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failed ablation?
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failed ablation?

I am beyond disappointed and depressed.Had my ablation on 9/15,found AV node reentry tacychardia(210bpm). I've continued to have a few skipped beats,rare flurries of brief palps. 2days ago felt my heart beat hard for about 15 beats..every beat hard and fast, as if my heart was in over time. Last night, sitting quietly,felt a skipped beat or two..took my pulse and it was irregular for about 20 seconds..Now, over the years I've had stress tests, countless ekgs and many event monitors.only the last one caught the atrial tachycardia, hence the ablation, finally.  by the way,i had a follow up visit with my cardiologist 4 weeks after ablation & he said my EKG was "perfect" and i had "ambient" PACs that maybe getting in better condition would help.My cardiologist is out of town and the ep doc won't call me back.I'm looking for some reassurance. I'm miserable. more,few, but worrisome palps this a.m.
1. with all my testing,knowing nothing is perfect,how good is the chance some malignant ( as in making me drop dead) rhythm would have been found, especially from the EP study ?
2. could this get better or is it time to face the fact the ablation probably failed?
3.ever seen someone with some runs of fast beats like this get better or is it always a failed ablation?
4. I am also extremely, extremely exhausted.this would scare me except it may just be sleep deprivation from a puppy who wakes me up really early, etc.  If i had heart failure or some kind of damage from the ablation causing this fatigue it would probably have shown up somehow by now(EKG,follow up doc visit,right?)thanks
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239757_tn?1213813182
Lynn,

Im very sorry to hear of your ordeal. I know this whole thing has been quite hard.

1.  Very small.  You rhythms are supraventricular and you've tolerated them well thus far. Your risk 'dropping dead' from this particular rhytm are not significant.

2.  It is common to have irritability in the post procedure period, with increased arrythmias. I would give 6-8 weeks before considering treatment failures. I would also use a holter monitor to confirm event failure.

4.  You should get someone else to walk the dog in the morning.

again im sorry. if you do have a treatment failure, another attempt at ablation may be worthwhile. i would consider a referral to a tertiary care center.

good luck
22 Comments
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Avatar_n_tn
So sorry to hear you are having all of these distressing symptoms.  I, as you know because we have talked before, had my ablation two weeks ago today for AV node reentry.  I am also having some problem such as occasional skips, a few skips that come at the same time that feel more like early beats and I also had a brief speed-up but it did not last more than 1 minute or so.  My pulse is regular but goes up and down in rhythm (72 - 89) and varies from day-to-day.  I spoke with my EP and he has me wearing a loop monitor for the next 28 days.  He states that he thinks my ablation was a success but wants to be sure that there isn't a new arrhythmia that may have now reared its ulgy head which can sometimes happen after an ablation.  I do not think you need to worry about it being fatal.  I do not blame you for feeling this way as I feel the same and am kinda sitting on pins and needles waiting for the other shoe to drop.  EP also said that there is heart irritation for up to eight week post ablation and that this can cause the above symptoms.  He said it was like the old arrhythmia wanting to start up again but has no place to go so then it terminates and like I said, it eventually goes away.  Hope this helps and feel free to post back and talk more.  I will post back.  Ablations (the thought of wires going inside one's heart) is a scarry though and until one experiences these weird heart beats they cannot know how very scarry they can be.  I think the best EP or cardiologist in the world would be one who has had to deal with arrhythmia themselves.  I do not think he or she would be so insensitive then and would pay much closer attention to a person emotional side of this event.
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Avatar_n_tn
Thanks so much for posting. I think I'm about up to that 8 week time and things should have calmed down not gotten worse.

I really don't think anyone will give me another event monitor any time soon..

hopefully, the doc will answer and make me feel better.

hugs,
Lynn
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Avatar_n_tn
>>Some of these tachycardias are not severe enough to warrant ablations and is better controlled with medications that are safe like beta blockers.<

Been there, done that. actually made my palps WORSE but it was all a blessing because when i stopped the beta blockers,despite tapering off, my heart was so "irritable" I had irregular beats 24/7 for a month and finally the atrial tachycardia was caught.

Many years ago, my heart would stay at 200 for hours.. I was basically told I was neurotic and having "panic attacks'. i knew it wasn't so. I learned all by myself to break the fast rate heart by putting my head into cold water and breathing so.. so I'm glad I had the reentry tachycardia focus ablated so i never have to go through the tachycardia getting "stuck" again like that.

