Short-run VT

[Dreamer Ho]

I am 27 years old lady and got heart diseases in 1997.  I have undergone EPS and cannot find the focus for mapping for ablation.  The diagnosis is stated as ¡§Right Ventricular Outflow Track ¡V Short Run VT¡¨.  However, after consulting with other cardiac specialist, he finds my situation is ¡§Left Ventricular Outflow Track ¡V Short Run VT¡¨ according to his experience.  I known that this situation is so rare and not many cases worldwide until now.

I have undergone MRI and Ultrasound, the heart structure is normal.  Also, there is no problem even in exercise stress test.  Now, I take Tambocor Flecainide Acetate 100mg twice a day (morning and night) and the VT can be controlled.  There is no VT found again in 24 hours holter under medicine treatment.  However, VT appears again recently, so would you please advise me the following:

1. why the VT will appear again under the medicine treatment?

2. any surgery can be done for my situation and the difficulty is high?

3. can increase the drug level (my weight is around 110 lbs)?

4. any danger if I do not increase the drug level and do not undergo any surgery?

Thanks a lot for your professional advice.

[CCF-M.D.-MJM]

Hello,

This is a very interesting question.

1. Why the VT will appear again under the medicine treatment?
Medications do not cure you from the VT, it simply suppresses the VT.  There is no exact science to picking medical therapy, it often is trial and error for what works and what doesn't work.

2. Any surgery can be done for my situation and the difficulty is high?
This may be a technical point, but I want to make sure we are on the same page.  Ablations are considered procedures rather than surgeries.  In the old days, ablations were open heart surgical procedures.  Fortunately those days are gone.  The recovery time is much faster for our current bedside ablation procedures.  

This a difficult question with out seeing what has been done in the past and I do not want to second guess your current doctors, especially having not seen what they have tried.  There are certain centers that have more experience with VT ablations.  If you are truly experience enough symptoms to pursue this, I would go to a high volume center like the Cleveland Clinic, University of Pennsylvania, or Brigham Womens in Boston.  This is by all means not an all-inclusive list, but these are three very good centers.

3. Can increase the drug level (my weight is around 110 lbs)?
Flecainide is not followed by drug levels.  The dosage is usually pretty standard.  You doctor may consider trying another drug if the flecainide is not working.


4. any danger if I do not increase the drug level and do not undergo any surgery?
RVOT VT is not usually a life threatening condition in a young person with a structurally normal heart.  Make sure you work with your doctor in adjusting your medication dosages.  If the symptoms are at all limiting, I would consider obtaining a second opinion regarding the ablation.

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

[nurse12hr]

Please be sure when you are diagnosing someone and suggesting a course of action to follow, that you let them know you are NOT a physician.  Some people new to this site and to the Med Help process may not understand that you are a lay person.
--------------------------------------------------------------

"I guess you have what is known as idiopathic normal heart VT, either arisng from the left or right ventricular outflow tract."

"even though verapamil is contraindicated in most cases of VT, I am made to understand that is has been effective in suppressing these VTs".

"another Ep study and possible ablation might be successful if it becomes very frequent."

[VTBen]

I saw the statement, RVOT VT is not "usually" life threatening in a young person.  I thought that studies have shown that a person with idiopathic RVOT VT have the same life expectancy as the normal population.  I have RVOT Vt and felt pretty good about my chance of dying.  Does the prognosis get worse as a person gets old?

If you have the time, clarification would be nice.

Thanks

[Dreamer Ho]

Thanks for your professional advice.  Since I do not have such knowledge, so would you please give me more information for reference.

(1) There are any proves that the drug effect will be reduced if one person takes it for a long time?

(2) Is it a rare case if the VT is arising from the left ventricular outflow track?

(3) The difficulty and technique of the current ablation procedures for the LVOT VT is higher than RVOT-VT?

[CCF-M.D.-MJM]

V-ben, I used the word "usually" very loosely there.  You are correct and should have no additional concerns.

Dreamer Ho
2. (1) There are any proves that the drug effect will be reduced if one person takes it for a long time?
No.  But this is a difficult question though.  The drug effects stays the same, but the way your heart conducts signals may change over time, thus affecting the drug works on you.  This doesn't happen to everyone and there is no prospective way to predict who or when this may happen.  Electrophysiology is not an exact sciences, as many of you already know. We are still trying to figure this stuff out.

