Re: ablation and pacemaker

Posted By Emily on June 13, 1999 at 13:27:40
I have been diagnosed with inappropriate sinus tachycardia.  I have tried several beta blockers and now a combination of Inderal and Digoxin.  My doctor is planing on repeating the Holter and echo and reccommending that I see an EP doctor in Bethesda (military).  I have been told that if I have an ablation, I will most likley need a pacemaker.  I have been dealing with this condition for 1 and a half years and I've come to terms with the idea of a pacemaker because my quality of life right now is poor due to the dyspnea, SOB, activity intolerance etc.  My question is ... if I due need a pacemaker 1) Will it be placed during the ablation?  2) Will it be done by the same doctor?  3) Will it require an inpatient stay... and how long?  I would also appreciate any other information you might think useful on the subjects of undergoing an ablstion and pacemaker insertion.    Thank You

[EDiE__0]

Posted By EDDiE on June 13, 1999 at 19:07:23
Dear Emily,
I'm kind of in the same situation,except I've been having arrythmias for 7 yrs.
now. It started with intermittant episodes of SVT for the first couple of yrs.until I was put on meds.i.e.,betablockers than the rapid rates, 135-190 bpm. were suppressed for the most part or as long as I stayed on the meds.However, the side effects are terrible,and now I get PVC's which were infrequent in the beginning but now are becoming frequent and intolerable to say the least! At any rate, I'm at the point in my life where I just can't deal with these frightening episodes which went from a couple every 3-4 weeks to a lot every other day, at least for the last week in my case. Anyway, I think the tenormin is just not working for the PVC problem, and often I still get inappropriate tachycardia too easily. Nevertheless, My only options it appears,is to consult with an EP Doctor, which I did and he advises either trying another med. called sectral or possibly going to the class of anti-arrythmics which I hesitate to do, despite how much these things bother me and are interfering with my life, but I a'm considering the EP study which may offer me the best help I can get, and believe me I'm not affraid to admit I'm scared to death they may worsen my arrythmia or I too might need a pacemaker if they screw up! I will say, from all the people I talked to and all the research I did It appears that most experts say theres a 1% chance that this will happen. Lets face it, it depends on who is doing it and where it is getting done,at least that's my oppinion and most doctors rarely speak against other doctors, that is they may not admit that who's doing the ablation or study for that matter, dictates the outcome. They will say it was something to do with the patient, and they (other doctors) know this is true! So get a second or even third oppinion before you accept what 1 Dr. tells you,after all they're  human too!
Sincerely,
Ed Sicoli,

[De__0__0]

Posted By Dee on June 13, 1999 at 19:54:17
Emily,
I wish you luck and will leave the questions you have to the doctors.  I do have a comment for Eddie though.
What Emily is referring to is probably a Sinus Node modification, which is not a screw up on the E.P.'s part.  They intentionally do this because there is no other way to control the heart rate (i.e. if meds aren't controlling and her quality of life is not there).
I had a PSVT that was taken care of in October of 1998 and I also have an inappropriate sinus tachycardia problem (diagnosed during RFA).  Anwyay, Tenormin controls my heart rate and my symptoms are not severe enough to have a modification done.  Also, I had my Thyroid destroyed last week because I keep having bouts of Subacute Thyroiditis.  Although, sometimes my Thyroid levels will be normal, I still think it is a contributor to my heart rate irritation.  My IST is because of a beta-adrenergic hypersensitivity problem.
It is always a good idea to get second opinions when it deals with the high probability of a pacemaker.  I know, I would, definitely.  But again, Eddie, it is not a matter of the E.P. screwing up, it is an intentional procedure, which unfortunately ends up in a pacemaker a large percentage of the time.  I just wanted to clear that up because sometimes it makes the E.P. look bad, when indeed that was the intention.
Good luck Emily, I hope everything works out well for you and your quality of life happens again real soon.
Also, Eddie, I hope everything works out well for you too.  It definitely isn't a fun time, but there is a lot of hope and success rates out there.
Dee
:-)

[CF-Cardio-MD-JMF]

Posted By CCF Cardio MD   JMF on June 13, 1999 at 20:26:20
Dear Dee,
Thank you for your comments.  You are correct sometimes and ablation  of the AV node (the electrical connection between the atrium and the ventricule) to cure a tachycardia.  This invariably results in a pacemaker as you have described.  
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. 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.

[Deb__0__0]

Posted By Deb on June 14, 1999 at 10:09:07
Hi,
This is for Emily, I also had the IST, and my doctor in my town, had me see a great doctor in Georgetown, that has a good deal of experience with sinus node modification for IST.  Her name is Cindy Tracy MD.  She is an EP doctor and a very nice person too.  She did do an EP study for me, but could not make them happen.  Which does happen at times.  Sometimes these types of arrhythmias happen on their own, and are hard to reproduce in the study.  Pacemakers are not all that bad, I have one for sick sinus node.  I am glad to have it. You can mail me if you want to see her or just call Georgetown, it is very near to you.  I think she also goes to the VA hospital near Georgetown.  
Hope this helps.
DEB










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