But if it took so long to document the atrial tach, i guess i worry that they haven't caught something else dangerous. i try not to worry but it is hard. thanks for your comments.

Lynn
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Avatar_n_tn


>>Some of these tachycardias are not severe enough to warrant ablations and is better controlled with medications that are safe like beta blockers.<

Been there, done that. actually made my palps WORSE but it was all a blessing because when i stopped the beta blockers,despite tapering off, my heart was so "irritable" I had irregular beats 24/7 for a month and finally the atrial tachycardia was caught.

Many years ago, my heart would stay at 200 for hours.. I was basically told I was neurotic and having "panic attacks'. i knew it wasn't so. I learned all by myself to break the fast rate heart by putting my head into cold water and breathing so.. so I'm glad I had the reentry tachycardia focus ablated so i never have to go through the tachycardia getting "stuck" again like that.

But if it took so long to document the atrial tach, i guess i worry that they haven't caught something else dangerous. i try not to worry but it is hard. thanks for your comments.

Lynn
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Avatar_n_tn
( sorry about the double post earlier).

You wrote: I thought your palps only lasted a few minutes or seconds from time to time. I didn't realise your symptoms were this severe, you have every right to be concerned and outright disappointed. I would be also!
Hope you get some answers and the relief and reassurance you so obiviously need.


Yep, for many years, my palps have only lasted a few minutes or seconds with the exception of some lower rate tachycardia around 130 or so for no reason lasting maybe an hour.

My cardiologist says sometimes that happens -- people get the long lasting tachycardia at one age and it disappears at another. But, because they found the reentry source of the tachy, they figured they zapped the cause of my most distressing symptom -- the very fast salvos of fast atrial beats that left me momentarily weak and so scared.. In truth, I haven't had any of that particular since the ablation but when I had the run of fast, HARD heartbeats night before last -- only lasted seconds, but still scary -- I thought.. oh, no, here some kind of tachy comes again.. and then last night i felt some of what felt like possible "bursts" of fast beats again along with skips. my heart felt like a conga drum for a short time.

I was so optimistic, so sure the ablation would be a new start for me. i guess it is not to be... thanks again for your insights and post!

Lynn
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Avatar_n_tn
>>but there has been cases that ablations have cause more distressing and serious arrhythmias than before the ablation,<<

oh, these are certainly less frequent than the bouts before the ablation... but still, at the time they are going on, scary.

I was mostly in my 20s and 30s when I had the racing heart for an hour or more, sometimes daily.. when I was told I was , basically, neurotic and couldn't even get a heart monitor.

I'm close to a decade older than you, not quite.. have great cholesterol, good BP.. I lead a healthy lifestyle EXCEPT for the fear of exercising because of these *&#^%@ palps which I had so hoped and prayed would be gone... at least the scary "salvos" of them.

oh, well.. I'll hush now and wait and see what the kind and learned doc has to say.