2) Is it a rare case if the VT is arising from the left ventricular outflow track?
Yes.

(3) The difficulty and technique of the current ablation procedures for the LVOT VT is higher than RVOT-VT?
Yes.  LVOT VT involves accessing arterial circulation.  The blood moves much faster in the left side of the heart and the catheter is more diffcult to place.  Sometimes these reentry circuits are not accessable from the inside of the heart and catheters need to approach the heart through the chest wall or sometimes through the aorta.  I will paste an abstract from a case here at the Cleveland Clinic.  Not all centers use the epicardial (outside of the heart) approach if the endocardial (inside the heart) approach doesn't work.  Some circuits are located outside the heart.

Hope this clears it up.

[CCF-M.D.-MJM]

Card Electrophysiol Rev. 2002 Dec;6(4):442-7.
  
Evaluation and management of ventricular outflow tract tachycardias.

Cole CR, Marrouche NF, Natale A.

Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

Ventricular tachycardia (VT) arising from the right or left ventricular outflow tract (OT) is a recognized arrhythmia in individuals with structurally normal hearts. Treatment options for OTVT include medications, ablation and, rarely, an implantable cardioverter defibrillator (ICD). In the past few years ablation techniques have developed to the point where most OTVTs can be successfully ablated. However, a percentage of cases have remained where ablation is unsuccessful. Some of these cases may represent an epicardial focus of the VT. Several approaches to epicardial VT ablation have been described. We recently described a LVOT-VT variant, which may be epicardial in nature, in a group of patients in whom prior ablation attempts had failed. A trans-aortic ablation approach to outflow tract VT was successful in these patients.

[wmac]

Im sorry but did you say that you have heart disease? I understood you saying you got heart disesase in 1997, is this correct?

[bigmick]

.

[bigmick]

Hey there my friend: hope you're in good health and enjoying that Carribean vibe!

I recently posted to another thread initiated by WPWGuy (re. concealed Accessory Pathways) the following:

"I somtimes get runs of palps (daytime & always at rest) as follows: a fast regular beat of 180-ish for a few seconds followed by a couple of heavy thuds interspersed with longish pauses, followed by a few more secs of the fast regular beat, then the whole thing resolves itself with a pause and THUMP.... and NSR. I have had 5 episodes of AF during the last 5 yrs too - all nocturnal, a few hrs duration, and self-converting with no meds. Interestingly, and bearing in mind the aforementioned, on the one occasion when I awoke to find myself going into AF (as opposed to awaking fully in it), I noticed that my heart was switching between 5 to 10-ish second periods of a fast regular rhythym and AF before finally (after 30-40 seconds or so) settling into AF. Almost as if the AF was kinda forced/propelled into being by the fast regular rhythym. I really do wonder just how many folks out there (like me) who get such runs of palps actually do so owing to the existence of a CAP??"

I don't know if you saw my post as above, but I would be most interested to know what you think.............

BM

[CraigAAA]

I could'nt agree with you more there Pluto,

I've had to go 'around the houses' so to speak because in initial opinion from my local doctor (not Cardiologist) he concluded that I have an Anxiety disorder which in turn is causing my arrythmia (frequent PVC's, bigeminy)

And as the saying goes 'mud sticks'.

Suffice to say I have since seen phycologists who determined that I do not have an Anxiety disorder, and the anxiety in my life is almost certainly derived from the arrythmia and all things associated with it.

Of course thats not to say Anxiety doesnt play a part in my, and many other cases, but it seems very easy for a Doctor to label a person with it, when a more detailed objective approach from the offset could pay dividens later on.

I lost about a year of prgogressively more frequent PVC's before I even got near a Cardiologist. Dont get me wrong I have the highest regard for Doctors. Just seems some are more 'on the ball' than others.

Regards

Craig

[Tommygun]

You folks are right on the money. My anxiety is 100% focused on something going terribly wrong with my heart rhythm, and the reason it's on my mind in the first place is because of my frequent PVCs. For those unfamiliar with my situation, I posted a question back on July 8th, I believe. My EP informed me it is his opinion that I in fact have RVOT VT...without the VT. In other words the focus that is causing my 6900 PVCs per day is in fact a trigger for VT that has only caused VT a handful of times in me, and for very short periods of time (lasting a few seconds). Because of this I am having RFA in a week and a half and hope to be free and rid of this affliction _finally_. The pain it has caused me through worry, anxiety and panic attacks is incalculable.

