SVT now A-Fib

[Sue143]

I'm 37 yrs old with SVT for almost 7 yrs, and I haven't had to go to the ER for it for over 6 yrs. Had all the monitors and tests. My heart is strucually normal and all the blood work ok. I ended up at the ER recently with a-fib and had to be put on a Cardizem drip to convert my heart rate which was 160-180. They had given me 3 doses of the other meds that usually stopped the SVT, but had no effect. The Cardizem controlled it in about a half hour or so. The Dr. said SVT and a-fib is like having 2 different cows from the same country. He put me on Toprol XL 25mg (I only weigh 105 lbs.) to see how I reacted to it. This is the first time I've ever taken any meds for this and now that I've taken it for a few days, I've noticed an increase in palpitations. Can the Toprol do this?
My other questions are
1. If I had ablation, can they fix the SVT and a-fib at the same time
2. How common is it to get a-fib when you have SVT
3. Now that I had a-fib am I more likely to get it again and how dangerous is it compared to SVT? I've been able to live with the SVT without letting the daily palpitations and occasional bouts of tachy. bother me, but I'm now concerned about the a-fib. Everytime I have a palpitation I worry it will turn into a-fib. I'm even afraid to go on vacation because I'm afraid it will happen again.

Thanks, Sue

[Maria77]

I was totally terrified about having an ablation.  I really was.  But it went much easier than I had thought possible.  The EP study and the ablation took a total of 3 hours.  However, I had IV sedation so even though I wasn't totally put to sleep, I may as well have been. lol  The 3 hours felt like a total of about 5 minutes.  

And yes, thankfully they were able to kickstart my arrhythmia.  I would have been awfully disappointed if they hadn't been able to get it going (and then, of course, ablate it).  

And yes, I certainly still get palpitations.  I was told that the ablation would cure my arrhythmia (I would get a very rapid heart rate that lasted for 40 min. last time).....but that I should still expect to get palpitations, thuds, etc.  The EP said most people get palpitations, not just people with arrhythmias.

AS for side affects after the ablation, I had many many palpitations on the 3rd day after the ablation, but then they gradually lessened.  Also, I had a wicked bruise in the groin area for a couple weeks afterwards.  

All in all, I feel things went very well, and I would not hesitate to have it done again.

[Sue143]

I don't know what kind I have yet, I go to my Cardio. on Tues. I'm going to ask to see an electrophysiologist. I'm worried about how small I am with a catheter. My aunt couldn't have an angioplasty done because her arteries were too small. My arms are very tiny and they always have trouble drawing blood from my left arm and use a very small needle for the right.

Maria, Do you have any side affects from the ablation? How long did it take? Have you had any palpitations since? The only surgery I ever had was a D&C. The thought of them putting my heart into an arrhythmia on purpose really frightens me. But so does living with it.

Thank you both, Sue

[Maria77]

Sue - I don't have WPW, but have AV nodel re-entry tachycardia (for many years).  Last month I had an ablation done and so far, so good.  I suppose there is a small risk involved with any procedure, and even though I was scared s**tless of having the procedure done, I just reminded myself of the possible risks of 'not' having it done, or the risks involved when someone takes medication for the rest of his/her life.

I have happy that I had the procedure done, and certainly have my fingers crossed that I will be arrhythmia free for the rest of my life.  Wow......that would be so wonderful.  

p.s. Don't quote me on this, but I recall reading somewhere that the success rate for ablations on AVNRT and WPW is approx. 95%.  

p.s. There is also a fairly active messageboard at heartcenteronline.com .

[Linda123]

As far as I know ablation is very effective for WPW (Wolfe Parkinson White)and well worth the small risk.  
Best Wishes

[Sue143]

Thanks to everyone who wrote, I've learned alot. Arthur you're a wealth of information. The Dr. told me about WPW SVT's. Can anyone tell me what WPW stands for? Does anyone know if it's more risky to get an ablation or to live with the arrhythmia's? I'm really concerned about undergoing an ablation if I don't have to since I have two small children. How risky is it really? I also keep reading about people who have problems after their ablations and I don't want to make it worse than it is.