L
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Avatar_n_tn
Hi there
Lynn, your story is so, so, like mine, infact it could be mine.  I too was having horrendous bouts of various palpitations and an EP study revealed, guess what, an atrial tachycardia nobody thought was there!  
I started having what I now know to be atrial tachycardia when I was 16, my heart would click into another gear and beat at around 230 bpm for a short while and then click back into normal rhythm.  I last had that particular palpitation when I was 24.  I'm now 47 and in the intervening years I have had irregular stuff, pvcs, pacs, nsvt and I very much suspect a-fib.  
My palpitations became unbearable when hitting 40 and entering the menopause.  Going on HRT has dramatically reduced the bouts of palpitations and also the weird feeling that I had in my chest most of the time - even when not palpitating.  
I kept hearing there may be a connection between hormones and palpitations and here's what my cardiologist had to say on this  - "it is quite common for palpitations to get worse at the time of the menopause and it is known that the cells that may start this are very sensitive to hormones such as oestrogen".  So Lynn, if you are that stage in your life this is one thing you might think about.
The other thing I would say is that my cardiologist thinks I may have been born with an accessory pathway and that would explain my teenage episodes and this pathway has turned into something else as I have aged.
My EP study also possibly revealed scar tissue in the right atrium.  The cardiologist who performed my EP study referred me onto another cardiologist and he doesn't seem to be that sure about the scar tissue and gave some other explanation for the a-tachy but I cannot remember what he said.
I haven't as yet had any ablation as my palpitations have gone quiet at the moment (only 6 or 7 extra beats per day) and so I am holding fire.  I do feel sure though that at some point in my life I will be having it done as I know they'll be back.
Lynn, I do know of a lady who had an ablation for a-fib and it took quite a few months for her heart to show any improvement, the lady I speak of was in a-fib for 80% of the time.  Now, however, after an ablation, her a-fib is very much improved and she is able to work again.
I wouldn't get too dispondent, I think like any wound, time will heal it, and in a few weeks you might find things very much better.  
Very best wishes to you, Linda
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Avatar_n_tn
hi,
im 30 y/o f.  i get runs of sinus tachycardia (about 100 - 130 bpm) that last for hours which literally scare me to death.  i am alone most of the time w/ 3 small children and get very distressed over this.  my palps started when I was 20, went away for years, and now have been back since June with a vengeance.  im sure they're going to kill me.  I was curious to know about what u said about putting ur face in cold water to stop the fast heart rate.  what do you do?  just stick your face in cold water??  does it work??  I have beta blockers, but have never taken them (just dont like taking meds) and was just wondering about this.  hope u feel better:)
thanks.
Pan
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Avatar_n_tn
Yes, I'd definitely take a beta blocker in your shoes Pandora, I think it would do the trick.  Give them a try.
Best Wishes
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Avatar_n_tn
tried to post about 20 minutes ago and didn't show up so I hope this isnt'a repeat!
I have to disagree with Hank a bit on this one. I'm a medical journalist and have talked to several heads of cardiology depts about this subject so , while I'm not offering medical advice, I think you might want to try the cold water immersion. Sinus tachycardia, number one , usually doesn't last as long as yours does. My guess is it is PSVT. Immersing your face in cold water should help regardless because it has a very specific physiological effect on mammals, slowing the heart rate.It worked like a charm on my tachycardia problem while other techniques didn't ( rubbing my carotid artery, pushing on my eyes, bearing down, etc.) The "recipe": take a big pot like you'd cook spaghetti in. Fill it with cold water and throw in some ice cubes. Bent over like you are bobbing for apples.Take a deep breath and exhale slowly through your nose. come up for air and repeat. Immerse your face/head as far down as the pot as you can.It's worth getting your hair wet. This technique worked so fast for me.. it was so helpful when I'd get the tachy episodes at home. here are links tosites that have more info on this technique ( have to read through some info to get to it). some talk about trying to splash cold water on your face. that might help but the immersion into cold water is the only thing that helped me. Also, I found a doc's answer in the archives of this board talking about it, but couldn't get the link to copy.. will try to find it again for your later:

http://www.emedicine.com/aaem/topic431.htm

http://www.healthsquare.com/mc/fgmc0111.htm

http://www.med.umich.edu/1libr/heart/rate08.htm

for technical info on how this reflex actually affects divers:http://www.deeperblue.net/article.php/225
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Avatar_n_tn
Here's the medhelp archive link to more info: http://www.medhelp.org/forums/cardio/archive/1330.html

Also, re: the advice on taking a beta blocker.  Talk to your doctor about it, of course. But beta blockers can have major side effects , although they are very safe, good drugs. They made me so tired I could hardly walk across the room ( no exaggeration and that was on a very, very low dosage) . They can make some kind of palps worse.. they are notorious for triggering or worsening depression in some people . For other people, they work great.  But I sure see no reason not to explore the cold water technique .

good luck!

Lynn

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Avatar_n_tn
I was thinking one thing and not explaining adequately. Of course, lots of people have elevated sinus rates over 100, therefore technically sinus tach for lots of reasons that lasts for hours, days or more ( i.e. hyperthyroidism). I was referring to heart rates that suddenly, like you turn a switch on, go from normal to very fast.. this is most often, I was recently told by the Chairman of the dept . of medicine and famed cardiologist at major med center, PSVT . We were talking about the diagnosis of panic attack vs. PSVT and one clue, he said, that a "panic attack" is PSVT is that in a panic attack the tachycardia that may accompany it doesn't usually last more than 20 minutes.. then starts to slowly go away.. in PSVT, it can last much longer.

