ablation risks

I have been told that I have AVNRT.  I am currently on digoxin for it, but have had break through episodes.  I would really like to get an ablation for this(rather than lifelong drug therapy), but am scared because of the small risk of death (we have two small children).  We live in a small town in the west, but have access through insurance to either go to the EP lab at the University of WA in Seattle, or to a Dr. Goldberg in Spokane, WA.  My questions:

In weighing my risks, is my risk of death or serious complication lessened if my arrythmia is AVNRT and if I am young(30) and healthy?

In considering drug therapy (ie. digoxin, beta blockers), are there actual risks from long term use that I should be considering?  Are there statistical "risks of death" from medication that I could compare to the numerical "risk of death" from an abaltion?  And are there any studies of just continuing on having episodes of AVNRT and the risk of accidents and injurys that can happen from the dizziness, etc.?

Do you know any  EP doctors in Washington that you'd recommend?

I'm trying to make an educated decision and a well thought out one.  Thank you for your time and input!  

[Cleveland Clinic, MD]

Dear kc,

AV nodal reentrant tachycardia (AVNRT) is a common cause of tachycardia in young people and can be treated with either drugs or ablation.  The decision between which treatment will depend on the patient and doctor's personal preferences and well as a weighing of the benefits and the risks.  

The benefit of ablation is that the problem can be cured in >90% of cases and there is no need for continued medication.  The risk of death during an AVNRT is very, very small but is still possible (perhaps 1 in 10,000 or less).  The more common complication with AVNRT ablation is the risk of a pacemaker.  This is more in the neighborhood of 1% nationwide, although at centers with more experience it may be lower.  

There is virtually no risk of death with digoxin, (except with an overdose), beta blockers or calcium channel blockers (all commonly used drugs).  If you required a stronger medication such as flecanide there is a very small risk of death.  The disadvantage is having to take life-long medications.

I don't know the physicians in WA but there may be some other readers who can post the results of their experiences.   Best wishes.

[Carol55]

dear kc
would you mind letting us know what AVNRT is, and what symptoms you have?  is it something like psvt, which is what i have.  and i too, am considering ablation, but am also leery, and frightened!
thanks,
dlt

[kris]

AVNRT stands for atrioventricular nodal reentry tachycardia and it is, from my understanding, one of the varying forms of PSVT.  My rhythm is usually set off by a jump, burp, or if I quickly bend over to pick something up off the floor.  I will have palpitations from the movement and then "click" into a fast heart rate, which for me is between 160-180.  If I am not able to convert the rhythmn by holding my breath or the valsalver (sp?) maneuvers, I go to the ER and am administsered adenosine.  This doesn't happen every time I bend over, jump, or burp, but I never know when it will.

From what I've been told AVNRT is a non-life threatening rhythm, but it does affect quality of life because you never know when it will happen, and I don't think it would be good for the heart to let it continue on for hours and days.  I feel weak and very anxious when I am in the rhythm.

[VTBen]

Ablations are pretty safe.  I've had four of them.  The risk of death is very small.  My last ablation was at the Mayo Clinic, and I asked them, "How many people have died during one of these procedures?"  They said nobody has ever died in their lab.  They have done  a lot of these procedures.  My first ablation was for AVNRT, and I was cured of that problem ever since. But there is a risk in any invasive procedure, but if this condition is life altering, I would think ablation would be just as dangerous as life long medication.  Good Luck

[Carol55]

kc,
this is incredible.  you've described exactly what happens to me.
sometimes the breath holding helps and sometimes it makes it worse.  sometimes the valsalva works and sometimes not.  what did your doctor tell you to do.  like how long do you wait til you need to go to the e.r. and have the med they give you?    and this never happens to me unless i bend over, just like you said, to pick something up.  is that what's called psvt?
i'm just assuming because a family physcian is who told me i have this.  i've done treadmill stress ekg, echo, 24 hour holter, the only thing showing were a few pac-s,  and with the echo they found i have mitral valve prolapse.  do you mind telling me more?
do you have mitral valve?  and what tests or procedures did they do to find you have this, because like i said, it's amazing how you said it hits when you bend over. i've told so many people this , including doctors, and they look at me like i'm crazy!   and i know what you mean, i don't faint or anything, but it's so fast and i'm so shaky.  how long is the longest you've had this rhythm last.  so far i've never gone over 10 minutes.  the longest 10 minutes of my life.  it seems slowly drinking ice cold water slows it down.  then you can actually feel it "click" right back into normal rhythm.  weird, isn't it?  thanks for letting me share!
DLT

