred only after 10 minutes of exercise, and there were no symptoms at rest.  The accessory pathway is eliminated now.  Given that I always experienced my original arrythmia during exercise, and had no symptoms otherwise, I presume that the precursor to tachycardia (rogue beats) were stimulated by exercise.  Why then after eliminations of an accessory pathway would there be short bursts of tachycardia at rest? 4. What is the prospect that my VT is actually AVNRT? 5. Why would my resting HR drop after ablation on left wall

[CCF-M.D.-MJM]

Hello,

1. The prodedure note states that the team "did transiently eliminate conduction with the catheter ontop of the distal poles of the coronary sinus" using a retrograde aortic approach, with the catheter introduced into the left atrium and then advanced to the mitral annulus. What conduction was eliminated and why was it eliminated?

I assume the pathway conduction, but it isn't clear to me from reading that sentance.  Eliminating conduction of the pathway is the goal of the ablation procedure.

2. Ulitmately, the catheter was introduced in a retrograde fashion with the catheter underneath the mitral annulus. What complications can arise when ablating tissue in this area?

That is a tough question.  There are many theoretical complications, but the overall frequency is low.  From underneath the MV annulus you could perforate the heart potentially leading to surgery, pericardiocentesis or death -- unlikely. Damage the mitral valve -- I have a feeling you are looking for something specific but I am not sure what to address.


3. Given that I always experienced my original arrythmia during exercise, and had no symptoms otherwise, I presume that the precursor to tachycardia (rogue beats) were stimulated by exercise. Why then after eliminations of an accessory pathway would there be short bursts of tachycardia at rest?

I don't know the answer this question.  It would be unlikely for a single or several point ablations to cause this.  These beats may be unrelated -- but there is no way to know for sure.  After abalating large areas like with atrial fibrillation ablations, it is possible to cause left atrial flutters.  What you are describing is not left atrial flutter.

4. What is the prospect that my VT is actually AVNRT?

Unlikely.  If you are very symptomatic, it is possible to do an EP study to take a look.

5. Why would my resting HR drop after ablation on left wall?

Don't know the answer to this one either.  It may or may not be related to the ablation or medications prior to or after the ablation.  We do know that after ablation, conduction properties of the AV node may change -- decreased refractory period of the fast pathway.  I do not know of any affect that accessory pathway ablation has on the sinus node.


I am not sure that there are good answers to your questions without further invasive studies.  If you are very symptomatic, you may want to talk to your EP about this.

Good luck and thanks for posting.

[WPWGuy]

I ran out of room for a thank you. Thanks for taking my question.

[gismatrix]

I am a 33 year old male.  I had an ablation on May 19th for AVNRT SVT.  I thought things were going great until I started having short episodes of SVT (~180 bpm).  My episodes before ablation would last anywehre from a few minutes to a couple hours, and were mostly all triggered during or after eating dinner.  A couple times I went to the ER because it would not stop.  Now my short episodes that I am getting last ~15 seconds then terminate.  I get them at a frequency of every other day at this point.  Since it has been 8 weeks to the day, should I consider my ablation a failure?  Is it possible that I am still in the 'healing window' and these episodes will subside?  Will these episodes deteriorate into what I was having before?  I avoid all caffeine and alcohol and do not smoke.  Please share your experiences with me...let me know where you think I stand and what my prognosis might be compared to your experiences.

Thanks and God Bless

-gismatrix

[skyelit]

Hey gismatrix I understand where you are coming from. I had my ablation a few weeks ago and I am having the episodes of SVT again to, although they are not like they were before I am still concerned. My doctor is having me wear the Event Monitor again for 30 days to see what is going on. Maybe you could talk to your Doctor about the Even Monitor. My other problem is I have been having leg pains/aches since my ablation. I had a sonagram done and thank God there are no blood clots, so we need to look farther to see what is causing them. Just wondering if anyone else has had leg pain/aches since their ablation.

Thanks,
skyelit

[gismatrix]

Thanks for your reply.  If you don't mind telling, how long do your episodes last and how frequent are they?  My doctor is also giving me the 30 day event monitor.  Do you still think there is a chance that this will settle down for us?  

Also, I too have some weird side effects.  I had leg pain initially, but that is gone.  Now I have a slower resting heart rate and seem to have pins and needles in my feet from time to time.  I also either have cold feet or hot feet... these side effects are also getting better/less noticable, but the SVT of course is very noticable, especially since I am so tuned into my heart after having all of this happen.  I hope you and I will get better and not have these episodes anymore.

Hope to hear from you soon...my email is ***@**** is you want to talk that way.

-Bill

[mdee88]

I can relate as well. I had an ablation for AVNRT SVT in Feb 2006. I have to say my condition is improved -prior to ablation I'd have SVT up to 250bpm lasting minutes and leaving me very weak.

Unfortunately, I'm still dealing with "bursts" of SVT (and plenty of other palpitations), probably not lasting more than 30s. It usually happens when I exercise or when I'm nervous. I've become so sensitive to my heart rhythms that even 30s of SVT is very hard for me to deal with. And it's frustrating to have to stop whateven activity I'm doing, especially if other people are involved.

