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Recurrent SVT
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Recurrent SVT

Firstly, thank you for providing this service and your expertise.

I am a 31 year old male, with recurrent SVT. I have had 3 RF Ablations in 4 years yet I have had 2 episodes since my last surgery. I have only had 10 episodes, and aside from the first 2, I've always gone to the ER. Also, aside from my first ER visit where Adenosine worked, Electro-cardiovertion 150 J, was needed.

I've had a Echo, and the first Ablation I had they went in through my neck (Angiogram?), but I've had very little feed back as to what my "condition/problem" is, aside from Recurrent SVT or A-typical SVT.

I also have severe anxiety, but am using medication for it, and handle it quite well. However I'm aware of its impact on my Hearts rhythm, and overall health. I have been unable to work or exercise for the past 2 yrs yet I do odd jobs.

My first episode happened 6 years ago, at which time I quit smoking cigarettes yet I still smoke Marijuana daily. Since my last episode I have had nearly constant (10-30 times a minute) PVC or PAC's (heart flutter) when I am stressed or physically active. I also have 2 abscessed wisdom teeth that due to my anxiety and finances have been unable to get surgery for yet.

My question, is "recurrent SVT" a form of heart disease, or a probable symptom of something else like CAD? I know that is difficult to answer with the info I've given, but I'm not sure if I should pursue a diagnosis or further testing from my EP or if Recurrent SVT is basically considered a benign nuisance.

& are my risks of Myocardial Infarction greater, less or unknown by my EP study?
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Avatar_n_tn
PlayDoh,

Thanks for the post.

There are a lot of causes of SVT, so I'm not sure what is the exact cause of yours. What I'm assuming, is that it is the type that is caused by a slight abnormality in the electrical system of the heart that results in a fast heart beat. In young patients, generally SVT is an entity separate from CAD. I would imagine the likelihood of CAD in you to be very small. An EP study only looks at the wiring of the heart so there is no prediction of MI risk from it.

Your overall risk for a heart attack in the near future is most likely small. However, these risk accrue over many years, so your behaviors and lifestyle now will have impact in 20 years. Thus smoking (yes even pot) will contribute to this risk as does your diet and activity level. You really need to try to find some constructive ways of dealing with your anxiety as you are setting yourself up for future problems if you don't get with it. I say this not to try to minimize your anxiety as it is clear that it is playing a great role in your problems, but to encourage you to try to seek help in dealing with it.

good luck
26 Comments
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Avatar_f_tn
Just another question.. how long apart where your ablations? Just curious because the full effects of ablation are not realized until about 6 months after surgery because the tissue around the ablated area is so inflammed.. and dont be sorry for wanting clarity from your doctors.. thats what they make 6 figures for ;)
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Avatar_n_tn
Just out of curiosity, does anyone mind telling me a rough estimate of what an EP study and Ablation cost?  I am curious.  Thank you! Michelle
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Avatar_n_tn
My Ablations were around a year apart. It definitely got worse with time, in terms of how often I would get a SVT episode. When I kept working I was in the ER twice a month. I have quit smoking Marijuana, and I rarely drink, and although I notice a improvement when I've quit, I find it too hard to resist. I get way too tense and stressed out when I don't use pot (denial speech).

My uncle did of heart disease at 53, and we were much alike regarding temperament, and Cannabis use. I also had fainting spells every year or so from age 13 to 19, which I think may have been SVT or arrhythmia related yet I never felt or noticed my heart. I used to play hockey for 12 years and I live at 4000 ft, so I had the lungs of a horse. I would notice the burning in my throat (Jugular and Lactic acid) I'd get when I was gassed hard wouldn't go away as quickly as it should. I.E, I wouldn't recoup normally, and after I caught my breath I would get out of breath quickly, almost instantly.