[psvt guy]

ive had this condition for years now and (and i can actually set it off sometimes by bending over and coughing!)....i did this for my GP once and he almost fainted!!!! i think it has to do with the vagal nerves and the connection to the heart, but you must have a condition that will predispose you to the fast rythm (i.e. AVNRT)....i am currently on meds. but i am also considering an EP study to see if im a candidate for ablation. if i can do it....i will have it done "in a heartbeat" (no pun intended).....to dlt...about 5 min was my longest, but it was the longest 5 minutes of my life and i did black out.

[Carol55]

Oh boy, now you've got me curious.  When you did that for your doc, what in the world did he do for you, or did you go back to normal rhythm yourself.  I guess that's my biggest question, when it races for you, are there any manuevers you use to slow it down.  You said your longest was 5 minutes!  Man, mine was 10, not a comforting feeling!  And when you said you blacked out, well, what happened?  That's my concern, because I have school age children, and husband works about 1/2 hr away, so if I go down, I'm here alone. And here's my biggest question.  I've read in all these books on panic, etc, that a healthy heart can beat at a fast rate for hours even DAYS!  Well, how much truth is there to that, before any damage is done!  I know what the books are saying, that the least nervous you get, the faster it'll pass.  But this happens with me without any anxiety at times, like out of the blue!  And boy, when she takes off, it's just like a train on a fast track!!!!!    Any advice?
DLT

[kris]

I don't have mitral valve prolapse.  I've had the rythm for periods of longer than an hour. . . that's when I go to the ER.  I've had doctors tell me not to let it go more than 15 minutes before going to the ER, and I've had other doctors say not to let it go more than an hour before seeking treatment(and even if it takes longer would, it probably not be permanetly harmful).  But I am probably different from the "PSVT guy" because I have never fainted from it- which probably means that his heartrate is faster than mine when he's in it.  Mine is usually between 150-180, but some people, from what I've read, have heartrates of way over 200.  That would be more scarey to me, I feel awful enough when I'm racing at 150-180.

They diagnosed my PSVT when I went to the doctor in the fast heart rate.  They hooked me up to an EKG machine and took a reading.

HOpe this helps!

[PSVT GUY TO DLT]

well, i converted by myself before he could get me down the hall and get the leads on for an ekg.....but he said that it was a psvt attack because my pulse was so high that he couldnt count it!!!!! he estimated it to be somwhere around 220-240 and he had me lie down....by the time they asked me to get up to go to another room it was..."ooops there it went"...and i knew i went back into NSR. that was the day that i went on atenolol....i blacked out one night while meeting with some friends at a bar....no drinking, i remember going into psvt and it was like tunnel vision that finally closed off, i got weak and shaky, and then i dont remember much, just coming to and realizing that i was back in normal sinus rythm (nsr)but beating very hard. that was the worst episode....they almost called an abulance for me!
and no, i dont have panic attacks. ive never had this happen to me in a "panic" situation. actually its always been quite the opposite. i have definately notice a corrolation between the episodes and times of stomach problems (like everybody else here from what i have read).....alcohol also used to set me off, but always the day after, because of some byproducts of alcohol metabolism from what i have read. but now, i havent drank in some time, and it seems to be getting worse.
they say that as long as you stay under 180bpm or so your ok...but over can kill you pretty quick if you dont get medical attention, because it could degenerate into regular VT or the heart could just "give out" as ive heard it put. my case called for immediate action because i passed out.....if this is happening to you....get to a doc.
hope this helps

[Carol55]

Thanks to both of you for your great input.  Today I had the event monitor "put on" .  So will see what happens.  You've both been great with my questions.  I don't feel quite so alone.
Everyone keep posting on progress and good luck.
Sincerely
DLT

[psvt to dlt]

right back atcha,
about your event monitor....dont let your cat anywhere near
the wires...i fell asleep twice to find mine chewed in half!
good luck in the future....
psvt guy

[Michelle]