[bigmick]

Hi there,

Thanks for the additional input.

*The question I was really trying to ask you above was what do you think the regular accelerated rhythym/arrythmia is that seems to kinda lead to AF in my case?

*Can a run of PACs be regular and fast? Or is it likely to be flutter?

I guess I'm really wondering whether a CAP can lead to SVT whether it be AFlutter of AFib. However, my last Holter 24hr evaluation also showed multifocal PVCs. My cardio/EP did not say how many focuses there are in my ventricles (I also get PACs too), but I'm assuming it may be two or three. He certainly didn't seem concerned: when I asked jokingly (but nonetheless a little anxiously) if I'd 'see' 70 yrs of age, he laughed and said maybe not......... but that it would likely not be my heart that would be the cause of my demise! My older Holters done say 10 yrs ago showed only unifocal PVCs, so I guess things have changed a little.

*Thing is, could someone have multifocal PVCs and a CAP where the two were inter-related??

*Or would the PVCs HAVE to be unifocal where a CAP was involved?

*Or does PVC activity resulting from a CAP have no focus as such in the 'normal' sense?

*Is a Holter even accurate enough for a cardio to know whether the PVCs are occurring as a result of a CAP OR as a result of a focus (or two) elsewhere in the ventricles? (Wow, this stuff sure is complex to get one's head around).

*Is there any typical limit to the number of ventricular focuses one can have??

Hope you don't mind all my questions, and I appreciate you are not a doc yourself. Nonetheless, I sure would (as ever)appreciate your valued input as regards my above points. Also anyone else, please feel free to wade in with your cents' worth!

Cheers folks,

Mick

[Intern]

I'd thought it was very obvious, since the warning in purple was added, that comments below this line were not from the CCF Doctors and only personal opinions.

Best

[Momto3]

I'm with you guys on the anxiety issue!  Been there...done that!! I guess it's like the chicken and the egg...lol

Tommygun,

Good luck with your upcoming ablation! I had RVOT-VT (but, not "true" VT (same thing as you, only very short episodes) and it was successfully ablated last year. In November, I had a second ablation for LVOT which was also successufl! Hope the same goes for you. Keeping my fingers crossed for you!

Dreamer,

My LVOT problem was initially thought to be another RVOT foci, but once the doctors mapped the activity....lo and behold, it was a late LVOT. They did have to enter the femoral artery and cross over the aorta, but it worked! Good luck with whatever you and your doctor decide.

Connie

[Dreamer Ho]

Doctor
Thanks for your detail reply and the useful abstract.  I would also like to consult you for the following, please.

1. Can I get pregency if I still have LVOT - VT (short-run VT)?
2. Will it inherit to my baby with the high possibility?
3. Any figures on the safety for the "Tambocor Flecainide Acetate" to be taken by a pregnant woman?
4. Further to your posting abstract, would you please tell me what is "trans-aortic ablation"?

Thanks again for your kindly effort.


wmac
Yes, I discovered this disease in 1997.


momto3
I'm so happy to know that u have mapped successfully.  The feeling of the albation is fine? Any side-effect after the albation?  Would you please tell me more details.  Thanks a lot.

[bigmick]

Pluto,

Thanks very much for the additional and most helpful input - it is much appreciated my friend.

Konopka,

Wow, what has Pluto ever done to you?? OK, I know he's not a Doc, but hey, the first cardio I saw further to having a few PVCs on a Holter (yes, I was VERY anxious - diagnosed with GAD for many yrs now) wanted me on Flecainide full time..... no thanks doc. When I had my first episode of AF 5 yrs ago, the same cardio wanted me on amiodarone stright away..... and gave me digoxin for my clearly vagal AF....... err thanks doc... but NO to the amiodarone!! Although I do greatly respect and appreciate the input and service from the Docsa here on this forum, I'm REAL glad that I do my own research rather than rely on the opinion of 'expert' medical advice from many died-in-the-wool one-solution-fits-all drug-you-up docs here in the UK.

