Re: Had SVT for ablation, also get Ectopics: PVC's? PAC's? Other?

Posted By Chris on April 22, 1999 at 01:08:35
Dear Doctor,
  I'm a twenty year old male, and I had my first attack of SVT in August 1998. I went to hospital with it and they did an EPS 4 days later. They discovered an AV Nodal Re-entrant circuit for which an ablation was performed (Heart is structurally normal). I was home the next day and no sooner than about 24hrs after the ablation, I got another attack of SVT. I was obviously very depressed about this and went straight back up to the ward i was in and told the doctors of my re-occurance. They did not believe me and put it down to a stress attack. Anyhow, for the following 3 months I had a further 15 or so attacks of SVT until they did a second EPS and finally discovered that the accessory pathway was still there - not totally ablated. They proceeded with the ablation again and this time gave it a good 3 or so burns. This time it worked and I am now SVT free five months later.
The doctors all told me that it is very rare to have so many episodes in such a short period (15 in 3 months). I told them that I am prone to getting regular ectopic beats and they said that this was probably why the SVT happened so frequently.
I have been getting ectopics scince i was about 15 but back then it was only occuring about once a week or so. As the years went by they have become more frequent. I used to do weight training in the second half of 1997, but had to stop because all of a sudden the ectopics started occuring at a rate of many a day with periods where they would happen every few beats which scared me badly and was very depressing because I was getting quite strong and fit doing the weights. Anyway, I couldn't do weights anymore because it seemed i could hardly exert myself without triggering them at this stage. Eventually, they subsided down to about 1 beat a day up until my stage of svt when they started happening more often again. in the last 5 months or so (since 2nd ablation) they have been getting bad again occuring anywhere from 5 to 20 or more a day. This is really depressing me as I am restricted in my lifestyle - like my Fiance and her family invite me water skiing (which I used to love) and I say no thanks because i am scared it will set off many more ectopics and trigger something else like
V tach because I have read this in various materials. My life is just Not the same anymore.
1.What type of ectopic do you think I am getting - pac's? pvc's? some other type?
2.How much excercise do you think I could do safely? Water skiing? Running?
  (currently i am only doing walking because i am too cautious to do         anything more because of what might happen.
3.Does excercise help to reduce PVC's AND PAC's?
4.I have had a constant cough for over 3 years and have heard that it can be because of irregular heart. Is this likely to be the cause of my cough?
5.I am on flecainide 25mg a day that doesn't seem to help much at all, is flec dangerous for me to take a higher dose (say 50 - 100mg a day, checking with my doc 1st of course)
Thankyou so much for listening, Chris.

[CCF Cardio MD - MTR]

Posted By CCF CARDIO MD - MTR on April 23, 1999 at 07:48:34
Dear Chris, thank you for your question.  I'll answer each of your questions in turn.
1.What type of ectopic do you think I am getting - pac's? pvc's? some other type?
I don't know. You would have to wear a portable heart monitor to determine this.
2.How much excercise do you think I could do safely? Water skiing? Running?
(currently i am only doing walking because i am too cautious to do anything more because of what might happen.
Again, I can't make specific recommendations in this forum.  I think it would be necessary to know what type of ectopic beats you're having and how frequently they are occurring before exercise recommendations can be made.
3.Does excercise help to reduce PVC's AND PAC's?  It depends.
4.I have had a constant cough for over 3 years and have heard that it can be because of irregular heart. Is this likely to be the cause of my cough?  That's doubtful.
5.I am on flecainide 25mg a day that doesn't seem to help much at all, is flec dangerous for me to take a higher dose (say 50 -100mg a day, checking with my doc 1st of course).
   Since you have a normal heart other than the accessory pathways that have been ablated, flecainide should not be dangerous, but you should always speak with your physician before making medication changes. Another medication class to consider is beta blockers.   Beta blockers reduce the frequency of premature beats and can stabilize the heart rhythm.  Thus, I suggest that you speak with your physician about using a beta blocker.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.












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