Re:AV Node Ablation

Posted By Ann Ibrahim on May 28, 1999 at 09:47:26
Thank you for your reply to my question relating to AV Node ablation and implantation of pacemaker for inappropriate sinus tachycardia. Your comments were very reassuring. I have since been informed however that there is another condition with similar symptoms to IST , its called Orthostatic Intolerance or POTS. How could these conditions be differentiated? I want to be sure that I have not been misdiagnosed before I go ahead and have my AV node ablated! For years now my only symptom has been tachycardia, 190 bpm with the absolute minimum of exertion. However I do often have a raised resting pulse of between 100-120 despite beta blockers. Recent symptoms which developed over the past few months include visual disturbances, throbbing headache and dizzyness upon standing(occasionally). My doctor has put these symptoms down to an increase in medication as my BP was up a bit and I was prescribed Irbesartn  (ace inhibitor).
An EPS and sinus node modification were carried out in February but symptoms still persist. My electophysiologist wants me off beta blockers sooner rather than later  because of the effects they have on my breathing (I'm asthmatic). The ablation is scheduled for 7 July at the Royal Brompton Hospital , London. What if this condition is POTs ? Would I still need the ablation to control the tachycardia when the beta blockers are withdrawn? No other drugs control the arrythmia, this is the major problem.
Thank you so much for your help. You all do such a wonderful job!!

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on May 28, 1999 at 13:16:50
Dear Ann,
The test of choice for the diagnosis of POTS is a tilt table test.  However it dosen't sound to me as if this is what you have.  the increased heart rate with POTS is only at the same time as the decreased blood pressure.  I would suggest discussing it with your doctor before proceeding with the ablation.
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.
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.

[Dorothy__0__0]

Posted By Dorothy on May 30, 1999 at 19:54:40
Dear Doctor,
Just to let you know, I am a pots sufferer.  The majority of pots patients do not have a decline in blood pressure with the rapid heart rates.  This is why so many people have a hard time finding the correct diagnosis as so few physicians know that this is one of the halmarks of this disorder.  

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on June 01, 1999 at 10:30:57

Dear Dorothy,
Thanks for the correction.  Here is a good article detailing the diagnosis of POTS.
Authors
Grubb BP. Kosinski DJ. Boehm K. Kip K.
Title
The postural orthostatic tachycardia
syndrome: a neurocardiogenic variant identified during
head-up tilt table testing.
Source
Pacing & Clinical Electrophysiology. 20(9 Pt 1):2205-12, 1997 Sep.
Abstract
Head upright tilt table testing has emerged as an accepted modality for identifying an individual's predisposition to episodes of autonomically mediated hypotension and bradycardia that are sufficiently profound so that transient loss of consciousness ensues (neurocardiogenic syncope). However it has also become apparent that less dramatic falls in blood pressure, while not sufficient to cause full syncope, may produce symptoms such as near syncope, vertigo, dizziness, and TIA-like episodes. We have identified a subgroup of individuals with a mild form of autonomic dysfunction with symptoms of postural tachycardia and lightheadedness, disabling fatigue, exercise intolerance, dizziness, and near syncope. During baseline tilt table testing these patients demonstrated a heart rate increase of > or = 30 beats/min (or a maximum heart rate of 120 beats/min) within the first 10 minutes upright (unassociated with profound hypotension), which reproduced their symptom complex. In addition these patients exhibit an exaggerated response to isoproterenol infusions. Similar observations have been made by others who have dubbed this entity the Postural Orthostatic Tachycardia Syndrome (POTS). We conclude that POTS represents a mild (and potentially treatable) from of autonomic dysfunction that can be readily diagnosed during head upright tilt table testing.

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.
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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Re:AV Node Ablation Dee 6/01/1999
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