Re: Is ablation necessary??

Posted By Kate on July 02, 1998 at 03:38:00:

In Reply to: Re: Is ablation necessary?? posted by CCF CARDIO MD - CRC on June 29, 1998 at 14:43:11:






: : I am 22 yrs old and have regular palpitations and a resting heart rate of 108.  Just a walk from one room to another can cause my heart rate to jump to 170.
I have had two hospital admissions in the past two months, as I was having palpitations and a continued heart rate of 220 per min.
They have performed two holters, which showed up only a little bit of SVT, and I do not have a result for the second holter as yet.
Echo was normal.   The Stress test showed severe tachycardia, (190 bpm in the first 15 secs) but no arryhthmia before I passed out.
I am taking 240g of verapamil daily, but it doesn't seem to do much.
: : I am now scheduled for an ablation in OCtober, but my worry is, Is it really necessary???  What if they can't find a pathway????  With such a small amoount of SVT shown on the Holter, is an ablation jumpung the gun??
: : Thanks
: : Kate
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Dear Kate,
The answer to your question depends upon the cause of the tachycardia. If it is caused by an accessory pathway (extra conduction pathway in the heart) then ablation is indeed the treatment of choice.  If the etiology is not clear then an electrophysiology (EP) study may still be in order to help with diagnosis and possibly with treatment.  
I have answered your other questions below.
What if they can't find a pathway????
: A: This is a possibility and they would have to try different medications.

: With such a small amount of SVT shown on the Holter, is an
: ablation jumping the gun??  
: A: No.
Thanks for your response.  I have some more questions.  I am still concerned abou what will happen if they can't find the accessory pathway.  Other medications are not really appropriate for me as I am a sever asthmatic, and beta blockers are contraindiacted.  I have tried Flecinide and now verapamil without success.  What then, if they can't find any accessory pathway??
Q2.  My cardiologist doesn't seem to think that such a small amount of SVT was a problem at all.  He was very blase about it.  He referred me to an electrophysiologist for evaluation for an EP study.  Instead, he scheduled me straight away for an ablation.  Why so soon, do you think???  Should an EP be done first??
Thanks so much
Kate Boffey






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Dear Kate,
Q1: What then, if they can't find any accessory pathway??
A:  Other potential medications include quinidine, sotalol, rhythmol, norpace, and amiodarone.  These would only be used if the pathway could not be found and the symptoms were very distressing to you.
Q2. My cardiologist doesn't seem to think that such a small amount of SVT was a problem at all. He was very blase about it. He referred me to an electrophysiologist for evaluation for an EP study. Instead, he scheduled me straight away for an ablation. Why so soon, do you think??? Should an EP be done first??
A: I suspect that he will do an EP study at the same time as the ablation.  You should discuss your concerns with him before the date of the ablation.
Sorry to bother you again.  I am NOT having an EP, I checked with the hospital.  Unfortunately, as I am in the public system, I have no opportunity to discuss it with the electrophysiologist before I am admitted.  What indications do you feel there are that show I need the ablation straight away (without an EP).
Also medications such as sotolol cannot ber used as I have had a really bad reaction.
My fear is still ' what if they can't find a pathway?' and what reason would they have for going straight in and ablating,rather than an EPs tudy first?
Thanks for your time,
Kate