Thanks, Sue

[arthur]

There's some research going on to figure out what exactly changes to allow PACs and such to surface.  Cardiac tissue is made up of two types of cells, structural/muscular and electrical.  Together, they make up the overall structure of the heart and the so-called wiring that permits ionic pulses to build up and discharge at the right frequency and go to the right places.  Mother Nature is generally a slob...ie, she relies on natural selection to clean up her act.  This clean up process only occurs if there is a problem that affects survival (evolutionarily speaking)...so, we all end up with hearts that contain electrical cardiac tissue embedded in areas of the heart where only structural cells are really needed.  Since this arrangement does not affect our ability to procreate, we have evolved with these islands (foci) in place.  Most of the time, they are isolated and really don't affect anything.  In some folks, unluckily, they may be located near enough to the normal lines of conduction to produce arrhythmias from early on.  For others, with the passage of time, these foci find ways to send their signals through.  The latest thinking is that through "wear and tear" and perhaps even exercise, the cardiac tissue tends to "stretch" a bit, and tiny passages form which allow new avenues of conduction for those foci.  Thus, once they show up, it's pretty unusual for them to go away.  Ablation is one way we have devised to close up those conduction avenues, essentially to re-isolate the foci.

Note also, that the nervous system surrounding the heart modulates the heart rate, ie, it governs, to an extent, how easily conduction occurs through cardiac tissue.  This same effect also governs how easily foci can send their signals, since they are indeed made of the same cardiac tissue.  So, there's the connection between anxiety and the production of premature beats.  Anything that disturbs (heightens) the nervous system activity around the heart will have this affect.

Of course, these are the opinions of a one person, and should be considered in that light.

-Arthur

[mis123]

What does A-Fib feel like?  I have either PAT or AVNodal
reentry Tachycardia.  But 3 times at least in the past few
years by heart does a flip flop/back and forth motion or it's almost like its quivering.  It's not a normal rythem at all.  I
have a problem where my heart with speed up but this is a normal
rythem.  Usually I hold my breath for a few times and it goes away.
With this weird rythem I can't make it go back to normal until
it's ready.  Luckily it's never lasted more than 5 minutes.  I
actually takes my breath away when it happens.  I start to feel
like I am hyperventilating.  I'm on atenenol 25 mg and my doctor
recommended increasing it but I haven't yet.  Too afraid of
an ablation at this time.  I have small kids and since my
heart always goes back to normal on it's own I have been too
scared yet.

[arthur]

The ablation was conducted at the University of Pennsylvania Hospital in Philadelphia (Dr. Francis Marchlinski).  The procedure involved the initiation of an AFib event (via isoproterenol, an adrenline mimic, infusion), monitoring via catheter electrodes, and eventual ablation via an rf probe.  It took some nine initiations before the focus was identified.  Care was taken to only "burn" the focus responsible in order to minimize possible pulmonary edema (as the focus was in the PV tract leading to the left atrium) and possible clotting complications leading to potential for stroke.  At the time, Marchlinksi's complication rate was 0% (compared with a national average of about 1-2%).  As this was several years ago, the technology may have advanced to allow more complete ablations of all foci these days.

The remaining foci do provide me with occassional PACs, but these are no big deal, regardless of their frequency, since it was the AFib I feared and not PACs.  The PACs before the ablation seemed to occur less frequently, however, seemed also to be on the rise (over a period of a year) commensurate with the increased frequency of lone AFib spells.  Looking back, it seems that the frequency of PACs now and just before the ablation is probably similar.  I don't recall having any PACs at all before the first AFib event...which, of course, begs the question "how or why did they ever start in the first place?"  The answer to that question remains a complete mystery to the medical profession.

Hope this helps,

Arthur

[dande4]

You seem very knowledgable,been doing your research, great!.. Have you come across any information or articles, etc. that had any possible reasons why areas of the heart, the tissue become irritated and start spitting out PAC's? I have often wondered myself why only after 20 years have they started, and when they do cease, what starts it up again. I wonder if something in particular irritates the tissue?

Any comments?

[Dr. Erik]

I'm just curious where did you have your ablation done? And what procedure did they perform on you? Also, did you have the PAC's as often before the alation as you do now?

[arthur]

As I understand it, Afib is not particularly life-threatening, however, because the atria tend not to empty very efficiently, there is a marked increase in the incidence of blood clot formation and subsequent stroke.  Doctors generally prescribe aspirin for younger patients with occassional AFib as an anti-clotting measure.

Afib and PACs are arrhythmias of atrial origin, ie, over-active islands of cardiac tissue (foci) generally located near or in the atria are responsible for generating electrical noise which gets picked up by the pacemaker circuitry and results in a premature beat.  In the case of AFib, other pathways may be present as well, which results in a very irregular heart beat (with the atria firing off rapidly and the ventricles trying to keep up).