Now my emotions impact or effect on my heart rhythm is massively exaggerated. If I get angry my heart pounds so hard and fast it instantly floors me, once with SVT. I've had Cognitive Behavior therapy which changed my life 180 degrees. Yet I still have zero energy, scary palpitations, and SVT usually triggered by exertion. It's interesting that I can "catch" a SVT or re-entry and if I like hold my breath (hard to explain) I can stop it. I always convert when I cant "catch" it. BTW I know I have out there analogies and medical conspiracy theories, lol.

Thanks again
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Avatar_n_tn
First, I appreciate your frankness on the daily weed thingy.  I'd be interested in hearing from others who occasionally indulge in a little marijuana consumption as opposed to those addicted to cigarettes/nicotine.  Although I have NEVER tried the stuff myself (chortle, chortle), I'm wondering what the relative risk factor for weed use would be, balanced by the calming effect some claim to get from smoking the stuff.  Be brave, fellow posters-let us know your experience/belief/doctor's opinion.
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Avatar_f_tn
i cant comment on what effect weed might have on the heart, because im not sure if there has ever been a legit study done, but it is known to cause anxiety and depression so its probably counter acting your anxiety meds.. Another thing to keep in mind.. THC can make your blood pressure drop, which in turn can increase the heart rate, which can lead to an episode of SVT..

I dont think recurrent SVT is indicative of CAD, but if you did have CAD, the svt would become more of a problem.  Im sorry your ablations havent worked, are you on a beta blocker or anti arrhythmic?
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Avatar_n_tn
I've found it difficult to discuss marijuana use with doctors or Cardiologists, for the obvious reasons. Its like telling your mechanic that you pour sand in your engine once in a while, but your hopeful it wont cause serious damage.

However to the contrary of my suspicion, most Doctors don't seem to think its that harmful. With that said, and like collegegirl143 mentioned, there has been relatively little research done on the long term effects I would assume. I would also think the number of Doctors or Cardiologist who use Marijuana chronically aren't that great (thank god). Also since its not always easy to discuss, a good portion of patients likely deny or don't advise their doctors about usage.

I've never been prescribed anything, and I've only seen my EP Cardiologist in pre and post surgery appointments. I did visit a Cardiologist before I had SVT episodes, and only because of frequent PVC's or PAC's. I'm really not sure which I experience, or if I get both. Some feel like I'm a split second away from dropping dead, and others I hardly notice. I believe due to the steady jolts of adrenaline I get with the PAC/PVC's effect my brain chemistry, Hormones, & behavior, which is either a cause in part or whole of my Anxiety, or a result it. Either way, its a vicious circle that I'm trying to get out of, and yet doing all the wrong things.

I figured if I was as straight forward as possible I might get a wake up call I actually answer. I know I'm a poster boy for Heart disease ignorance in ways, but I'm far from the worst. I avoid saturated fat and cholesterol as much as possible. I haven't had my Cholesterol checked, and I've only worn a Holter monitor after my ablations.

I also should have mentioned that my EP told me I fine after every ECG/EKG I've had. Yet I got a SVT episode 2 weeks after my 2'nd post op appointment/EKG. I'm not the greatest at talking with doctors in terms of getting a complete understanding of whats going on. I feel guilty about asking, since my knowing only serves to ease my mind. But I'm going to get an appointment soon and try to figure out if theres anything to worry about.

Thanks for the comments.
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84483_tn?1289941537

I never did smoke cigs, but I still have a few beers and smoked weed very occasionally while in high school, last time I smoked ganja(marijuana) I was 17 years old , I'll be 42, 2 weeks from tomorrow. I always suffered from tachycardia and occasional prolonged episodes of PVCs. I remember that is the one reason I just had to stop smoking weed with my friends , it would just make my heart speed up to the 140s to 150s after a few puffs, trust me anyone with heart rhythms problems, marijuana, alcohol and cigarettes should be a no, no,  in my humble opinion. I can drink a few beers now and dont really have a problem with tachycardia or PVCs , it is probably because I take atenolol for the palps. Maybe you should lay off the weed and see if it makes a difference, it might take a few days or weeks to notice the change. Good luck.
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Avatar_f_tn
Michelle.. no idea.. but whatever it is.. its worth it if you have a treatable kind of arrhythmia.

