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had an abnormal EKG and set for new EP study
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had an abnormal EKG and set for new EP study

I had an ablation sept.15 for AVRN tachycardia.I havecontinued to have many palps,including runs of fast and irregular beats but was basically told i must be anxious and depressed and was started on 10mg.prozac.
yesterday at my postablation checkup my cardiologist said the ekg showed something that had never shown up before.something about the P waves.he said it was supraventricular and,ithink, ectopic tachycardia?

He seemed concerned,frankly,but told me it isn't life threatening but wants to me to have an EP study/ablation ASAP (early next week it looks like) "while this thing is showing up". he showed me a diagram of the heart and where the reentry tach had been zapped and said this newly caught arrhythmia was coming from up above it.

My pulse has been around 100 for a couple of days, by the way,after a computer crash and literally no sleep for one whole night and mega stress.

Can you throw any light on what might be going on with the P waves?Does this sound like something easily fixable(usually) via ablation?
Could it cause the irregular beats as well as fast rhythm?

could the prozac had precipitated these ekg changes( my doc doesnt' think so)?

I feel like my heart is beating fast with sporatic skips, "drops" and runs of faster beats. I am so tired of this.20 years of trying to convince the medical world i'm not "anxious" but, indeed, have something funky and disturbing wrong with my heart rhythm. I KNEW the ablation hadn't "fixed" me. and i was right.

thanks in advance for your answer.

Best wishes,
Lynn
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239757_tn?1213813182
lynn,

The P wave is the electrical representation of your atrial chambers beating on the ecg. Normally the atria begin to beat form the top of the chamber down to the connection with the ventricles.  Any abnormal beating changes in the activity of the atria can often be shown on the ecg.

Most likely your doc saw an abnormal structure of the p wave which represented abnormal electrical activity associated with atrial beating. The abnormality is causing your heart beat to beat faster then it should.  

It is not related to the prozac.

Yes it is something that is amenable to ablation.

Lynn, you've posted here alot. I don't think anyone has doubted that something is wrong with some aspects of your heart. Because of such, you've had ablations to correct some of the abnormalities. This, ectopic rhythm is something that sometimes can arise out of an ablation.  Remember, alot of people have anxiety issues completely aside from the other medical conditions that they have. It might be wise to continue to seek treatment to address some of your anxiety issues because that might be a more complete 'FIX' for you in the long run.

take care



19 Comments
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Avatar_n_tn
Prozac is almost definitley not responsible for the change in your P Wave. Chances are that the ablation either exposed another arryhthmia or created one. Follow your doctor's advice for the EP study and see what it happens next.
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Avatar_n_tn
>>This, ectopic rhythm is something that sometimes can arise out of an ablation. <<

how so? from cellular damage done by the catheters? or what?

Yes, I'm anxious about heartbeat... trust me, if 20 years ago  ( for many years off and on, sometimes daily) your heart got "stuck" at 220 rhythms and your doctor blew you off as having "panic attacks" that lasted for hours ( I call it psychic medicine.. she could just TELL with no documentation).  and if you had felt like you were about to black out off and on, evenif momentarily, for the last few decades, you would want to get to the bottom of your heart arrhythmia problem.  I have managed to do an amazing amount of stuff in my life -- but only I know how hard it has been to deal with and hide the ongoing arrhythmia problem. I know that while other people may think I'm just anxious or scared or weak, I have been quite brave. I know that in my, forgive the phrase, heart of hearts.

I have tried to blow off the constant blips, skips, runs, tried to take drugs so I won't care... but I have always known that there was something quite wrong and while I am not asking for a perfect heart rhythm, I would like to think anyone in my situation, feeling as badly as I do most of the time ( I've been sitting here in tachycardia for days non-stop) would want to do something other than ignore it, take drugs and say, well, that's ok.. live with it..

Thanks for answering my questions.

