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Heart Disease (Expert Forum)
Ways to control arrythmias
Answered by
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Ways to control arrythmias
by C.N., Jan 30, 2001 12:00AM
I have a few questions to ask relating to chronic arrythmia problems. I am 32 and have had acouple of ablations, and now have a pacemaker. I now have more frequent and more serious arrythmias than before the ablations. They are coming from several focal points. One of the rhythms they have said is wide-complex tachycardia at rates up to 300bpm. I'm a little confused as I have had seen cardiologists in the hospital that have said I need an EP studies to determine if the rhythm is atrial or ventricular. My EP doc says he doesn't want to do an EP studies right now and thinks it's probobly atrial.
My question is
1)Can you know for sure whether wide complex tachycardia is coming from the atria without doing an EP studies. During these rhythms, my blood pressure drops dramatically.
Because I also have a-fib, I am taking coumadin. My doctors have said that because I have a P.F.O., I have a higher risk of a clot going through the shunt.
Question
2)Is this a reason to have the P.F.O surgically repaired. No one has mentioned this to me but I am curious.
My next question is
3)If you had a patient with these types of arrythmias would you prescribe tikyson or amiodarone. I have tried all others to no avail. Now I am on amiodarone, but I'm wondering which of the two has the most potential for serious side-effects?
I still don't understand why I have these rhythms. When I got my pacemaker, they told me I had sick sinus syndrome, rates down in the single digits. From my own understanding that means that you can have a problem with fast and slow rates. This to me would explain the cause of my arrythmias. But my doctors keep saying they don't understand why I'm having these rhythms and think there is another underlying cause.
Question
4)Could you explain why they are not blaming the rhythms on sick sinus syndrome if that is what the diagnosis was that led to the pacemaker?
I know there is so many questions. I don't know if your able to answer them with the information I have provided. I am hoping for a little more insight, if at all possible.
Thank you so much.
My question is
1)Can you know for sure whether wide complex tachycardia is coming from the atria without doing an EP studies. During these rhythms, my blood pressure drops dramatically.
Because I also have a-fib, I am taking coumadin. My doctors have said that because I have a P.F.O., I have a higher risk of a clot going through the shunt.
Question
2)Is this a reason to have the P.F.O surgically repaired. No one has mentioned this to me but I am curious.
My next question is
3)If you had a patient with these types of arrythmias would you prescribe tikyson or amiodarone. I have tried all others to no avail. Now I am on amiodarone, but I'm wondering which of the two has the most potential for serious side-effects?
I still don't understand why I have these rhythms. When I got my pacemaker, they told me I had sick sinus syndrome, rates down in the single digits. From my own understanding that means that you can have a problem with fast and slow rates. This to me would explain the cause of my arrythmias. But my doctors keep saying they don't understand why I'm having these rhythms and think there is another underlying cause.
Question
4)Could you explain why they are not blaming the rhythms on sick sinus syndrome if that is what the diagnosis was that led to the pacemaker?
I know there is so many questions. I don't know if your able to answer them with the information I have provided. I am hoping for a little more insight, if at all possible.
Thank you so much.
Doctor's Answer
by Cleveland Clinic, MD, Jan 30, 2001 12:00AM
, Jan 30, 2001 12:00AM
Dear Chris,
It does sound like a complex situation and I will not be able to give you very specific answers without having seen all the data but will try to give some general direction for you. Wide complex tachycardia can be due to arrhythmias in the atria with "abberancy" in the conduction pattern to the ventricles or can be due to ventricular tachycardias. The differentiation between the two by surface ECG is beyond the scope of this forum but is may be done with some certainty. In some cases however EP study is necessary to tell the difference. In either case I do agree that you probably need medical therapy and either amiodarone or tikyson (dofetalide) are good choices.
The PFO may need closure depending on the size and this can now be done without open heart surgery. However, I would wait until all the arrhythmias have been addressed because it is possible you may need a left sided ablation and the PFO will help in this circumstance.
Lastly as to the cause of the arrhythmias this is a very hard question to answer without know exactly what arrhythmias you are having. Sick sinus syndrome is unusual in someone your age. Have your doctors looked for arrhythmogenic right ventricular dysplasia (ARVD) with a CAT scan or echocardiogram? Also a pulmonary vein focal tachycardia could be causing similar symptoms.
If you would like a second opinion I would recommend Dr. Walid Saliba or Dr. Bob Schweikert here at the Cleveland Clinic. Best wishes.
It does sound like a complex situation and I will not be able to give you very specific answers without having seen all the data but will try to give some general direction for you. Wide complex tachycardia can be due to arrhythmias in the atria with "abberancy" in the conduction pattern to the ventricles or can be due to ventricular tachycardias. The differentiation between the two by surface ECG is beyond the scope of this forum but is may be done with some certainty. In some cases however EP study is necessary to tell the difference. In either case I do agree that you probably need medical therapy and either amiodarone or tikyson (dofetalide) are good choices.
The PFO may need closure depending on the size and this can now be done without open heart surgery. However, I would wait until all the arrhythmias have been addressed because it is possible you may need a left sided ablation and the PFO will help in this circumstance.
Lastly as to the cause of the arrhythmias this is a very hard question to answer without know exactly what arrhythmias you are having. Sick sinus syndrome is unusual in someone your age. Have your doctors looked for arrhythmogenic right ventricular dysplasia (ARVD) with a CAT scan or echocardiogram? Also a pulmonary vein focal tachycardia could be causing similar symptoms.
If you would like a second opinion I would recommend Dr. Walid Saliba or Dr. Bob Schweikert here at the Cleveland Clinic. Best wishes.
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It does sound like a complex situation and I will not be able to give you very specific answers without having seen all the data but will try to give some general direction for you. Wide complex tachycardia can be due to arrhythmias in the atria with "abberancy" in the conduction pattern to the ventricles or can be due to ventricular tachycardias. The differentiation between the two by surface ECG is beyond the scope of this forum but is may be done with some certainty. In some cases however EP study is necessary to tell the difference. In either case I do agree that you probably need medical therapy and either amiodarone or tikyson (dofetalide) are good choices.
The PFO may need closure depending on the size and this can now be done without open heart surgery. However, I would wait until all the arrhythmias have been addressed because it is possible you may need a left sided ablation and the PFO will help in this circumstance.
Lastly as to the cause of the arrhythmias this is a very hard question to answer without know exactly what arrhythmias you are having. Sick sinus syndrome is unusual in someone your age. Have your doctors looked for arrhythmogenic right ventricular dysplasia (ARVD) with a CAT scan or echocardiogram? Also a pulmonary vein focal tachycardia could be causing similar symptoms.
If you would like a second opinion I would recommend Dr. Walid Saliba or Dr. Bob Schweikert here at the Cleveland Clinic. Best wishes.