Playdoh.. i had svt to, mine was treated with ablation.. but i know what you mean when you say your heart rate is extremely sensative to your emotions. mine is too. My EP told me this has nothing to do with the SVT, its a sensativity to adrenaline. I think beta blockers might help, but it doesnt bother me enough to find out.. This sensativity to adrenaline though is what triggered my palpitations and in turn my svt. Maybe you can try treating that with a beta blocker and by proxy help reduce your svt episodes.
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61536_tn?1340701763
My sister used to smoke pot.  She said it calmed her anxiety some but it also increased her palpitations dramatically.  I can't even imagine that tradeoff being worth it, since the palps trip me out so much.  I don't know if it might be affecting you the same way, but I thought I'd weigh in with what I know.
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Avatar_n_tn
anacyde, I tried to ask you a question in a previous post, but I don't think you saw it.  I noticed you have pac's pvc's and psvt.  Can you tell me how you were diagnosed, and what they did for you?  I'm gathering from what I read you haven't done an ablation, what about an EP study?  I have been plagued with pac's and pvc's for 6 years, but just recently started getting a fast pulse, which I think is from the anxiety of the darn skips, but my Dr. said SVT, read below please.
collegegirl, thank you for advice.  I don't know if I warrant an ep study or ablation, since I can get my heart rate down by myself, and it's triggered by my emotions,(adrenaline).  I have anxiety/panic attacks, and they only occur when I have to do something I am afraid to do.  And when I exercise hard, but then I have an anxiety attack, because I hate feeling my heart rate go up, so I freak out and it sets it off.  When I first wake up in the morning it can go to 180, for a minute, and then slowly goes down.  I still need to see a Cardiologist, but they only recorded 2 brief episodes of svt, rate 154, for a run of 6 beats.  That's the only time it's been recorded, so I wonder if I just have regular sinus tach, and it was misdiagnosed, I don't know how easy it is to misdiagnose or not.  Anyways, how bad was your svt to get an ablation done?  Thanks, Michelle
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I had two EPS' and ablations.  As I recall, each procedure was approximately $33,000.  YIKES!!  Fortunately, I had health insurance to help with the expenses.

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61536_tn?1340701763
Hi.  I didn't see it but I'll go look.

I was diagnosed with PSVT at age 16.  They did nothing to treat it, told me it was annoying but not deadly.  I had brief bursts of it.  That was probably the worst time I ever had with palpitations.  This was observed on continuous monitoring while I was in the ER for several hours.

At 21, I went to Cleveland Clinic for a second opinion, as I had a recurrence of the PSVT and some new flutterings.  They diagnosed me with PACs.  I had a few on a Holter I wore for 48 hours.

My local cardiologist, who I started seeing at the same time, did his own Holter and came up with the same results, plus two PVCs.  Everyone said the same thing, no worries.

When I was pregnant in 2003, I was admitted to the cardiac unit because I was having multiple PACs and PVCs per minute and also had an elevated cardiac enzyme.  Turned out to be a lab error and I was released the next morning.  The palpitations subsided over the next few weeks.

Early this year after my son was born, I had the most palpitations I've ever had.  All PACs except for one PVC while I was asleep.  They suspect my PACs are adrenaline-induced, and the occasional PVC is just what the normal population can expect from time to time.  No treatment, medical or otherwise.  With careful diet (no caffeine, strict limitation of sugars) I find relief.