I accordingly greatly appreciate - as do many others here - Pluto's input. He's clearly and educated and intelligent individual who has thoroughly researched (more than most cardios have time to I'd bet) the subject of arrythmias, with his diligence in this regard being to no small extent fuelled by by his own intrinsic anxiety and neurosis about his own arrythymias! (No offence or disrespect intended Pluto, but I'm sure you know that.) BTW and FWIW, I myself have a PhD and do not suffer fools gladly.

Mick

[BigBoy2u]

I guess the fact that is an open forum is what makes this so great.  It’s also what allows Pluto to leave his valuable comments.  Unfortunately it’s also the same privilege that allows you to make your less than informational and typically sarcastic posts.  Since October when I developed my first episode of NSVT it was Pluto’s posts that have greatly helped me deal with it.  It’s been Pluto’s posts that have helped me understand the meds, the anxiety and everything else we all seem to go through.  In these last months I have read many posts by Pluto on a daily basis.  He is very informed and knowledgeable, as we all know.  He states over an over he isn’t a doctor and really doesn’t try to be one however, he has explained more talked more and told me more than my 4 Dr’s combined.  This includes my GP, Cardio doc, EP doc and an ER doc.  But in relationship to your post about Pluto well quite frankly I have seen nothing that comes from your posts on this forum that have any value.  So you don’t like his opinions and I don’t like yours, but until today I never said anything.  You seem to have an axe to grind with most everyone on here and mostly target Pluto.  Sure you can have your opinion but I rather see someone like Pluto share his educated opinion with us and not stop/slow down because you choose to flame him.  I read this board everyday and find it very educational.  I have yet to find any of your posts educational but only full of sarcasm to others and patting yourself on your back for getting a second opinion and doing more research than your own doctor.  I am sure you have anxiety when you get shocked but at least you know you have an ICD that is going to kick in if you need it.  I don’t, I didn’t qualify to get one.  That doesn’t mean when I get PVC or PAC’s I don’t get anxiety bad and think, “oh **** this is it”.  Maybe my anxiety is less, more or equal to yours I have no idea…or do you.  I can only say I have it, so can you.  You can’t measure it, quantify it or share it.  So realize, it maybe the same, worse or less than anyone else.  That’s how it goes, same with pain.  If you’re in pain I can’t relate and can only assume it’s as bad as that type of pain I have felt before.  But I really don’t see where you get the nerve to flame someone who clearly the only intention is to help others when your clear intention on this forum is to beat your own drum about your own problems and how wonderful you think you are.  You know you create more anxiety on this board than is necessary.  Most of the time anxiety kills (ruins your life) for most of us more than anything else and hearing over and over PAC’s and PVC’s wont kill you is a GOOD thing.  But then you post about how you read someplace it’s a precursor for this or that and they might kill you.  Well I know someone someplace died from a PVC or a PAC and you know what…people that are “normal” just drop dead from sudden cardiac death syndrome everyday.  With no preexisting condition at all and people have aneurysms and a whole host of things that can kill you at anytime.  For no apparent reason it happens. Period.  But for those of us that haven’t died yet and live with the PVC/PAC’s daily I rather be told…matter of fact lied to that it wouldn’t kill me.  Why? Because I don’t want to spend the rest of my life worrying that the next PVC/PAC “might” kill me because the odds are it wont…. ever…and we need to hear this often…at least I do.  I try to get past the anxiety and not live in fear and you only help promote fear in people on here.  We all know anyone can die at anytime for any reason but the PAC/PVC’s and arrhythmias is a constant reminder.  That is what makes this so much more different that anything else you can have wrong with you. It can just come out of the blue.  There are not many conditions that can create so much anxiety that you can literally feel.  So my sympathy, compassion and understanding go out to those who suffer with PCA/PVC’s and arrhythmias that give them distress, yours should too since you truly know what its like.

[Rocko1]

I certainly hope that Pluto does not stop posting because of those rude remarks. I take offense in the fact that she doesnt think I have the intelligence to discern the difference in a comment and a diagnosis....

