Ventricular tachycardia

[wmac]

Hello and thank you in advance for taking my question. First off recap: I have pacs pvcs, svt, aivr and nsvt. Longest nsvt was 26 beats with 187bpm when I was on low dose of toprol xl for three days. I just recently went and saw my cardio/ep and she said that the only two options I have is to do nothing or try flecinide. Well flecinide scares me to death. I would have to be hospital for the first three days. She did a echo and everything is fine with trace mvp. My ef is 74%. She believes flecinide is my answer. I have had two attempted rf ablations at the university of Utah no luck. My cardio in Boise Id will not attempt one she says im not fixable. Well im getting 3-4 runs of nsvt a month. It is controling my life which it has for five years now but my runs are more often and its very disturbing to me. What would cleveland do would they just send me out the door and say dont worry or would they try another eps and ablabtion? I am willing to go there if you think that they would try. All my other heart test have been normal, mri, stress test, ekg, tilt table, etc... I would just like to be fixed and live a normal life. Thank you
also who would you recommend if I go to cleveland?
thanks wmac

[Forum-M.D.-MJM]

Hi WMAC,

I understand your concerns.  To some people, PVCs and NSVT has significant impacts in quality of life.  

The standard of care for PVCs and NSVT with a structrually normal heart is reassurance that this is not a life threatening rhythm and beta blockers to reduce symptoms.  Beta blockers work for some people and not others.

The next step for symptomatic PVC/NSVT in a structurally normal heart is usually a class Ic medication like flecainide.  Flecainide may help to reduce your symptoms and is worth trying.  Some physicians do not even hospitalize patients for drug loading of flecainide.

If you continue to have significant symptoms and understand the risks of the procedure AND your PVCs/NSVT have on predominant morphology (location in the heart), an ablation is a reasonable options.  Important questions are what triggers the rhythm (stress, exercise, caffeine, change in menstrual cycle).
The morphology can be tricky to catch -- it is most helpful to see it on a 12 lead EKG and that is sometimes hard to get.

As far as who to see....that is tricky question because they are all very good. Patrick Tchou and Robert Schweikert two physicians that may be helpful.

If you decide to come, bring records with you.  They sometimes don't make it from your doctors office.  Any 12 lead EKG with the PVC, echo report, previous EP studies, etc.....

I hope this helps.  Thanks for posting.

[ireneo]

That seems like a rather long v-tach run. Has the doc mentioned an ICD?

[Carrie41]

Sounds like my life wmac.  I have had two failed ablations as well but have PVC's, PAC's and runs on non-sustained v-tach.  It controls my life as well and I would give anything to get it fixed and live a normal life.  I take anti-anxiety meds because I am so strung out about my heart.  

I would also LOVE to get to the Cleveland clinic but I live in Canada so I don't think it is an option.  I would be interested what the docs respond to you and how much the cost would be with no US health care to have an ablation at the clinic.

[wmac]

I thought that was a long run too. I had gone to the university of utah a couple of times before that run so I had already seen a cardio/ep down there and at that time no one was worried about my nsvt. I had a loop recorder implanted and they said just keep recording. Then a few months later after lots of test I finally decided to go on toprol because I just couldnt take it anymore. Whenever I get the nsvt runs is at rest or watching tv or on computer things like that. I feel my heart gets too slow. Then when on the toprol three days into it boom I had the 26 beat run I ran to the doc where I live he couldnt blevieve it so he faxed the info the my normal cardio/ep and she said dont worry keep taking the meds its no different than the five beat run. Im like no way. So I called my cardio in utah told his asst. about it she said you fax me the strip now. So I did and within one hour Dr.Freedman called and said you need an ep study and possiably an icd. Im like WHAT!! Before you said this was not life threating and is it now, he said I dont know. so with in a week I was in utah and had a ep and possible ablation. So during the ep they were so aggresive (aggressive) with my heart they could not induce nsvt or vt but did put me into vfib. Had to shock me back. They were not a bit concerned. They say beings they cant indcuce the vt they are worried and they can induce vfib in anyone. So they sent me on my merry way. Then over the months Things kept getting bad so 8 months later had another ep and they couldnt induce nsvt or vt but I had evidence of a dual av node so they did 11 burns there. But my nsvt is not fixed. Here I go again. Still have nsvt every month 3-4 episodes a month or more sometimes less. I just want to be fixed but they keeep saying dont worry live with it.Haha right. Not possible and I WONT go on the betas again I think it slowed my heart too much and thats why I had the bad run. any way cant wait for the doc response. I will be on a plane tomorrow if I could.
wmac

[CollegeGirl143]

so wait.. You dont have VT? you have NSVT? have you ever been in vt?? Your post is a little confusing, sorry LOL.. Even the 26 beat run at 187bpm, does not even come close to qualifying as vt... Ide follow an EP's lead on this one.. Even if you start the medication, or have a successful ablation, do you think you may still be worried with the "what ifs"? do you have any structural abnormalities??? If not, your condition is considered benign yes?? Or have you been told otherwise?