I do get episodes of tachycardia and bradycardia.  The tachycardia is usually due to salt, the bradycardia seems related to my esophageal problems.  It's all been seen and it never has been anything other than sinus rhythm.
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Avatar_n_tn
Hi thank you for telling me, I was curous because I too have everything you have.  I have pac's and pvc's too.  Just diagnosed with SVT, but it isn't constant and doesnt last long.  My Dr. did call me back today and said they don't think I need an EP study at this time and that this isn't life threatening.  She does want me to take Xanax and a very low dose beta blocker for now.  My heart rate is always between 80 - 130, unless I'm asleep. When I have an anxiety attack or do heavy exercise it goes up to 200, again for maybe 5 to 10 minutes. I was so worried this last week because when told me the holter results she was telling me I need to see a Cardiologist and get the study and possibly ablation done. I spent the whole week in panic mode.  Then I called another physician for a second opinion and he said svt is usually always benign and in someone like me (he knows my history and also has done two previous holters in the past for my pvc/pac's and they were normal results), he said I definetely right now don't need a workup, except maybe blood tests for thyroid.  I would like to get on here to get an opinion from a good Cardiologist, but it's hard to post.  It sure is nice to talk to you guys, my mom is an RN and my friend is a heart nurse and they had me scared to death.  Take Care, Michelle
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Avatar_n_tn
Tickertock,

I was talking to someone the other day about PVC initiated SVT and I remember you knew quite a bit about this.  In particular, do you recall what percentage of SVT are initiated by a PVC? I seem to remember it was something like 20%.

Hope you are doing well.

Jeff
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Avatar_f_tn
Michelle.. my svt was bad.. it was triggered everytime i ate.. So i wouldnt eat out of fear.. i got down to under 90 lbs, so it was nessecary for me. But also you have to keep in mind, yes SVT is not life threatening in most cases, but if you are ever diagnosed with coronary artery disease, it can become life threatening. Im a big advocate for ablation in most cases of svt (except afib) because the risk to benefit ratio heavily favors having the ablation, and it eliminates the problem rather than cover it up with beta blockers, but it really is a personal choice.

Jeff.. sorry im not tickertock, but your question was of interest to me too.. i had AVNRT type svt.. and it was always caused by a premature beat (pvc or pac). This is very typical of AVNRT, and avnrt is a very common type of svt, so i would gather it would be higher than 20 % but im not sure on the exact numbers :)
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84483_tn?1289941537

I'm doing well, hope you are too. I think from what I remember around 30% of all SVTs ( including AVNRT, AVRT) are initiated/triggered by a PVC. As always I'm not a MD.
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Avatar_n_tn
"my svt was bad.. it was triggered everytime i ate.. "

Interesting, I often have tachycardia after eating a fatty meal. It sure annoys me. If I eat a light meal (especially something that's high in fiber), I don't have a problem with it.

Does anyone have a similiar problem?
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61536_tn?1340701763
Interestingly, yes.  My doctors sort of just dismiss it and say, "Good, eat healthy!"  lol  But yeah, I have the same issues.  Fatty or high sugar foods trigger me big time.
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Avatar_n_tn
Tickertock and Anacyde; Forgive me if I sound ignorant, but do I understand then that you both just have regular tachycardia, and NOT svt?  I'm confused, so I'm sorry if it sounds dumb.  I'm just trying to figure out if I have the same thing as you.  I was told if it was just Sinus Tachycardia, it is ok, but if it is SVT, it is not ok.  Do you guys know if ST and SVT can be misdiagnosed on an EKG strip?  
collegegirl143, thank you for sharing your story with me.  As this is new to me, I guess I will just have to weigh my options and maybe see where this all goes.  I know they do want to run some blood work to make sure that I don't have anything wrong, like hypoglycemic, or thyroid that is bringing this on.  Obviously mine is not nearly as severe as yours was, but if it was a daily occurence, you bet I would be thinking of the ep study, but right now I don't think I need to go that route just yet.  I am definetely changing my lifestyle though.  It kind of gives you a wake up call.
One other quick question for you guys if you don't mind, I've never really bothered to notice before now, but when I first wake up, my hr can be around 140, and then go back down, and then during the day when I am walking around doing things, my hr is around 120 to 130, then goes back to 100.  I don't even notice it, no symptoms, so is this an ok rhythm?  Since this holter I've been super aware of my heart.  Driving me nuts.  Thanks guys, Michelle
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84483_tn?1289941537
Remember SVT is a broad term in describing any tachycardia that occur above the ventricles , sinus tach, inappropriate sinus tach, atrial flutter and atrial fib can all be included as SVT from my understanding. AVNRT, AVRT, and WPW are often the most SVTs seen, any ectopic ectopic foci in the atria that triggers a tachycardia that does not arise from the heart's natural pacemaker( the sinus node)is often just referred to as atrial tachycardia or PSVT( PAT) is older term if just paroxysmal. Some atrial tachycardias can masquerade as sinus tachycardia.