[jkf]

I normally just read this forum and rarely place comments.  However your message to Pluto drove me to take time out of my busy day to respond.  I will make this short.  You don't deserve my time.  It is clear to me why you must be shocked as much as you have been.  You are a very angry human being.  

regards

[bigmick]

Mmmmmm..... Well I guess ya sure can't please ALL the people ALL the time!!!!

Best Regards to ALL of my twitchy-tickered fellows here on this excellent forum!

Mick

[Dreamer Ho]

Doctor
Thanks for your detail reply and the useful abstract. I would also like to consult you for the following, please.

1. Can I get pregency if I still have LVOT - VT (short-run VT)?
2. Will it inherit to my baby with the high possibility?
3. Any figures on the safety for the "Tambocor Flecainide Acetate" to be taken by a pregnant woman?
4. Further to your posting abstract, would you please tell me what is "trans-aortic ablation"?

Thanks again for your kindly effort.


wmac
Yes, I discovered this disease in 1997.


momto3
I'm so happy to know that u have mapped successfully. The feeling of the albation is fine? Any side-effect after the albation? Would you please tell me more details. Thanks a lot.

[Dreamer Ho]

Doctor
Thanks for your detail reply and the useful abstract. I would also like to consult you for the following, please.

1. Can I get pregency if I still have LVOT - VT (short-run VT)?
2. Will it inherit to my baby with the high possibility?
3. Any figures on the safety for the "Tambocor Flecainide Acetate" to be taken by a pregnant woman?
4. Further to your posting abstract, would you please tell me what is "trans-aortic ablation"?

Thanks again for your kindly effort.


wmac
Yes, I discovered this disease in 1997.


momto3
I'm so happy to know that u have mapped successfully. The feeling of the albation is fine? Any side-effect after the albation? Would you please tell me more details. Thanks a lot.

[Momto3]

Dreamer,

Sorry I missed your follow-up question...Anyway, the ablation procedures went very well -- no complications, no pain. The only uncomfortable part (for me) was when they applied pressure to the entry sites after the procedure. They do that to prevent bleeding problems. The first time, the doctor applied manual pressure which I kind of remember as being a little uncomfortable for a couple of minutes (they had me on IV meds to keep me comfortable). The second time, because they entered the femoral artery, they used a "plug" of some sort. I do remember that being a little uncomfortable. As far as the procedures themselves - I don't remember ANY pain or discomfort.

The only "side-effects" of the procedures were that my leg was a bit sore from all the entry sites and the probing.  Because they were in and around the heart, some of the pvcs continued for a few weeks. Other than that, no side effects.

Hope that helps.  

connie

[Dreamer Ho]

Connie
Then will the ablation cause the body inside feel hot for a while, and have anaesthetist  makes u sleep during the whole process? Thanks.

[wmac]

I also have nsvt, can you please tell me alittle bit about yours? if we run out of room on this post you can email me at ***@****
I live with this everyday of my life and also aivr (acclerated idioventriular rhythm) it sucks.
To pluto, some of us still love you and alot of us still value your opinion! Please dont stop posting just ignore those mean people.  Your my salvation!
wmac

[Momto3]

I did not feel anything during the procedure.  Anesthesia kept me comfortable throughout the entire procedure.

[ADrocks]

I used to really enjoy this forum, but stopped for the same reasons you did. I pop in rarely now and wanted to support your comments. Hankstar, flipflop, Erik without the doctor, pluto and I'm sure others, has con't to practice medicine without a lisence. I agree that the network of posters in that group should con't their conversations via personal e-mail.

[bigmick]

Hey Pluto,

If you get pi$$ed off with posting to this forum - and I wouldn't blame you if you did - then please let me have your e-mail address so we can continue to natter off forum. I enjoy your input and, furthermore, your views and opinions always closely accord with my own thorough and scholarly researches into common arrythymias.

Kind regards,

Mick.

[416340]

I'm a 24 year old female who has been diagnosed with RVOT VT with about 25,000 PVC's a day. Over the past year, I tried living with this, but my episodes started becoming more frequent and more intolerable (dizzyness, extreme fatigue, palpitations, chest pain).  For the past few weeks, i have been taking a beta blocker (Sotolol) and so far it's been very effective.  However, i am concerned about the long term side effects of beta blockers and am debating if i should get ablation done.  Has anyone here choosen ablation even when the beta blockers were working? Thanks!