My doctor seems to think this will get better, but it's been 6 months now. I'd be interested to hear about whether others see an improvement.

[PlayDoh]

Unfortunatly I've had 3 RF ablations for A-typical SVT. AV node re-entry. I just had another one today. My EP seems to have given up on me, she was sent all my stuff after my last one (Mar 06). I never did get a follow up appt, not for the 2nd ablation either.

I've talked to my Dr who suggested a new EP, and now I know I'll need an EP for sure. I figure if the procedure is 99.9% sucessful then I'm truly a one in a million patient. Although I dont want to sound ungrateful.

I've never taken med for SVT, and don't really have a cardiologist. I had to goto the ER with SVT 5 times a month b4 they set me an appointment for the following year. I'm 31 btw.

[lakesidepam]

I had a cardiac ablation 7/10/06 for SVT.  I was told that it was not 100% because part of the pathway was outside the heart, so I was place on meds following the procedure--the doctor assured me that he thought this would work.  For a couple of weeks I felt ok.  I had a couple of episodes where my heart fluttered for a second or two, but that was about it.  Last week, I started having frequent episodes of feeling my heart pounding briefly--nothing like before the procedure--no chest pain--it would do it and then stop for a while and then repeat.  This lasted a day.  Then, I had two days of nothing.  Last night, the episodes started again--lasting longer and more frequent--no pain, just awareness of my heart beating fast and then back to normal.  I had a Holter monitor last week, but not sure that any of these episodes happened while I was wearing it.  Again, these episodes are not like I had pre-ablation when I had to go to the er for conversions--I just get anxious when they happen.  I have a call into the dr, but this forum has made me realize that I am not totally alone.  I was hoping this ablation would be a cure-all and I could go on with my life--think they left this part out.  Maybe I just have to give it more time--my ablation took 8 hours, and that is a long time to be inside my heart.  If I just knew this would all subside eventually, I could bear with it.  Thanks for listening.

[RHYTHMRN]

HI,
I HAVE HAD 2 ABLATIONS ALREADY FOR AVNRT. 1ST WAS 4/19/06. WAS OK FOR 4 WEEKS THEN WORSE THAN EVER WITH SVT.  HAD 2ND ABLATION 6/22/06.  STILL AM NOT BACK TO WORK, HAD INAPPROPRIATE SINUS TACH. FIRST AND PUT BACK ON INDERAL.  NOW HAVING CONSTANT PACS AND PJCS.  ANXIETY LEVEL IS HIGH DUE TO THIS (NOT THE CAUSE).  HAVING FREQUENT SHORTNESS OF BREATH, ACTIVITY INTOLERANCE. I AM GETTING VERY DISGUSTED OVER THIS. HAD THE PROCEDURE SO I DIDN'T HAVE TO WORRY ABOUT SVT AND TO GET OFF MEDS AND NOW I FEEL WORSE THAN EVER.  ANYONE ELSE EXPERIENCE THIS POST-ABLATION??? WOULD BE GLAD TO HEAR FROM YOU.......

[hollyloxx]

i am a 24 yr female whom had severe svt that was not helped by medication, so i had an eblation. in 2001. i was told by my dr what to expect after and he said that afeterwards it would feel funny for a couple weeks maybe a pounding feeling. they also said that it could return but the chances were slim. 5 years later i am glad to say that it has not.
i have had palpitations still and wonder if they could be related to the eblation.i had gone back to my cardiologist took mointor test again and he found nothing harmful......
Does anyone else whom had the eblation have this? to me its scary. jsut as scary as the svt. it comes and goes. months i will be fine then its tons everyday.

[mdee88]

Hollylox,
I found the same thing. (I'm a 26 year old female, had an ablation for SVT in 2/06). Sometimes I think i'm better because I'll go a week with no palpitations and then I'll have very frequent ones for days in a row. It scares me as well. I've been told they're not harmful, but it's difficult for me to really believe that when they're happening and my heart just can't seem to get back on track. It's very hard for me to focus at work when it's happening. I can become quite anxious at times.

My doc believes they will subside with time, but it's been 6 months now. Do I have any reason to believe they will get better? Do they do ablations for palpitations (not SVT)?

[hollyloxx]

mmmmmm i dont believe they can do ablations for palpitations. my dr said its something i need to learn to live with. i am a very stressed out person all the time. which all my dr's think has alot to do w/ it. i am  a worry wort i worry about everyone and everything.
i dunno what to do anymore. mine come and go some days i have one and it will be like that for months then there are times like now that they never end.
i too know how you feel lately its been interfering w/ my job too. they are testing my thyroid by a sonogram they felt a lump they think that it could be enlarged and that night have something to do w/ it. its the waiting to know thats driving me nuts. the symptoms of anxiety and thyroid are very similar so its hard. i have always had blodd work done to checkmy thyroid but they said it deosnt always show.... wish me luck and i wish you luck too!! i remember for a awhile after my ablation it felt funny. i htought they said that it might feel like its skipping but it could be your heart trying to go into an svt attack but cant because its been blocked.