Swallow Induced SVT

[c-bomb]

Hi.  Back in January of 2004 I was diagnosed with swallowing induced SVT.  I have been on a small amount of Lopressor taken daily (25MG x twice a day) to keep it in check.  The doctors and nurses never could tell me why it developed in the first place.  I have not had the problem since taking the beta blockers.  I have been told that stopping the meds could be a dangerous thing but I can't help but wonder if I still need the beta blockers.  Perhaps my body has healed itself.  Just looking for comments on this.

Thanks

[CCF-M.D.-MJM]

Hello,

Swallowing increases your vagal nerve tone and can lead to arrhythmias -- although not usually dangerous arrhythmias.  If you can find EKGs of the arrhythmia that you had, it might be worth showing them to an electrophysiologist.  It might be an easily ablateable rhythm if it returns.  If the medications suppresses it with few side effects, that is an equally valid option.  Talk to your doctor before you stop the medication, but these rhythms are rarely life threatening.

I hope this helps.  Good luck.

[CollegeGirl143]

i had svt too..(not "swallow" induced svt).. mine was cured by a RF ablation. if the beta blockers are keeping your condition in check and not harming you in any way i wouldnt want to mess with it. i dont think svt is something that heals itself either.

[c-bomb]

Yes,my doctor talked to me about the RF Ablation, but 1. I'm a wimp and 2. The beta blockers keep it from happening and are very cheap.  Like I said, I lived without it happening for 45 years and nobody could answer why it was happening in the first place.  It makes me wonder if whatever underlying condition caused the problem may have went away.  Medicine isn't always an exact science (that's why they call it a practice..lol) and the body sometimes does correct itself.  

Thanks for the input CG!

[joe h]

hope i dont seem to num, but what is swallowing induced svt.

[c-bomb]

"hope i dont seem to num, but what is swallowing induced svt."

Well Joe, I had gone to the doctor when for several days in a row I started getting lightheaded and my heart raced for about 10 seconds everytime I swallowed food.  I could actually feel my heart rate increase even before the food landed in my stomach.  I have a history of stomach ulcers so the doctor was lining me up for the usual tests (upper GI and stuff) and decided to give me an ekg.  After looking at the ekg he told me to head straight to the hospital where he admitted me to the cardio unit.  I spoke with the head nurse and told her my symptoms, which she looked at me and said "I've never heard of that before".  An hour after that my dinner arrived.  I sat up and began eating knowing what was going to happen.  She came running into the room asking if I was ok as the monitor I was wearing showed my heart was racing away.  I said "Yep, that's what I was telling you happened".  My heart was getting up around the 150 BPM range.  Made it through all the tests just fine and was told I have SVT, though they said they don't know why swallowing triggers it.  I had never heard it referred to as "swallowing induced" until I read this forum today.

Sorry so long!

[StephPT]

I can comment directly on swallowing-induced tachycardia, as i had it!  I am surprised that the beta-blockers are working for you, as they didn't for me.  Mine began at the age of 31 (coincidentally, in 2004!), out of nowhere.  initially, i would have good days and bad days, but it progressed to the point that every swallow of food, every swallow of beverage, and every burp would trigger it.  it only lasted a few beats (usually between 2 and 20), but would range anywhere from 160-210 bpm.  i would get lightheaded if i was standing up.

I tried darn near every medication out there, and nothing controlled it. i had two failed attempts at RF ablation locally, and nothing could be done, because the arrhythmia could not be induced with medication...if they put me to sleep (which is routine for this procedure), i wasn't swallowing, and if i wasn't swallowing, it wasn't happening!

The bottom line theories on this are two-fold.  It is either a mechanical stimulation of the esophagus on the heart (meaning the esophagus rubs the atrium of the heart with each swallow, thereby causing the arrhythmia), or it is a vagally mediated arrhythmia (the vagus nerve is involved in both heart function and digestion).  in my case, it was vagally mediated (which is why the beta blockers made it worse...beta blockers have been known to do that with vagal a-fib).  we found this out during the first of two ablation attempts at OUMC (oklahoma) where i was kept awake (not for the faint of heart...it's the longest day of your life) and allowed to swallow a carbonated beverage to induce my own arrhythmia for the purposes of mapping it's location and ablating it.  The doctor had me swallow barium under x-ray, and they clearly saw that the location of my esophagus was nowhere near the focus of the arrhythmia.

To make a long story short, it took two tries to ablate this beast while awake (the first time, they did a focal ablation and it came back in a few hours, indicating they stunned the general location, but didn't burn it completely), and i ended up having a 2 vein PVI (pulmonary vein isolation, an accepted treatment for a-fib), and two ganglionated plexi ablations (which are also thought to play a role in a-fib).  I have been arrhythmia-free for two months now.

This is a frustrating diagnosis.  as of my last literature search, there were only about 50 cases reported worldwide.  No one locally had heard of it, and i had to do a lot of searching on my own.  Even the guy at OUMC (who is regarded as one of the top physicians on the world for treating arrhythmias with ablations) had never seen this before, but was willing to take on my case based on the experience of their lab.  Just prior to my second ablation, there was a journal article printed from a team in Tokyo that had successfully ablated this type of arrhythmia, so that was very encouraging.

Something to keep in mind is that this is a BENIGN arrhythmia by all the accounts i have read.  If the medicine is working for you, then that's all you need.  You CAN get off a beta-blocker, but you need to do it under the direction of your doctor, since it will probably need to be tapered.  In my situation, none of the medicines worked, and it was significantly interfering with my life, so i opted for the ablation. One doctor had told me (and i'm not sure if this is accurate or not) that by having an arrhythmia like this long term, i could have been at an increased risk of developing a-fib earlier in life. I am now undergoing a w/u for esophageal problems, as i have had heartburn since the procedure, and i just wonder if the two aren't related...fix one problem, and create another.

