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SVT
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SVT

I have been diagnosed with SVT and have some questions regarding that.
1.  What medication would you recommend as the first line of defense for SVT in terms of safety and effectiveness? (I believe I have the AV nodal one.  They have said they don't think it's WPW).
2.  In considering a possible ablation, what are the statistical risks?  (I am a 29 year old now and have been told that other than this, I have a healthy heart). Should I do meds first?
3.  Where in the Northwest would you reccommend having one done?
4.  Several of my ekgs show ST-T changes - "ST-segment depression," "diffuse ST-T abnormalities," "inferior and lateral ST-T changes," "extensive ST-T changes," "ST-T changes in inferior leads."  My doctors have said that in my case this probably isn't significant.  What does it mean?  Am I out of shape?
5.Before my last episode of SVT, my heart seemed to stop and start several times and roll, and then when I converted through a valsalva maneuver, it did the same, feels like it may quit.  What do you think?  Thank you so much for your time!
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Dear Kris,

Supraventricular tachycardia (SVT) refers to a variety of conditions.  Basically what it means is a fast heart beat originating from the upper chamber and includes:  paroxysmal supraventricular tachycardia (PSVT), atrial flutter, atrial fibrillation, WPW and AV nodal tachycardia.

The treatment of SVT depends on what type of SVT it is.  PSVT is often treated with a catheter ablation but may be treated medically as well.  Atrial flutter is almost always treated with ablation now days.  Atrial fibrillation is usually treated with medications but may sometimes be treated with certain surgical and interventional methods.  AV nodal tachycardia can also be treated with ablation.  It may not be possible to tell which type of SVT on has from surface ECG recordings and if that is the case a special type of study called an electrophysiology study is performed.

Sinus tachycardia is defined as a heart rate of greater than 100 beats per minute originating from the sinus node.  Sinus tachycardia is classified as either appropriate or inappropriate.  There are many causes of appropriate sinus tachycardia such as exercise, anxiety, panic attacks, dehydration, deconditioning, volume loss due to bleeding or other loss of body fluids, hyperthyroidism, electrolyte abnormalities and many other conditions.

Inappropriate sinus tachycardia can only be diagnosed when all causes of appropriate sinus tachycardia have been ruled out.  It is not clear what causes inappropriate sinus tachycardia but possible etiologies are an increase in the rate at which the sinus node depolarizes and an increased sensitivity to adrenaline.  Once the diagnosis has been made by ruling out all of the potential causes of appropriate sinus tachycardia  there are several treatment options.  If the symptoms are not overly concerning no treatment needs to be done.  There is no increase in morbidity or mortality in persons with this condition and they can expect to have a normal life-span.  For persons in whom the symptoms are unbearable medications such as beta blockers or calcium channel blockers can be used, usually with good results.  In the rare person unable to tolerate medical treatment catheter ablation (burning) of the sinus node with insertion of a pacemaker or surgical removal of the sinus node have been used in the past.  Newer techniques are being developed using catheter ablation to modify and not destroy the sinus node thus avoiding the need for a pacemaker.

I've tried to answer your specific questions below.

1. What medication would you recommend as the first line of defense for SVT in terms of safety and effectiveness? (I believe I have the AV nodal one. They have said they don't think it's WPW).
A: It would depend but probably a first line drug would be a calcium channel blocker such as diltiazem or a beta-blocker.  If these were not effective an antiarrhythmic drug such as flecanide could be tried.

2. In considering a possible ablation, what are the statistical risks? (I am a 29 year old now and have been told that other than this, I have a healthy heart). Should I do meds first?
A: Ablation is a pretty safe procedure with the risk of serious complication less than 1%.  The decision to try meds first or not is up to you and your doctor.  Personally I would prefer an ablation to taking long-term medications.

3. Where in the Northwest would you reccommend having one done?
A: Probably at OHSU in Portland or U of W in Seattle.

4. Several of my ekgs show ST-T changes - "ST-segment depression," "diffuse ST-T abnormalities," "inferior and     lateral ST-T changes," "extensive ST-T changes," "ST-T changes in inferior leads." My doctors have said that in my case this probably isn't significant. What does it mean? Am I out of shape?
A: Most likely this is not significant and not an indication that you are out of shape.  It may be related to your SVT.

5.Before my last episode of SVT, my heart seemed to stop and start several times and roll, and then when I converted through a valsalva maneuver, it did the same, feels like it may quit. What do you think?
A: It is normal to have what is called a 'compensatory pause" following a fast rhythm and this is probably what you felt.


4 Comments
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Avatar_n_tn
Hi Kris,
I get that same feeling (as though my heart stops/pauses prior to beating really fast for about 15 seconds then again when it converts back to normal.  My doctor doesn't seemed worried.  My pause is long enough for me to think it won't start again.  Is that the feeling you get?  (at least 3 or 4 seconds) - good luck
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Avatar_n_tn
Hey Kris,
I can definitely relate. I am a 26 y/o male, I have had SVT since I was 3. It was treated with meds (Inderal & Lanoxin) until I was about 15, when I went off the meds. I had some minor episodes, but nothing severe until about eight months ago.
I had the exact same sensation you described, I describe it as kind of like a very exaggerated skip, or two. This may be a-fib.
I have been told that a-fib can be a pre-cursor to SVT. Anyway, I knew it was a bad one, so I went to the ER. My pulse was 230 bpm. It sustained for about 30 minutes, when they finally converted it with adenosine. I went back to the Doctors who treated me as a child, and they explained the EP/Ablation practice to me. This procedure was not available when I had come off the meds, and I had not seen a MD for my heart since. I have been on Atenolol since the episode, they started me on 50 mil once a day, but I was having rebound sympoms at night, so I have benn taking 50 mil twice daily for about three months. This is very effective at controlling the tach, but it sometimes causes slow heart beat, tiredness and depression. I do still have skips but no tach since then. I have not yet decided wether or not to have the study done. I am not in the greatest shape, and the atenolol does make it dificult to excercise hard, so I may try to cut down on the dose.
Anyway, good luck.
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Avatar_n_tn
Hi Aaron.  I just read your comments to Kris, and I am a 27 year old who just had the ablation done 2 days ago.  Thought you might want to know what I experienced.  It really wasn't bad.  I opted for general anesthesia, because sometimes people who are heavily sedated start moving their arms and legs around after being on the table a while, and that seemed more risky to me.  My surgery took about 3.5 hours, and I have a <2% chance of recurrence.  The entrance site for one of the catheters is very sore today because they had to enter an artery due to my pathway location.  I have a pretty enormous bruise there right now.  Also they had to use the defibrillating paddles on me twice during the surgery, so I woke up with a rectangular burn on my left breast area, and one on my back.  Surprisingly though, they dont hurt... they just itch like crazy. Anyways, I've been home since yesterday, and other than a nasty back ache from having to lay still so long, I have no pain whatsoever.  I highly recommend going for it if you are healthy enough to.  I am so glad to get rid of PSVT for good.
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