Lynn
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Avatar_n_tn
Lynn - I'm really sorry for you, you ARE brave.  Stay in touch.
Best Wishes, Linda
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Avatar_n_tn
I am so sick of people laying this heart rhythm problem on anxiety.  I wish every bleeping doctor could experience these weird, rapid, wild, scarry heart rhythm for just one week and then tell me if a head check is in order.  I think if I read one more post about anxiety being the blame I am going to puke.  Here is an interesting story that happened to me.  After an accident in a swimming pool I started to have pains in my back and my sides.  Pretty soon the pain was so severe I had to sit up all night with my back proped against the wall for relief.  It wasn't long and I slowly begin to lose the use of my right leg and had very little sensation as well.  To make a long story short, I seen 8 different doctors over the course of all of the above and was told "go home and live your life, it is just anxiety."  "We can't find anything wrong with you." "Live with the back pain."  "Women have lots of back problems due to fatigue." etc., etc.  Finally, the last doctor I seen was a woman and for the first time I was told "There is something very wrong with you and I am sending you to The Mayo Clinic."  Well, by this time I could hardly walk, and had the most horrible pain ever.  Within 2 hours at the Mayo I was in surgery for a thoracic disc slowly severing my spinal cord.  I was told that a few more months and I would never have walked again.  So much for the anxiety bull####.
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Avatar_n_tn
Linda, thank you for your kind words.. God bless you.

Glassheart -- what a story! I am so sorry you had to go through that but so thankful SOMEONE finally took your pain seriously and you got help...

I would never deny that there is a mind/body connection. I am a big fan of Candace Pert's seminal research on the matter and have read extensively about psychoneuroimmunology, for example. HOWEVER, that said, it is ridiculous to so often blame truly physical ills ( that CAN, of course, produce anxiety and depression) on psychosomatic causes .  I have so many examples -- a dear friend who was losing weight, sick to her stomach constantly, and after biopsies were fine was told it must be anxiety -- SHE TRAVELS ALL OVER THE WORLD! I could not BELIEVE no doctor put the fact she had returned from Thailand right before she came down with her "mystery neurosis". In fact, she had a parasite ( only discovered because her FRIENDS suggested it and she kept fighting tooth and nail for a diagnosis).

Oh, well, don't mean to get off the subject.. but I, too, am sick and tired of the emphasis being on anxiety and depression instead of getting to the physical causes when symptoms are not quickly able to be diagnosed.
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Avatar_n_tn
on my last EKG it said NON SPECIFIC T WAVE ABNORMALITy....i wonder what that means? well i know how u feel, my heart rate is constantly at 100 BPM. i got my holter results and i have 751 PVC's and 3.3 hours of tachycardia, no svt's in 24 hours.my cardiologist recommended i start taking Ameradone, but that drugs scare me, im only 18 i dont want to start taking a drug that can kill me. well the doctor says i need to see a EP ASAP so they are going to call me in the next few days to set up an apt. he said an ablation could possibly be done but how could that help my sinus tach? good luck with your second ablation. kim
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Avatar_n_tn
The ablation could actually cure the tachycardia.  The amiodarone is a very effective drug though with many side effects in preventing and controlling atrial arrhythmias.  My electrophysiologist explained to me that even though my ablation may interrupt one pathway, there is no gaurantee that another pathway will not develop which is what really happened to me.  There is a lot that medical science still does not understand.  I have been told that electrophysiology is still in its infancy stage.  There is a much that is known but there is still much yet to be learned and therapies yet to be developed.  I have been encouraged to try to stay on medications and that in a few years there will be new approaches and new ablation techniques that could help me.
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21064_tn?1309312333
If it's of any help to you, I have had 2 ablations and am doing quite well. My first ablation (8/03) was for pvcs and RVOT tachycardia. Although it was a success, I still had frequent pvcs from another foci. The second ablation (11/03 LVOT) was to reduce/eliminate another pvc foci. After years of pvcs and I believe NSVT, I am nearly free of the ectopies. Hang in there...the second one was the charm!!

I understand your frustration regarding the anxiety issue. I suffered with pvcs for over 20 years also. Who wouldn't be anxious with palps, dizziness, SOB, etc? I hope your second EPS study is able to pinpoint the trouble spot and that a RFA will knock it out for good!! Hang in there Lynn!

connie

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Avatar_n_tn
Thanks, Connie!  I was awakened 4 times last night with my heart beating irregularly. I am exhausted and trying not to be scared -- and trying to believe that maybe the next EP study/ablation will actually cure this.

best,
Lynn
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Avatar_n_tn
Hi Kimma,
Good luck with everything and please know I understand what you are going through as do many, many of us on this board!

I think there's a good chance the ablation could help so you don't have to take the drugs. Please keep me posted on how things go.