[wmac]

Are you a doctor??? I know that I only have nsvt I never said I had VT! Do you have nsvt or VT????
If you do and you can live with it then your a heck of alot better person than I and if you dont have it then you have NO idea what it is like! I have read alot of your post and you sound like your a doctor or a med student are you? You seem to have alot advice for everyone.
wmac

[sb786]

I thought a 24 beat nsvt at 187 bpm is definitely VT???
My Ep says that if your heart is structuarally normal then even vt wouldn't cuase any major damage unless it was very very fast and lasted for a long time.

[CollegeGirl143]

Sb, Its the amount of time that the episode lasts

Wmac, i wasnt trying to upset you... I was just confused by your post because you kept mentioning vt, i didnt know if you where suffering from that as well.. I definatly know what nsvt is like wmac...Its incredibly terrifying! After my ablation for svt, i was in bigeminy and had runs of nsvt for over a month,, talk about scary!! I totally sympathise with you.. At the end of the day, you're going to have the make the choice for yourself whether or not to try another ablation, leave it alone, or try flecinide, i dont blame you for being scared, i would be to!! I definatly had medication anxiety as well (about taking beta and calcium channel blockers).. Its a scary choice isnt it? Take the risk (even if its small) and take the meds, or try and learn how to cope and do nothing..  I wish there was something i could tell that would make the decision easier, but im sure you know, theres nothing.. I just hope you find a middle road :) Even if you do opt for the meds, i know how scary the "what Ifs" can be... Im quite some time post ablation, havent had another run of svt, with only occasional palps and nsvt and it took me a LONG time to let the what ifs go. I hope theres something that can be done for you that you havent tried yet that helps you cope with that, as well as the nsvt! God bless :)

[Momto3]

wmac:  Long time no "talk" to : )

Sounds as though you're still battling with the ectopics, sorry ; (

I don't know if this will help, but I was on flecainide for a few months and it significantly reduced the pvcs and nsvt episodes I was having.  

Hope you find the answers you are looking for, maybe in Cleveland....


sb786:  No, VT is not necessarily determined by the number of ectopics...."Technically" a 30 beat run or more is VT, but still not dangerous in a healty heart.  

Take care everyone.

connie

[CollegeGirl143]

(sorry to hijack the thread for a moment)

Hi sb :) how are you doing? Have you decided whether or not to opt for the ablation yet?  I know one of your concerns is your svt leading to vt, and trying to understand the dynamics of your situation, i found a website i thought you might like to read, that might better explain what VT is to you

http://en.wikipedia.org/wiki/Ventricular_tachycardia

[wmac]

Ok I mentioned nsvt and VT when I was talking about the eps. I said that they could not induce nsvt or VT. I only have nsvt. but they were just trying to induce anything. VT is considered 30SECONDS OR LONGER NSVT IS CONSIDERED LESS THAN 30 SECONDS. Thank god I have not had the VT,
I would just shoot myself on the spot. I just hope I get a cure someday soon weather it be meds (which i doubt ill do again) or another eps and ablation or it just stops haahha.....im just so tired of this controling my life and I know its my choice on that part but I cant help it. It does control me everyday and everytime I have an episode I freak and wait for the next one. I dont do alot things because of this. I need my life BACK!!!

[CollegeGirl143]

you sound just like i did.. I wouldnt let myself be more than 5 minutes from a hospital at any given time.. dont blame yourself, its not really your choice at this point.. if you could make the choice at this point, whether to just "be ok" or keep suffering, well duh thats not a hard choice! LOL... I think you're doing the right thing by fighting back the way you can and trying to seek help.. i hope they can give you some help so you can take some of the focus and put it into other things, like healing mentally as well as physically, it takes a HUGE tole on someone mentally to constantly be fearing for their life.

[tickertock]

I think, though I'm not sure a 26 beat run of nsvt at 187 bpm would only last around or little over 7 seconds, not even 8 seconds. I think sustained Vt is defined as 30 seconds and over, though I imagine 5 seconds of nsvt would feel like an eternity if you're aware of it.

It is my understanding that nsvt is basically treated no differently than simple PVCs and the prognosis is basically the same with a normal heart, even normal heart VT pose very "little" risk and the "risk of SCD" is probably on par with the general population than dont have it.