Inappropriate sinus tachycardia is a diagnosis that is made after all the other possibilities are elimated.. Pandora, does your heart start beating fast all of the sudden? or does it come on gradually? or do you have a fast heart rate all the time? The answers to your questions can help your doc make a diagnosis.

boy did THIS thread get off topic. I'm still hoping to hear from a doc about my post-ablation questions~
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Avatar_n_tn
thanks for your help, guys.
my resting heart rate is usually between 70-80 bpm.  id like to get it lower.  i know exercise is supposed to help this.  i dont exercise, though.
My doc said sinus tach after i wore an event monitor for 3 weeks.  would an event monitor distinguish between sinus tach and PSVT??  i guess it comes on suddenly, usually after eating, but sometimes just when im doing nothing.  My heart causes me much anxiety, and ive read that panic attacks arent supposed to last long, which is why i don't think it's all anxiety.
Thanks for the sites, lynn.  im going to try the cold water thing.  the other stuff, bearing down, etc., has not worked for me.
Sorry we got off the pvcs and ablation questions.  i really appreciate all your help.
Pan
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Avatar_n_tn
about the event monitor.. I have been on them many, many times over the years and only once did they catch PSVT and only once catch the atrial tachycardia.. although that is CLEARLY what I had going on. So  the official diagnosis, if you just went by th event recordings with the two leads, was "inappropriate sinus tachycardia". But, my symptoms sounded like PSVT.

I talked to the EP doctor about that and he said event monitors are helpful it is sometimes difficult to distinguish between sinus tach and PSVT , and normal fast sinus rhythm and atrial tachycardia on these tests.  So the EP study was the appropriate test and finally clarified things.

Medicine is an art and a science -- meaning that physicians have to rely on clinical impressions, signs and symptoms as well as technology to come up with the most reasonable diagnosis. In my case, that was PSVT, even when the only document fast rhythm for the longest time was sinus rhythm.

So hang in there... keep looking for answers. and good luck!

Lynn
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21064_tn?1309312333
Hi Lynn! I had an ablation for multifocal pvcs on 8/1/03 and was pretty much symptom free for about 2 weeks. They ablated one predominant foci. They attempted to aggravate other foci, but the ablation calmed everything down and they were not able to isolate another foci. Began experiencing pvcs about 4 weeks post procedure so the doctor ordered a 30 day event monitor to be sure there were no "significant" new arrythmias. The event monitor showed pvcs, but apparently nothing more prevelant. At my 6 week follow up appointment, I was experiencing frequent pvcs again. Doctor wanted me to wear a holter monitor 10 weeks post ablation to quantify ectopic activity. The holter came back with frequent pvcs (no surprise, since we knew I was multifocal) and a second ablation was suggested. Had the procedure on 11/7/03 and so far I have had only a dozen or so pvcs (mostly the first few days). I know they may creep back up on me, but for now I'm enjoying the rhythm of a synchonized beat!! It's awesome! Try not to be discouraged as it does take a couple of months (2-3) for the heart to calm down from the procedure. It sounds as if you are not having the same level of arrythmia, so that in and of itself could designate a successful procedure. If you continue to be concerned, ask your doctor for an event monitor. That may give you greater reassurance.
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Avatar_n_tn
You wrote:
>>>1,You rhythms are supraventricular and you've tolerated them well thus far. Your risk 'dropping dead' from this particular rhytm are not significant.<<

Yes, but I guess what I'm asking is would the EP study have elicited any otherwise occult propensity toward a malignant ventricular rhythm?  

>>It is common to have irritability in the post procedure period, with increased arrythmias. I would give 6-8 weeks before considering treatment failures. I would also use a holter monitor to confirm event failure.<<

As I wrote, I had the ablation on Sept. 15, 8 weeks ago. However, my symptoms are far fewer.. just still happening on occasion. So would you say there's still a chance things could calm down more? (I doubt i can get another event monitor yet as the insurnace company is refusing to pay for the last one that led to the ablation! )
>> You should get someone else to walk the dog in the morning. <<

I wish! Some things -- like palpitations -- seem to be one's fate in life.

Thanks again.

Lynn
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239757_tn?1213813182
Lynn

No, you will not have a highr propensity for malignant arrythmias.

I think if you notice a large difference in your symptoms, I would be encouraged to hope for some improvement in the next few weeks.

Lets see. Try not to worry, believe it or not, there are worse fates.

update me.

good luck.

