20 years of SVT now A Fib

[bellaT]

I am 35 and have had SVT since I was 14. At first, I got it once every few years. For the past 10 years I'd say I have an episode once a year on average. I always convert on my own within an hour or so. The medics and ER docs insist I convert with adenosine but it never works. I go right back into SVT and after Valium and letting the adrenaline wear off, I am back into normal rhythm. Last week, an SVT episode happened again, but this time right after the second adenosine push I was in atrial fib. This lasted in the ER for 5 hours, while on a betablocker IV drip. We were waiting for my lunch to digest so they could shock me. Well, thirty minutes before it was to occur, voila, I came out of it.

I have had a normal stress test, normal echo, normal resting 12 lead EKG, thyroid and cardiac labs. I never had atrial fib before this. Well, after feeling it, I can say I might have had it once a few months ago but that's not verifiable.

My question is, I am a good candidate for an EP with ablation? My doctor, I found out on this forum, accidentally ablated a young person's AV node and now I am worried about.

Thanks,
Tamra

[imagery]

I had a cryoablation (freezing) for AVNRT about 9 days ago (I had two AV junction boxes). I don't have heart block and the operation was a success. It took about 2 hours and they made a total of 9 full freezes in my atrium. The only thing I can tell you after such a short amount of time is the SVT has not since occurred. However ... and this may just be a result of my anxiety ... it does feel like I get more PVC's or PAC's when I exercsise now that the ablation has been done. Again, this may just be my anxiety .... I dunno. I had the occasional PVC or PAC (dunno which I feel) prior to the ablation, but there seem to be far more now when I exercise. I rarely feel them at rest. It could be that I am obsessing about my heart when I exercise which causes anxiety which in turn causes more skipped beats. These skipped beats are why I still lurk the forums.

BTW: I have a structurally healthy heart, BP 110/70, resting pulse 72, electrolytes normal.

Don't be affraid to ask your doctor questions about his success and failures. I asked some very directed questions; how many have you done (3,000+), have you ever unintentionally caused heart block (once with RF, never with cryo), has anyone ever died from one of your procedures (no), has anyone ever had serious complications  from one of your procedures (yes; punctioned heart wall and sack around heart had to be drained, pulmanary embolism from a blood clot). If he can't answer these questions, then you don't want him operating on you. Period.

I agree with the doc; the internet can be a very dangerous and biased place. People who don't have heart concerns don't post in these types of forums. For example, if someone had a successful ablation and no other conerns/complications, they most likely would not conitnue to read/post in this forum about their success. They would no longer be reading about their problem. However, if someone did have a complication from an ablation (AV node destroyed), you would see them post. So the number of complications seems far more prevelant than successes when reading internet forums.

[Michael J. McWilliams, M.D.]

Tamra,
Adenosine can cause atrial fibrillation -- this is not a concern.
Any doctor can cause heart block by ablating the AV node.  The risk is approximately 1%.  The problem with the internet is that people use it a weapon sometimes if they have a complication -- they are only bound to tell their side of the story, I am sure your doctors side was not well represented.  Ask your doctor what complications they have had and how many.  If they took at 3-4 AV nodes this year, it might be time to find a new doctor.  This might have been his only complication ever --  you never know unless you ask.

It sounds like your arrhythmia might be treatable with ablation.  You will have to hear your doctors risk/benefit discussion and decide if it is acceptable to you.