Lynn
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Avatar_n_tn
I'm pretty sure it was an AVNRT ablation. I had had another EKG about six weeks after the ablation that was normal. My cardiologist  is a highly experienced heart expert,chairman of the dept.of medicine, and he was clearly concerned about my EKG. I am sure he would have known if the changes were something seen sometimes after an ablation.. he didn't give me any details except to say it appeared my tachycardia ( which i was in at the time) was supraventricular and it appeared from the P waves to be coming from up in the atrium well up from where the ablation was done. If I understood correctly ( and i felt dreadful so wasn't taking everything in) , i believe he was saying my heartbeat was originating from up in the atrium -- from ectopic foci not from where it was supposed to be originating. He said it was definitely supraventricular and not life threatening but he wants me to have the EP study/ablation while this is showing up.. plus i am so symptomatic i am miserable.

Lynn
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Avatar_n_tn
Lynn,
100 bpm is low/normal for me! :-)                        

Good luck, hope they can do something for you!
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Avatar_n_tn
What is ablation and what qualifies one to get it?
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21064_tn?1309312333
Hope this helps...It is from the NASPE website http://www.naspe.org/

An ablation is a procedure that involves inserting catheters into a blood vessel (often the neck or groin), and winding the wire up into the heart.

Once the catheter reaches the heart, electrodes at the tip of the catheter gather data and a variety of electrical measurements are made. The data pinpoints the location of the faulty electrical site. During this
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Avatar_n_tn
Hi Lynn.  I know I've commented before on my feelings regarding anxiety, and how detremental it is, but I'm behind you here.  Don't let anyone make you feel like your crazy.  Your symptoms (as well as mine) are no doubt physical problems.  Glassheart's story really has a great point.  I think we all know someone who's either been misdiagosed or been told to move on when there really was a problem.  Keep fighitng on!
   Just for the record, I do think the doc was trying to be constructive with the comment.  I hope you didn't take it as a dig.
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Avatar_n_tn
I have had PVC's, flip flops, and even some tachycardia off an on through the years...it started when I was twenty. (I am 47 now) And the drs. told me the same thing...your heart is fine...it is just anxiety. They even sent me to a psychiatrist to deal with the "anxiety." Well guess what? My heart is still flip flopping away whenever it feels like it. The therapy made me feel better about my life but didn't do anything for my palps. I have just learned to live with them. I am 47 now, going through menopause, and the palps seem to be worse now because of the fluctuating hormones. And guess what? My dr. told me that menopause doesn't cause OR make palpitations worse. I beg to differ with him. Told him to read a few of the good books on menopause written by very good doctors such as Dr. Christiane Northrup, and THEN tell me that fluctuating hormones can't cause palpitations. If I hear one more doctor tell me that it is all anxiety I am going to SCREAM!!I would like to know what the CCF drs. think about the hormone/palpitation connection....

heartdancer
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Avatar_n_tn
You seem to know a lot about this subject.  

Have you heard of the new procedure, "transthoracic Maze procedure" that is done OUTSIDE of the heart? My cardiac surgeon says there is "practically zero" risk of the clot/stroke that is concomitant with the RF ablation typically done for AF.  He feels this is the way to go.
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Avatar_n_tn
Thanx for your reply.

I goofed: the procedure is called "thoracoscopic Maze procedure".  and yes, they go in between the ribs with the arthroscopic instruments and 'scope and manipulate them outside the chest wall while watching on the screen.  I was given the stats 70-90% success rate with "practically zero" risk of clots/stroke vs. the 30-60% MAYBE success rate of the typical RF ablation procedure.  My cardiac surgeon has done lots of the other types of thoracoscopic procedures as you mentioned above, so feels confident this is the way to go for me.  He works together with my EP doc who has been going in afterwards with the catheter thru the femoral vessel to the heart to make sure all of othe foci have been treated.  (and to collect data for their research manuscript and success rate stats), but I refused this second procedure.  I'm just gonna take my chances that the mini Maze procedure will do the trick.

You are right about it's being NEW:  when I scheduled mine, my surgeon had done ONE! (successfully)  He's done about 8 by now, and I'm waiting to hear how successful they are.  'Course there are no long term stats since this procedure is so new, but I'm happy to be a guinea pig if it'll help others.    :-}

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