They know alot more about arrhythmias these days than they did 20-30 years ago through long term studies, monitoring & EP studies. Though terrible and annoying to those who feel them they are merely a nuisance and rarely pose a threat to a otherwise normal healthy heart. This is my understanding only I'm not an MD.

To wmac if you are definitely having hard time coping, then maybe a consult with CCF would put your fears to rest. Good luck.

[maggiemag]

wmac, can you say how you know the runs you feel now are NSVT??  It could be that they are SVT, as they can feel the same.  I have both and if I feel a run it is SVT, and I don't feel the NSVT, if you can believe it!  I have a loop recorder so it is interrogated every so often.  Flecainide sounds a bit drastic with all the possible side effects.  I understand how they can produce a lot of anxiety, but... you need to do what you have to do.  Good luck.

[sb786]

Hi there, hope things are good with you. I've decided to go for the ablation which is now booked in for late June! I am hopeful that the procedure will be able to offer me some relief from the anxiety. I just hope that once the svt is ablated (fingers crossed) the pvcs will not bother me as much. I'm hoping that i will be able to just accept them. Thank you for the link it was very helpful in explaing what vt is.

[Momto3]

EEE GADS!!  My oooops!!!  I meant VT is at least a 30 SECOND run......Sorry everyone!!

[wmac]

Well I too had a loop recorder for awhile. I just know what they feel like. My svt is fast feeling my nsvt is slow feeling even though it actually is fast. when I had the 26 beat run i felt a thug and felt like a reallllllllllllllllllllllllllllll long pause then boom. All my other nsvt runs feel like thump thump thump thump with no normal beats and I have worn a king of hearts monitor and the 24 hour monitor enough and every time I suspected it was nsvt it was for sure according to the monitors. so I really have no doubt to whats going on. I wish  was I just ignorant to all of this because I really believe it now ignorance is BLISS!
  

Carrie I would like to hear more of your story about your nsvt!

wmac

[Forum-M.D.-MJM]

Hi WMAC,

I understand your concerns.  To some people, PVCs and NSVT has significant impacts in quality of life.  

The standard of care for PVCs and NSVT with a structrually normal heart is reassurance that this is not a life threatening rhythm and beta blockers to reduce symptoms.  Beta blockers work for some people and not others.

The next step for symptomatic PVC/NSVT in a structurally normal heart is usually a class Ic medication like flecainide.  Flecainide may help to reduce your symptoms and is worth trying.  Some physicians do not even hospitalize patients for drug loading of flecainide.

If you continue to have significant symptoms and understand the risks of the procedure AND your PVCs/NSVT have on predominant morphology (location in the heart), an ablation is a reasonable options.  Important questions are what triggers the rhythm (stress, exercise, caffeine, change in menstrual cycle).
The morphology can be tricky to catch -- it is most helpful to see it on a 12 lead EKG and that is sometimes hard to get.

As far as who to see....that is tricky question because they are all very good. Patrick Tchou and Robert Schweikert two physicians that may be helpful.

If you decide to come, bring records with you.  They sometimes don't make it from your doctors office.  Any 12 lead EKG with the PVC, echo report, previous EP studies, etc.....

I hope this helps.  Thanks for posting.

[shooie]

Hey - I'm from Boise too!  I totally understand the frustration and how all this can overwhelm your life.  I've been through years of all the monitors, tests, medications, pvcs, pacs, psvt, etc.  I also considered a visit to CC just for peace of mind.  If you do go, I would love to know if it helps with resolution for you.  Who is your cardio here?  Best of luck!

[Celeste07]

Sorry to hear about your ordeal. You mentioned that you come down here to Utah to see your Cardiologist at the U. I was wondering if you have checked out other Cardio's here? I too have arrhythmia's, mainly PVC's, some runs of NSVT and recently, I've developed IST. I see Dr. Jeffrey S. Osborn with the Utah Heart Clinic. I have to tell you that he is one of the best here. Dr. Osborn specializes in Arrhythmia's and Electrophysiology. I simply adore him.
Anyway, I just wanted to give you an option if you ever wanted to get a second opinion at some time in the future...

Here's some info on him if your ever interested...
http://www.utahheartclinic.com/physician.php?Pid=15&PHPSESSID=b8419545aaae982ac3d04a00729044ed

[wmac]

Im actually from McCall!! I see Dr.Marks

Celest, I went to Dr. Freeman, Dr. Wall did the first eps and Dr. Klein did the second one.