I've never heard of someone dying with rates over 180bpm.  I also have PSVT and my heart has jumped over 200bpm and stayed there for about 15 minutes, and that caused no harm to my heart.  My cardiologist was also aware of this and he even said that it is not life threatening if the heart is healthy.  I also thought of getting the ablation done, but was also  leary.  I am now 4 months pregnant, and so far SVT free, I just hope the rest of my pregnancy is the same way

[Michelle]

I've never heard of someone dying with rates over 180bpm.  I also have PSVT and my heart has jumped over 200bpm and stayed there for about 15 minutes, and that caused no harm to my heart.  My cardiologist was also aware of this and he even said that it is not life threatening if the heart is healthy.  I also thought of getting the ablation done, but was also  leary.  I am now 4 months pregnant, and so far SVT free, I just hope the rest of my pregnancy is the same way

[bob]

I am not sure where your source of information is coming from, but your heart can beat above 180bpm and your risk of death does not increase dramatically.  I had PSVT since I was 14 (now I'm 27) and, therefore, had been seeing cardiologists since then.  I had always been healthy otherwise and when I had my SVT episodes, my HR would go above 200 (exercise would precipitate it and my HR was probably close to there anyway during the exercise).  All of my cardiologists (which were many) said "You're not going to die or anything..Just let your heart go back into NSR and if it doesn't go to the ER and we'll give you meds to convert...not to worry".  I did have an ablation at Georgetown by Dr. Cynthia Tracey (who is world renowned according to the fellows there-I did an enormous amount of research as far as who to have do it) two months ago and so far I'm much better.  My point being if your heart is healthy structurally and you're not blacking out, I don't think you have much to worry about but check with your doc.

[Cathy]

I have been very interested in this thread as my 12 year old daughter has periodically complained to me over the past year of episodes where her heart races after a jump, bump or awkward body position ( as when she engages in a crouching motion to catch a ball). Her heart checked out fine at the dr. as did an ekg. I am wondering what causes this and why would it only start
at the age of 11 and not be evident before. She has always been a very healthy kid and I'm wondering what would trigger this at her age. Is it in any way stress related? Are any of you aware of any natural (ie. homeopathic remedies) that might prevent this from happening. I hate to go the drug route. Could it have anything to do with hormones what with her being pre-puberty? Is it possible to outgrow this? Could illness (sore throat or flu) bring it on? Sorry I have so many questions but I just can't see how  healthy people with apparently healthy hearts can have this just happen out of the blue. I'd appreciate any info you good people might have. I might add that a few years back I was bothered by rapid heartbeat especially at night in bed. It lasted for about a year and of course I was too afraid to have it checked out so I lived with it and it passed. I attributed it to stress but I'm wondering now if, perhaps, I had assumed an awkward position while sleeping and that trigged the episode.

[Cathy]

I have been very interested in this thread as my 12 year old daughter has periodically complained to me over the past year of episodes where her heart races after a jump, bump or awkward body position ( as when she engages in a crouching motion to catch a ball). Her heart checked out fine at the dr. as did an ekg. I am wondering what causes this and why would it only start
at the age of 11 and not be evident before. She has always been a very healthy kid and I'm wondering what would trigger this at her age. Is it in any way stress related? Are any of you aware of any natural (ie. homeopathic remedies) that might prevent this from happening. I hate to go the drug route. Could it have anything to do with hormones what with her being pre-puberty? Is it possible to outgrow this? Could illness (sore throat or flu) bring it on? Sorry I have so many questions but I just can't see how  healthy people with apparently healthy hearts can have this just happen out of the blue. I'd appreciate any info you good people might have. I might add that a few years back I was bothered by rapid heartbeat especially at night in bed. It lasted for about a year and of course I was too afraid to have it checked out so I lived with it and it passed. I attributed it to stress but I'm wondering now if, perhaps, I had assumed an awkward position while sleeping and that trigged the episode.