Rates of 120-140s I would get checked out if it is occuring very often even its sinus tachycardia in origin as it could be inappropriate sinus tachycardia. Rates that take off out of the blue or are triggered by a PVC or pac 160 and above is often PSVT from my understanding, sinus tachy usually have a warm and cool down period, while SVTs usually turn off and on like a switch from what I gather. Sometime there is an argumant among even the best cardio and EPs as to what type the tachycardia truly is.Most people experience some type SVT at sometime, some are not aware them.It usually depends on if it occurs often , how long it last, can it be controlled with manuevers, what symtoms (symptoms) are present ,if any at all, that leads to treatment. Identifiable WPW, AVNRT and AVRT are usually treated with RF ablation, persons that are candidates for this procedure usually have significant symptoms or in persons with WPW that are considered at a risk.This is my understanding only , I'm not a medical doctor.
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Avatar_f_tn
in a short answer, yes they can be misdiagnosed, but it depends on the setting.. on an EKG any rate above 160 is automatically stated to be SVT. It takes a trained eye to look at the waves and tell if its a normal sinus pattern or if its actually abnormal.
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Avatar_n_tn
I was in the hospital on Sept 21 with a fast heart rate and my blood pressure was very high for me. I am 33 and I'll never forget the nurses  scared look when they came in the intensive care unit-the look that they thought I was going to go into cardic arrest. Since then I have seen every doctor cardiologist to electro doctor-The thing that happened to me is-a year ago my fast heart threw a clot one night-it almost killed me. My doctor believes it is hormonal with me-many women have this problem where the estrogen drops during certain times of the month. It can make the heart "skip a beat" beat fast...So now they are going to do a EP on me. I just notice in one of the blogs before me the cost..yikes!!  I don't believe that most rapid heart-rates throw a clot but for some reason that night it happened to me. It's great to find this site and know that I'm not alone in this!!!!!
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Avatar_n_tn
From what I've read, SVT is always about the "sudden onset of rapid heartbeat" which is why I don't think I have SVT. I had a friend who had clear symptoms of SVT - his heart just starts beating around 160 bps after a beat and it would last for a few minutes then it'll stop suddenly. I would definitely freak out if it happened to me. For him, it doesn't seem to faze him. He would just sit down and wait for it to pass with no apparent anxiety. I wish I have his attitude!

Mine is definitely sinus tachycardia. It doesn't start suddenly.. it gets faster gradually and it slows down gradually as well.

I also suffer from PVC's... sometimes I have bad days with lots of PVC's and sometimes I have days when I had one or two PVC's. It stresses me and it makes me anxious because it always makes me realize my own mortality. Eeek!

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Avatar_n_tn
So, if high heart is just sinus tach, how high can that go, up to 200?  I'm just wondering how a holter would interpret that as normal?  Thanks, Michelle
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Avatar_f_tn
ive had regular sinus tach up to 220 during exersize..  A holter would not interpret this as normal though, As a rule a holter will diagnose any kind of rate above 160 as SVT or VT.  a physician can look at the actual print out and see If it is an abornmal ryhthm like svt or vt, or just sinus tach
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