SVT and ablation on child

[cathy756]

Hi, Thank you for taking my questions. My 11 year old son was diagnosed approximately 2 years ago with SVT (common re-entry type).  For at least 18 months he had been controlled with 25 mg atenolol. His weight now is 71 lbs. approx. 10 lbs. more than 2 years ago. A few months ago he began to experience breakthroughs and his cardiologist increased the dosage to 37 ½ mg.  On September 3, 2006 he experienced an episode, which we were unable to break and  resulted in an ER visit where they administered 3 pushes of adenosine, 1 at  3 cc followed by 2 at  6 cc which did not work. His heart rate was 240 beats/min.  He was given verapamil, unknown dosage, in an IV drip over 15 minutes.  This broke it but it returned in a half hour later to a lesser rapid heart rate (160 beats/min).   They gave him another push of adenosine but it did not break it.  Another dose of verapamil in the IV followed by an oral dose of verapamil broke the tachycardia.  The total time frame of all this spanned 3 ½ hours.  He stayed over night in the hospital and was released the next day at 5 pm. He was to continue with 37 ½ mg atenalol once daily and 40mg verapamil q3d.  Follow up with his cardiologist, 4 days later revealed too slow a heart rate.  His verapamil was decreased to 20mg q3d.  The decision to do a heart ablation was made.  Even on all those medications, he had a break though while waiting for the scheduled ablation.  Four days prior to the ablation, all meds were stopped.  He had no tachycardia episodes.  On September 25, 2006 he had the 4 hour ablation procedure, under general anesthesia, done at Morgan Stanley Children’s Hospital at Columbia-Presbyterian.  The Dr.’s were hopefully optimistic that they got it.  They said it was hard to illicit the tachycardia during the procedure but did find it and ablated it several times. The Dr. said that in the end he could not get the heart to race but was unsure he got it all since it was hard to cause the tachycardia in the first place. He was released the following day.  Over the next couple of days he had experienced some heart fluttering. Ultimately he had several episodes of tachycardia which prompted his cardiologist to place him on verapamil 40 mg q3d.  This is where we stand now.  A follow up at the cardiologist will be in a few days where we will discuss some more treatment options.  We are disappointed that it did not work and concerned what we can do in the future.  My son is a very active, sports minded child and wants to be able to participate competitively.  We are unsure what to do now.  We would like your thoughts on what to do now.

[CCF-M.D.-MJM]

Hi Cathy,

I realize these can be very frightening events, especially when it happens to members of your family.  These are almost always problems that can be fixed with ablation.  Without seeing the records it is difficult to say what type reentry it is and what the fix is.  Dr. Rick Sterba is the pediatric electrophysiology at the Cleveland Clinic and would be happy to help you if you come here.  There are many other experienced centers it the country that can help, including Columbia Presbyterian.  It is always worth obtaining a second opinion, but if you do this bring the records of the first ablation with you.

We usually do our ablations with people awake (with sedation) because it is often easier to induce the arrhythmia when people aren't too sedated.  That might be the next approach.  I wouldn't be that concerned that they didn't get it the first time, we occassionally have similar experiences.

I hope this helps.  Good luck and thanks for posting.

[CollegeGirl143]

Was the tachycardia svt? or just sinus tach??? Sinus tach is not uncommon after ablation, and PVC's and PAC's are very common in the first 6-8 weeks following ablation. I had both myself after my ablation. The important thing is to find out what type of tachycardia he was having post procedure.

[KarenSA]

Hi Cathy
Thought I would share my ablation experience with you as it may be of interest to you.  This is not to say your son is the same, it is just my personal experience.
Had an ablation for slow AVNRT and Atrial Ectopic Tachycardia on Oct 11 2005.  My EP had warned me prior to the procedure that I may experience worse symptoms in the immediate +/-6 weeks after the procedure due to inflammation in the heart around the burn sites.  I did experience a racing heart, the first event just 4 days later and thereafter quite regularly. It felt like the AVNRT was running sometimes and also the Atrial Tach, this lasted a few months and I was thinking I needed a second procedure.  I also suffered shortness of breath which lasted some months, especially on a very hot day.  
After about 6 months, I realised that my heart had not raced for some time and as of today, 12 months post ablation, it has a calm rhythm, seldom over 80 beats/minute.  I still get PVC's and PAC's which were not targeted in the ablation.
I read an EP study which advised that some patients may have similar symptoms to that which they had before the procedure for some time after the procedure and then eventually they may stabilise.  
Like I said, this is just my experience.  Tachycardia ablations have a very high success rate but some people do need a second ablation.  Good luck with your son, be patient and positive and make sure you have a good EP. Best Regards Karen