[Carol55]

Cathy,
My own daughter, who is 13, developed having skipped beats from time to time.  I really freaked.  Had her seen by a leading cardiologist from big med center.  He insists it's benign pac-s. We did the holter monitor for her.  It was fine.  She's had about 4 ekg-s ,  so far all were fine.  But the one thing he stressed like crazy is, absolutely NO CAFFEINE!  Anyone with any heart palps can be so sensitive to it.   I really do think so much of this is pre puberty.  Because I'm the one who originally wrote in and complained about this rapid heartbeat occuring only before my own period.  And looking back, all this started when I was pregnant.  For no known reason, out of the blue I'd get this racing heartbeat.
So, for your own peace of mind, have her tell you when it happens, and if it becomes really frequent, see a pediatric cardiologist, just to relieve your own mind.  I'm glad we did.  And yes, I do think so much of this is hormonal.
Sincerely,
DLT

[WA State Cardio pt]

Hi Kc,
   I am a cardio pt in WA State also.  I see a great cardio EP doc named Dr. Michael Belz at Virginia Mason in Seattle.  He performs EP studies, pacer implantation's etc.  His staff is great and his other cardio partner Dr. C Fellows is very good also.  Just thought I would let you know.  If you want any further info or want to talk, please feel free to e-mail me at ***@****.  Have a nice night.

[Cathy]

DLT, Thanks for the information. My mother, too, insists that it must be hormonal as "she's at that age" before menstruating. I know that my owm experience with rapid heartbeat was always at its worst pre-menstrually. Certain foods do seem to precipitate these episodes with my daughter certainly coke and any food with
blue and yellow and green dyes in them. I can understand her being sensitive to certain additives in food, but what baffles me is when it happens after a jumping or upper body bending over. Is this something to worry about? Once she was swimming with one of her friends and the friend accidentally kicked her in the chest and my daughter said she felt like  the racing was about to happen although it did not on that occasion. That's another thing- sometimes she can feel that it's about to come on. In light of this, I'm wondering if anxiety can be a contributing factor. I'm praying that this will pass. In the meantime, I'll control what she eats and I'm going to look into alternative remedies and keep you posted. Once when it happened, I immediately gave her some liquid calcium/magnesium and she said it stopped immediately. Unfortunately the last time I tried the same remedy and it didn't work.

[ONE WHO KNOWS TO BOB]

trust me 240bpm is WAY too fast for any extended period of time....ventricular filling will be almost nil. bp crashes as a result (as it probably did for psvt guy) and things could happen....from what i have read, some people with svt are lucky and never get real high rates....for others though, i can be a real problem though.

[from psvt guyto michelle and bob]

i dont know where you 2 get your info, but id check into getting to a different doc....high rates are bad...very bad...check the posted  response from the doc. from above

Answered By: CCF CARDIO MD - CRC on Monday, February 05, 2001



Dear Anne,

Have you actually been diagnosed as having hypertrophic cardiomyopathy? I would be suspect of that diagnosis based on the data you told me but it is impossible to know without reviewing the actual studies. R waves are due to the ventricle and poor R-wave progression refers to the pattern as it shifts across from leads V1 to V6. You are correct that the P wave is due to atrial contraction which is usually due to the sinus node. A rapid tachycardia, even for just a short time, can cause damage to the heart. Generally this is a decrease in the pumping function of the heart, not an increase in the wall size. PACs and PVCs are generally regarded as harmless.

[stevebu]

To all the bending over people that trip their psvt.  Been there and done that for 25 years (since I was 9 years old).  Other quick movements can also set it off.  Also, when teenager experimented with weed and it always set it off until I was finally smart enough to realize the connection.  I had rf ablation done june 2000 and I am now cured.  No more 1 hour episodes requiring me to head for the ER.  What a relief.  Please consider this option for your sanity.

[kim]

THIS IS THE WAY I CONVERT MY SVT

Having gathered info from Mayo clinic and other experts in electrophysiology and much frustration I found a method of converting back to normal rhythm that works for me.

As soon as the episode starts, I go to a private room and lay down flat on the floor and take deep breaths.  The doctor at Mayo said elevate your feet but this didn't work for me.  

By the way, those interested in knowing why bending over starts an episode......you are irritating your vagal nerve in the stomach which caused a PVC and jump starts the SVT.

[jan]

Doesn't the max heart rate according to age come into play? A younger person can go higher and be fine, as you get older... At 170, almost my max, I've passed out. My cardio says if it happens often (tachy) it will damage your heart (chf or cardiomegaly). That is why he is treating mine. I do have mvp, mr and tr, but that is not why he is treating my tachy.