[wmac]

I dont know if youll see this or not. But you mentioned the monthly cycle. And that is when I usually get my runs of nsvt. Is usually the week prior to the cycle if its not then its during and or after. But its always around that time of the month. Does that change the signifance of anything meaning less worrisome. thanks for your time.
wmac

[knightrider]

I just got out of the hospital about a week ago.I just went through an episode.At the time I was pacemaker depended.I was working outside when my chest was pounding and felt funny.Checked my B/P and it was 50/40.Got to the ER and the EKG had my heart Quivering and pulse over 200.They had to shock me while awake.WOW.Well that got me on the right track.They ran an Angiogram and found a small blockage 30/35 that couldn't set it off.They then shipped me to Little Rock Heart Hospital ( Arlansas ) There I had an Electrophysiology Study.They discovered I have Ventricular Tachycardia.I ended up getting  Implantable Cardioverter Defibrillator  ( ICD ) and meds of MEXILETINE 150mg 3 times aday for starters.

[wmac]

Ok im a bit confused. If your heart is quivering wouldnt you be in vfib and if your in vfib you would be unconcious right. So when you got to the er were you in VT? Did they ablate your vt did it turn into sustained vt  explain to me more info to why you had an icd implanted???  Had you had heart problems before or symptoms you said they found a small blockage but it had nothing to do with it right? explain to me all you can please.
wmac
thanks for your post

[PikaPika88]

knightrider,

Isn't it your pacemaker already had and ICD?  If I'm not wrong, why your pacemaker didn't kick in?  I think yours pacemaker is same as mine.  Would your cardio turn it down to too low?  or your Pacer had some reason FAILED! Don't scare me!  

[knightrider]

OK,I had a pacemaker placement in 2000.Betweeen 2001 to 2004,I had 4 ablations.The 4th one they made me pacemaker depended.2006,I needed a replacement due to the battery was low.Dec.2006,they tested it and everything was OK.Jan.2007,I had a episode where for about 20 mins.with the sweating,weak,and my chest was pounding with my shoulders feeling like they had a ton of weight on em.In mid Feb.I had another one,but it lasted close to an hour.I went in to my Cardio and he checked my pacer and the findings were,from Dec to the present time,I had 250 episodes but felt only 2.He put me on Cardizen.It was the 2nd day when the 3rd came along.This one lasted forever,but I had passed out for a few seconds.The wife took me to the ER.There they ran a EKG and B/P was 50/40 with a pulse over 200.I seen the pads coming and was shocked.This brought me down and B/P backed up.
While in the Mountain Home Hospital,they done a Angiogram to see if a blockage caused it.Results had shown no.They sent me to Little Rock Hospital to have a Electrophsiology Study done.Test results had shown I needed the ICD.

[knightrider]

It took me awhile to find some of U.Where has everyone been hanging out.Besides U,I found VA TONY.OK,I had only a pacemaker which it's
use was for preventing my pulse from going low.With this ICD,it slows my pulse down from racing high.I have a Pacer and a Defibrillater (ICD)

[wmac]

Why do you have a pacer and an icd?? knightrider do you mean Mountian Home Idaho??

[knightrider]

Mountain Home Arkansas.The ICD is all one unit.

[PikaPika88]

Knightrider, the site where we come from is still open.  Sue, Tony, Ireneo and ....... many of them still there.  Ian is here too.  I think mine PCD is almost same as Ian one.  His one is newer version, smaller and lighter but the function is almost the same.  Both are St Judes.  Pacing at right ventricle can cause heart failure or LBBB, do you know that?  While my EF is still good.  This time when I see him, I'll ask him to turn it off because he didn't know how to turn it down.  
http://www.medhelp.org/forums/cardio/messages/34886.html

Wmac, why I have the PCD?  It is a very long story.  At first they told me put the pacemaker in then I don't have to take medicine.  But it wasn't true and it only lasted for 3 days.  They gave me a bag of med to take home and enjoy when discharged.  After that, each pacemaker replacement, they upgraded.
Now my left wall movement is impaired.  My left side beating can't catch up with the right side pacing!  Errrrr, hard to understand?  Hard to believe too!  I've wpw.

[wmac]

Gosh I havent been to that site in awhile how is everyone doing over there??

[knightrider]

Well,I had my second shock in 20 hrs.I have an Appointment tomorrrow to get myself checked.This time,I was just going for a walk. PIKA,what was the old link where everyone was before they closed off our forum.

[PikaPika88]

Here is the link.  It'll bring you directly to the site.  

http://heart.health.ivillage.com/community/index.cfm

[knightrider]

I went to i village,but there's no community section anymore.

[PikaPika88]

Copy and Paste the path (website that I given here).  It brings you straight down to the community board.
Then it'll show you to login. After login and will bring you right to the front page again.  Then you paste the path (website that I given here).  You can start to post.

It didn't have the community section at the front page anymore.  

Please try again.