wide complex tachycardia

I am a female 34yrs.  I have a pacemaker for SND.  I seem to be having a number of arrythmia problems, despite meds.  including amiodarone, and cartia for rhythm.  I have asthma so cannot take beta blockers, and developed long QT with tykison.  Have done, rhythmol, tambocor, sotalol and the one that worked the best thus far has been amiodarone.  Now however, I am not responding so well to it.

I am getting alot of arrythmias, and I am wondering if a person can develop a tolerance?  I am at the highest dose they will allow 400mg.of amiodarone with elevated liver enzymes.

My last 24 hr. holter showed 2000 wide complex beats with couplets, triplets and runs of sustained wide complex tach. I have a-fib.  Is it possible to know for sure if this wide complex rhythm is v-tach, or a-fib with aberancy without an EP study?  My ventricular rate gets up to almost 300, and I don't feel well.  When this occured at one point while I was being monitored I had a relative drop in systolic pressure (20-mm).

What is the signifance of this report?
Is a relative drop in blood pressure acceptable when I get this problem at home?  Can I just wait it out?
Are there any further steps that can be taken at this point?
Thank you so much.

[CCF-M.D.-RCJ]

lyn2,

Sorry to read of your troubles.  I find it very unusual that a 34 year-old woman has sinus node dysfunction, afib, and possibly VT.

The significance of the report is that your arrhythmia(s) is/are poorly controlled.  A diagnosis is essential and should be sought aggresively.

Distinguishing between afib with aberrancy and VT can be tough from a holter, but should be possible in greater than 95% of cases if caught on an ECG.  Thus, hospitalization with monitoring by ECG could certainly be an initial alternative to an EP study.

Seek an opinion at a major medical center with an EP service.  You are too young to let this go.

Good luck.

[seska]

hi

I am a 27 yr old female. I also have sinus node dysfunction (sinus arrest, brady and junctional rhythms caught on ECG many times, tho it is not bad enough for me to have a pacer yet). Mainly my real trouble is IST, I have documented episodes of sinus tach up to 200bpm climbing stairs (about 10 steps), my resting rate is usually 120 - 140bpm (although I am not aware of any 'palpitations' under a rate of about 150). I also have documented VT (longest known about was 3 minutes long).

I was always told how strange it was that I could have so many things going on in my one heart! I think I have confused my cardio! I am not on meds now for the tach because they make the SND worse, though seem to have tried practically all the same ones you have.

I hope you get appropriate treatment soon and I hope you have a good EP looking after you care. Best wishes.

Seska