[alicia]

Hey guys...I hear everything you're saying...i'm 27 and feel like i'm losing my mind..I am scheduled for an ep study/ablation on the 15th and am pretty terrified....they say it's similar to a cardiac cath and I had that done three years ago...i've had problems with my heart rate for five years now and they've got fast rates recorded on a holter and two event monitors, but i've never had my worst ones recorded..my actual diagnosis is atrial tachycardia..all i know is that my quality of life has suffered greatly..i have horrible anxiety and depression...i hope this is the answer...is there anyone who can tell me what to expect???Are you asleep most of the time???Do they go through both of your femoral arteries?Are there ways to check out the doctor and hospital for statistics on their procedures???Thanks!!!

[Kathy E.]

Hi guys, I have been I think the entire route.  I have had ablation both septal(for hypertropic cardiomyopathy) and a AV node ablation for A-Fib(SVT) I also have recently had a ICD pacemaker inserted. I am 45 and was using all kinds of drugs to control the rate of my heart, until the doses of the drugs became toxic and no longer worked.  The pacemaker is very new, but already my heart is much quieter.   Also, it controls the rate.  The(Av-node) ablation was not painful, they knocked me out, I had to keep my leg still for 4 hours, then was allowed up after 6. The pacemaker was painful after for about 2 weeks, I survived though.  If it all works I will be very, very happy!  Now, for the mothers, have you children checked every year.  I was born with the hytropic cardiomyopathy , it was not dicovered until I was 30.  I had tons of symptoms that everyone put down to hormones and age.  Getting the children a echo once a year isn't a big deal.  I have my kids screened every year.  Also, I found that sometimes putting my head in a bucket of ice water would slow the rate down, and sometimes shock me back into sinus.  (but ask your doctor, I only know what worked for me)Well, Good Luck everyone.

[fake name]

I developed CHF after having episodes of PSVT/SVT's.  They were never caught on monitors but I did have to be chemically converted once.  I did not have many episodes before I developed signs and symptoms of CHF.  I had a heart cath done after the first episode.  According to the cardiologist, everything was normal.

The only other problem I had was an incomplete cervical spinal cord decompression.  I was assured by both the neurologist, Dr. M. Brown of HUP and the cardiologist, Dr. Husain, Chief of Cardiology Chester County Hospital that this was not the problem.

To the person that mentioned stomach problems prior to PSVT, check your sitting/standing blood pressure.  When I had the stomach problems and episodes, my standing blood pressure did not rise, it went down when I stood up.

To the person that used ice water to stop episode, you might have something there as there is a connection between soft palate and hypothalmus.  Use a search engine and research hypothalmus.  Somewhere there are references to cold affecting hypothalmus.......also hot things can cause autonomic dysregulation.

Good Luck!

[jan]

You can go to Healthgrades.com to check up on a hospital according to procedures and you can check up on dr.s,too. You can also fill out a survey on your doc and see if others have. I will note that the one and only neg. one I did was never posted, and I did it twice. It makes you wonder. Also, a local hospital I checked out I believe should of had a higher rating. It's the only site I know, though. Hope this helps.

[alicia]

Thanks Jan for the healthgrades info...it was very useful...it's reassuring to know people are looking out for one another-you're a nice person:)

[Jessica]

Well I would like to let everyone who is thinking of having the EP study and ablation for their rapid heart rates, think very carefully about it. I am 25 I have had rapid heart rates for as long as i can remember but everyone said it was anxiety or hormones when i was pregnate with my second child i started to feel like i was going to faint but never did, the highest rate they caught was about 215 but i know I had worse ones. Anyway,I didn't want to have to take meds so I had the EP study and  ablation,they found out i had WPW and AV node reentry, the first ablation didn't work then i had it done again we thought it worked that time but i went into 1st degree heart block and now have a pacemaker. It isn't the worst thing that could happen but if i had it to do again I would just take the meds. Now i have had the pacer since june I feel everytime it beats and one of the leads is going bad so they have to go again and put in a new one. Now all the Docs tell me that this just doesn't happen   very often much less to the same person but it is something to think about. My doctor who did the ablation has done thousands of them only one other time he had to put in a pacer,so he was good. I just want everyone to know it can happen.

[genie]

We have just returned from the hospital where my spouse had 260 pulse for over 40 minutes. He is 40 yrs. First time this has happened and we are pretty scared.  Prelim diagnosis is AV Node re-entry.  Dr want to do ablation in 3 days with out trying any meds.  We believe that he has had smaller, less severe episodes prior to this, becoming more frequent. Would like any comments.

