ABLATION - AVNRT

[Leah39]

I had my ablation in October 2013.  Experienced PAC after procedure and 1 week post op experienced the SVT.  I saw improvement over time and PAC decreased over next few months.  Now, out of nowhere I am experiencing severe PAC/PVC lasting for weeks.   It's horrible.  I'm having them every few beats at times lasting mins to hours.   They have been constant.  Along with that I am getting the rapid heart rate at times.   These are the symptoms that were the onset of the AVNRT.  I've seen my EP and he tells me EKG is fine.  Wants me to buy a device that connects to my phone that will monitor my heart like an EKG so I can record my episodes.   It feels like I am back to square one.  Has anyone had multiple ablations?  I've been told if I need another one I will likely end up with a pace maker.   This condition has altered my life in many ways.  I still take beta blockers.  Anxiety medication which is a result of the SVT.  I have eliminated caffeine, tobacco, alcohol, cardio excercise, ans still no relief.  Am I the only one?  Help... I'm only 39 years old.  

[tom_h]

To describe the procedure at a layman's level ( which is the best I can do), If you had AVNRT, the reentrant pathway was merely blocked or severed by the burns and subsequent scar tissue buildup.  In other words, the circuit remains, but it can no longer conduct.  Think of it merely as snipping a wire in half.  Sometimes, the conductive muscle tissue can reform and literally bridge the roadblock of scar tissue, a splice in the wire if you will.  When this happens, conduction resumes.  With AVNRT, the conductive pathways are formed from tissue that behaves very much like the AV node, and some physicians even regard them as part of the AV node.  The use of cryoablation in these sensitive areas allow an electrophysiologist to literally "try before they buy".  They can freeze an area to temporarily halt conduction, examine the results and allow it to warm up and reconduct if it doesn't look good.  When the spot is found, the freeze that be applied to completely destroy the tissue with a cryogenic burn.  If you current electrophysiologist doesn't practice cryoablation (some don't) I'd search around and find one who can try it again using this method.  Of course, a pacer could be required and one is always ready just in case.  But you're probably young enough to greatly benefit from getting rid of this once and for all.  If it were me, I'd want to try it again.

[RNRita]

Although I have not had an ablation, my heart reacts very much like what you are saying.  I can go for months or years without anything that really bothers me, then out of nowhere, I can start having them, and they can progress to bigeminy for weeks.  Sometimes I have feelings that I don't even know what is going on. It is just that weird.
My question is, are you more tired than usual?  High stress and anxiety, then fatigue predisposes me to my bad months....

[Leah39]

The pacemaker was mentioned by my EP because he feels if another ablation is done, because my pathway is located so close
To the av node it could potentially damage it.   Therefore needing a pacemaker.   I guess I don't understand how out of nowhere after having the ablation 2 years ago my symptoms are all coming back.  I was fine for almost two years with very little issues.  Or at least livable issues.  Now the PVC/PAC are so severe that I can't do anything without having them.   Just curious if this has happened to anyone else

[VCJohnson]

In answer to your question about multiple ablations, I've had three EP lab studies. The first was 3/2014 and my EP ablated a slow pathway (AVNRT)very near my A/V node.  But like you, my PVCs became much more frequent over the next 9 months.  Also, short runs of SVT continued for about 9 months.  During my 2nd and 3rd EP studies, SVT could not be induced.  My EP probably ablated it all the first time.  In retrospect, I think that my 2nd and 3rd ablation attempts were unnecessary.  Now after about 13 months, the SVT has stopped completely and the PVCs are very infrequent and occur very rarely, and when they happen it is only during intense exercise.  I take no medication.  I already had a pacemaker implant 15 months before the first ablation, for 2nd degree heart block, Mobitz type 2.  You said that you were told that if you have another ablation, you would likely end up with a pacemaker.  I've never heard of a pacemaker implanted for PVC/PAC or SVT.