I wish you the best of luck.  I found it very frustrating how little was known about this, and i hope this information about my journey helps.

steph

[shooie]

I did have swallowing induced SVT that seemed to have been triggered when I had been sick with just a bad cold.  Needless to say it is VERY disconcerting to have tachy each time you even swallow your spit!!!  Anyway - I did go off beta blockers after about a month and all was fine.  I figured since it had come on so suddenly, it may have left the same way, so I tapered off the beta blockers and - YAY no problem.  Check with you doctor if you are going to try it so he can gradually reduce your dosage.

[shooie]

Congrats on your success!!  I can't imagine having lived with that for ANY amount of time.  I lost so much weight in just the couple of weeks I dealt with it - I started breathing with my mouth open in hopes of drying it out so I wouldn't ever need to swallow.  I am fearful of it returning, but at least I now know that others have had the condition (my doctor had no clue), and that there is success with treatment.

[StephPT]

Thanks for the kind words.  A nuisance, indeed!  It was a long road to successful treatment...first, having to find a doctor that would take the problem seriously (I got a lot of "oh, how bad can it be? just learn to live with it"), to finding one that was willing to take a chance on keeping me awake, letting me swallow on the table, and risking aspiration in the process.  And finally, there was the "out of network" battle with my insurance company...the second procedure was well over 100K.

I hope and pray that it doesn't come back (I don't see how it could, as they burned a substantial portion of my left atrium), and each day, it gets a little easier to not worry about it.

I wish you continued success, and NSR!

steph

[cristabelle]

Hello,
How very interesting about swallowing induced SVT.  I had not heard of such an issue.  I guess we learn something new everyday.  This is one element of the forum that is so very awesome.
Thanks
cristabelle

[PikaPika88]

I told my cardio at the last visit that after I eat the heart beat goes funny.  He asked "Is it the palpitations?"  I'm not allowed to say palpitations because the pacemaker beat is over ride.  He stared at me!  I thought I'm the only person who came from other Planet!  LOL.  I feel comfortable now that I've found so many friends here.......

Pika

[c-bomb]

Thanks for all the feedback folks.  I was very frustrated back when this happened to me and I could not find anyone else who had SVT triggered by swallowing.  

Steph, it sounds like you've really been through a lot with this.  I'm glad that the beta blockers have kept things at bay for me without having to have the Ablation procedure done.  Thoughts and prayers that you remain SVT free!

Shooie - that is why I am thinking about trying to ween off the Lopressor thinking that maybe I no longer need it.  Every day I split a 50MG pill and take 1/2 in the am, the other 1/2 in the pm so its not like I am taking a large amount.  I have had much less energy since being on the meds and I'm tired of being tired!  I will say that the 1 advantage to being on lopressor is that I had always had borderline high blood pressure, but not anymore!  I have a relative that is on lopressor as well to control her blood pressure.

Pika - you said that after you eat your "heart goes funny".  Is this after you finish a meal or while you are in the act of eating and swallowing?  I myself would have my heart race only when I swallowed.  After 5 to 10 seconds I was fine again until taking the next bite of food.  My wife said I was just getting sooo excited over her cooking....lol!  She is a great cook, but it happened with hospital food as well. :)

[StephPT]

Been thru the mill, indeed!  I am just glad it is gone, hopefully for good.

I certainly share your experience of the monitor in the hospital...had darn near every doc and nurse on the floor come running in when my heartrate went over 200...i was just dining on a bad, hospital-made turkey sandwich!  And, there sits my dad, saying "that's cool, steph...can you do it again?".  very sympathetic.

I know what you mean about the beta-blocker.  I tried Toprol, and they cranked me up to pretty high doses before we figured out it was actually making things worse.  i was dragging myself around the hospital at work, and my patients all wanted to know why i was so tired.  But, if it's helping your BP, maybe you want to stick with it.

Good luck with your decision.  I disagree with the CC doc...it is NOT easily ablated, especially if you are like me, and they can't induce it on the EP table with medicine or pacing.

steph

[PikaPika88]

I'm very enjoy eating food but sorry not the magic bullets.  While I'm swallowing the fish oil capsule 1000mg (it is a quite large bullet) and my heart goes funny too.  I think it goes funny after I eat.  The funny heart beats are not as short as yours.  Mines one go on more than an hour, sometime a day.

After the gastroscopy, my cardio called me back and he changed the pacemaker mode from DDDR to DDIR.  Nothing different to me.  I'm wandering, if something happen while I was sedated during the scope put in my stomach?  I found 2 more needles hole (poking) at my hands.  The needle for sedation was still stick at the armpit.

Pika

[Duchess47]

I have posted to the gastro. and heart forum before asking if there was a correlation between eating and rapid heart rate since this also happens to me each time I eat.  I specifically asked if this happens because of the vagal nerve.  I was told that your heart rate can increase a little because of digestion, but not much.  I have had this problem for months now.  Beta blockers kept my heart rate low, but I came off of them 6 months ago.  Have you changed your diet because of the Tachy?

[StephPT]

i guess it depends if you are talking about an increase in heart rate that happens AFTER you finish eating (which can be a normal part of digestion, as the heart circulates blood at a faster rate to aid in the digestive process), or an increase in heart rate that occurs transiently with each bite.

my arrhythmia (and i suspect the person who posted initially shares the same experience) came with each swallow.  didn't matter if it was food, beverage, or burp (the reverse direction, but still a change in esophageal pressure), it happened.  there was no dietary change i could make to make it go away.  definitely vagally mediated.