[tracy]

Where do I start, I started having SVT Pat  when I was 18, my heart rate would go up to 350, sometime would have to go to ER to convert it over. Had drs. tell me it's just stress, anxiety, all in you head, nothing is wrong with you , you can control this.  Heard this for years, Started to believe it.   took many years to Dx it. If I was  not having the attack at the time to see the begining and the end couldn't tell what the heart rate really was. 1989 had EPS IN Ann Arhbor MI.  DX with AVNRT had the First ever Albation surgery  thru the heart cath. This did not go well. The first rap of the electric shock wave  wiped out the whole Av node. Put me in 3rd heart block. I was 27 at the time and a med student with 2 small children. Spend 6 days in CICU and recieved a Pacemaker. Took me a year to recover. 1993 had a modifed SA node albation for Sinus Tach. Now 100% paced, still have all kinds of arrythimias, and coronary spasmias  I'm in and out of the hospital at least every three month which is funny since I'm a nurse and I work on the cardica floor.The Doctors don't know what to do with me stating I'm a difficult case.  The medications they have tried don't work to control the arrythimia the dose they need to get me up to I can take they bottom my b/p. They want me to take buspar or xanax for anxiety .Iam just frustated.  I don't want to discourage anyone out there but this procedure has not been done for very long and not all the studies out there are done yets. I took meds for 10 years and got to the point I couldn't do anything without sending my heart rate going up. It was happening multpy times daily.Just remember before me was a monkey......how is he???

[Eddie]

I am a 41 year old male.  I consider myself in pretty good condition.  I was diagnosed with SVT about 3 years ago.  I have since been on a med called Rythmol to control my heart rate.  My Cardiologist (electro-physiologist) recommended to have the Ablation procedure to cure the SVT about two years ago.  I have been putting it off because I didn't like the idea of having a thin tube so close to my heart.  I am a very nervous individual.  However, last Monday (April 9th) while lying in bed, I had another attack.  My Heart rate skyrocketed to 230bpm.  My wife rushed me to the ER and the Dr's administered a med through a intravenous line to bring the heart rate down.  It took them three tries to get my heart rate back to normal.  I have been there many times before and was administered medications, and it always worked on the first try.  This time I got real nervous.  I was admitted overnight and seen by my cardiologist (electro-physiologist) the next morning.  I told her without hesitation that I wanted to have the procedure.  I am set to have the procedure on April 26th.  I am starting to have second thoughts about getting it done.  I have butterflies in my stomach and constantly think about it.  Can anyone please inform me with any info about this procedure  for I am due to have it done tomorrow (April 26). Thank you.

Edward

***@****

[kamran]

A doctor has recommended my mother to go with EP Study and perhaps Ablation if necessary. She lives in Pakistan but will come to New Jersey in Summer. I have been trying to find a good clinic/hospital with lots of experience near NJ/NY area where EP Study and Ablation can be done by an expert. Can anyone please suggest a good clinic in NJ/NY area.

[ray888fl]

I have had atrial fib since 1987. Gotten worse over the years. December 1999 I had my first ablation. Didn

[Eric]

Im 21 now and have had this problem since i was little and they thought i was crazy or it was anxeity, until i went to the hospital with a rate of 240, oh let me tell you that was fun ya right I had a Ablation for SVT on June 14 2000, everthing went good or so they told me. In september, that year, sometime during the month i had an episode which i went to the hostipal, and they said it was because i didnt have enough water that day or something. Then i became very depressed and was put on Paxil and Xanxa(which dont take paxil it sucks). Nov. i was on paxil and xanxa which made me have alot of skipping beats during everything sitting, walking, etc. Got of both of those drugs, after they were out of my system everything was good, Dec i was placed on Buspar just for aneixty. Everything since then has been ok but i still get little beats which are called PAC. Its just werid did the ablation do this to me or what i dont know now. But it is now june 9 2001 and i have been on the buspar every since then but now i think that the buspar is causing me to have more pac and stuff, i will be fine all day and then i will have one and then the rest of the day i will just have them until i just lay down or something, i would just like to see if ne one is having this same thing or just some input thanks later Eric