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Avatar_n_tn
I remember telling my mom my heart feels funny (when i was very young) and i didnt get diagnosed with SVT until i was 16.  I notice it gets worse every year and i am worried because i am young, i have 9 month old twins and a whole life ahead of me and a wonder what condition my heart will be in when i am older. Every morning i wake up and i feel dizzy, short of breath like i ran a marathon, i ALWAYS feel like my heart is pounding and you can even see it pounding very hard, even when i am resting.  I feel weak and i cannot lie on my back because my chest feels very uncomfortable. I have to sleep with several pillows or i feel like my chest is caving in. i had an ablation in march ( i was in there for 6 hours because it was in a rare spot) and another ablation in july.  i still have SVT. I have had these symptoms before i had the twins.  i always have them and they always feel worse as time goes on. And since the second ablation i see light visuals like flashing and "stars" along with a headache. I've gone to the ER several times with chest pain or discomfor and palpitations but my blood work is fine so they send me home telling me that i am young so i am okay. but i don't feel okay and i know that being young, i should not feel like this everyday. i feel like no one can help me. Any sugestions? could i have more than just SVT? and what condition is my heart going to be in 10 years from now?  Plese help me.

***@****
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21064_tn?1309312333
CONGRATULATIONS ON THE BIRTH OF TWINS!!! How exciting!!  Sorry to hear you are having such a tough time with the SVT. I also had 2 ablations this year (for pvcs), but what prompted me to write was your comment about the visual disturbances. I had that after my first ablation in August. I did not experience the headache, but definitely had these visual auras to the left of right. They were flasing, jagged lines and the doctor said they are ocular migraines. I had 2-3 of them in the past, but after the ablation I had many for about 3 weeks. They decreased in frequency over the 3 weeks.  Dr. speculated that maybe it was because I had gone off of Rythmol which has a beta blocker in it, and beta blockers are sometimes used for migraines. Thought maybe it was a withdrawl (withdrawal) type thing....dunno. After the second ablation, I woke up with a headache and the flashing lights...But, only one minor occurrence since then (10 days ago). Interesting!

Have you had an echocardiogram or EKG recently? What are the doctors saying about the chest pain? Have they explained why you continue to have SVT after 2 ablations? Wishing you the best and enjoy those babies!
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Avatar_n_tn
Momto3:
Have you had an echocardiogram or EKG recently? What are the doctors saying about the chest pain? Have they explained why you continue to have SVT after 2 ablations? Wishing you the best and enjoy those babies!


Yes and it was normal at that time.  The doctors didn't really say much about the chest pain but to come back if i have pain again, however they would just say the same things. the doctors never answer my questions.  But the pathway that caused the SVT was in the center of my heart, right next to the heart's natural pacemaker. so it was tough to get to.  Thanks.. i sure do enjoy them :)

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Hankstar:
My svt varies it can be extremely fast or not.  but once on a holter monitor it was recorded at 230 and strangly it felt like a slower episode, i was suprised. so i am guessing anywhere from 120-300s.  
no i don't know what type of svt i have.  when my heart pounds it isnt necissarly beating fast or slow but just that it beats very hard and it is noticable from the outside.

i guess i just wonder if i have anything else (other than svt) and mainly how my heart will be 10 years from now.

thanks for responding.

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Avatar_n_tn
I just sent a message to you on another thread before reading this one.  Sorry about that.  I really do agree with Hankstar when he said that you should wait it out a little longer.  We are only one week apart as far as when we had our procedures.  I am still having some symptoms, but they are better than they were, say a month ago.  My girlfriend gave me some great encouragement that I'd like to share.  She had a Fybroid operation a few years back and she said she would still have times when she was "aware" of the wound for quite some time.  Well over 3 months.  She was patient and now feels great and urged me to be patient as well.  I know it's a different thing, but despite how you are told that you should be fully healed within, 2-3 weeks, 6-8 weeks, or 3 months, internal wounds may not heal for a while.  BTW, I've heard all of those time frames and more.  Makes you question their validity.  I've just grown to understand that the only thing I can trust is my own experience, not someone elses guidelines.
   It sounded as if you were having trouble with you EP.  Mine also has a tendecy to "forget" to call me.  I decided to seek out new doctors for extra reassurance.  I am still waiting to see an EP, but I have seen a new cardiologist who has been very active in checking me out just be sure that my hearts general health and function are o.k.  I strongly suggest that you get another opinion and a little assurance that your going to be fine.  If nothing else it could relieve some of the stress.  Believe me these have been the most stressful 2 months of my life and I know it's the same for you.
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