If you had but one AFib episode a couple of years ago, I have to believe that it's not a big deal.  However, having said that, the reason your doc gave you the aspirin is because it's possible for you to have short runs of AFib without you being aware (especially while sleeping).  I had pretty much the same thing as you are experiencing, with the minor exception that further short episodes of AFib did occur (about 6 in one year).  I decided on an ablation, which was successful.  PACs still occur ... initially at a rate of about 1-6 per minute for the first year post ablation, and have now (a couple of years later) settled to something like 0-2/min (it's difficult to be precise, since I have stopped paying attention, which btw, is a great way to reduce the frequency of those buggers).

Hope this helps you out and cope with the PACs.

-Arthur

[CCF-M.D.-RCJ]

Sue,

Toprol can lead to increased palpitations in some people.  Most persons experience less palpitations with the drug, however.

(1) Probably not.  The afib ablation procedure is at its beginning stages and takes a long time to perform.  The ablations would need to be staged.

(2) Some types of SVT may lead directly to afib, like an atrial tachycardia.  Other SVTs, like WPW, are associated with afib in a higher number of persons with SVT than in the general population.  In fact, if your SVT is caused by WPW, it would be a good idea to be evaluated at this time for consideration of a WPW ablation procedure.  Many patients find that the afib goes away when the WPW has been cured.

(3) Asking "which is more dangerous, afib or SVT?" is like asking "which is more dangerous, a gorilla or a tiger?"  The answer is "it depends" -- is the gorilla at the zoo or in your living room? Is the tiger a cub?  Are there trees nearby? etc.  (I hope you like my analogy better than the Cow analogy told to you previously -- I frankly don't understand that one.)  Likewise with afib versus SVT, the danger depends on how your body responds to the arrhthymia and the conditions surrounding the arrhythmia.

I would recommend seeing an electrophysiologist at this point.  Medications or an ablation might make sense.

Good luck.

[arthur]

SVT and AF are related, as both are of the same atrially-mediated family of arrhythmias.  AF is disorganized, while SVT is organized.  I would check out possible ablation approaches with your cardio/EP.  As far as I know, lone AF, which sounds like what you had, can repeat with greater frequency with time...ie, it may tend to occur again.  If this is the case, statistics that I am familiar with, suggest that eventually the lone AF becomes a chronic problem (due to the heart remodeling itself).  I also believe that the SVT and AF will have a common focal source, thus making it amenable to ablation, particularly when caught early on (as it may be in your case).

-Arthur

[Dr. Erik]

Arrythmias come in many diferent flavors is what my Cardiologist told me. I have always had PVC's and PAC's. I am only 35 years old. I had a four hour episode of A-Fib in October 2001. I was already on Toprol which is a great medicine for A-Fib and Ectopic beats, although it can make some skis more noticeable. I was put on Cardizem at the hospital and converted back to sinus rythm on my own afer going home. Your episode may or may not signal that more episodes are on the horizon. Lucky for me I haven't had any more sustained episodes. Just a flutter here or there that lasts for a few seconds. If they can find a cause for the episode like low electrolyte  levels or alcohol or caffeine intake, that would be good. If not, then you might have to stay on the Toprol and Cradizem to prevent further attacks. I don't know if an EP would ablate both your arrythmias on one try. May have to do them seperate. Good Luck!

[valger]

Hi everyone, I was just wondering about the A-Fib thing.  I had a short episode, caught on holter moniter, a couple of years ago.  I have lots of PVC's and PAC's, and was going through an especially hard time with them, when the atrial fib occured.  The doctor didn't seem to concerned, and just told me to go on one aspirin a day.  Anyway, I have PVC's and PAC's a real lot now, I have one every few beats or so, and I was wondering if this could lead to atrial fib again, is there a connection between atrial fib and the amount of PVC's that you are getting?  I have to fly to Texas tomorrow and am so nervous that I'll feel terrible while I'm flying, it just makes the anxiety worse about it.  Sometimes mine slow down to about one every 20 beats or so, but usually it's more than that.  I've tried medication, but the ones I've taken had too many side effects, and eventually made the palpitations worse anyway.  The doctors seem to say that the palpitations aren't life threating, so to try to live with them.  Is atrial fib life threating?  Anyway, thanks for all the advice, Val