Ablation vs. Medication

[pg1949]

I've had SVT for several years, but ended up in the ER this week and had to be converted.  My doctor has offered the choice of medication or the ablation procedure.  I'm 58, active and don't want to take medicine the rest of my life.  I am going to the Cleveland Clinic for a consultation regarding catheter ablation.  My family is against this.  I've been having an SVT episode about once a month now for 2 years.  I'm always able to convert, until now.  I just want to be rid of it, but I don't want to do anything foolish either.  I'm just confused and would like to hear anyone who also had to make this choice and how it turned out for them.

[js555]

hi i am 20 years old i think i have this! i first started noticeing it my senior year in high school sports! as time pasted my freshman year i was playin college baseball and i would just be bending over or throwing a baseball it didnt matter what i was doing i would have everything yall have been talking about! i went to a heart doc and he put me on 50mg beta blockers and they dont work ive been to the er twice cause my heart rate went up to 204! they arent sure whats wrong yet but my walking just relaxing heart rate is around 185! is it ok to play sports with this? i am a sophmore in college and i am about to turn 21! ive been on meds for almost a year!they just arent workin! what can i do?

[richtemp]

Also sorry about the spelling i have paroxysmal supraventricular tachycardia
For those wanting to know these are the forms
Premature beats
Supraventricular Arrhythmias
Atrial Fibrillation
Atrial flutter
Ventricular Arrhythmias
Ventricular Tachycardia
Ventricular Fibrillation
Bradyarrhythmias
Triggers: Stress, Smoking, heavy alcohol use, heavy ecercise, use of certain drugs (cocaine or amphetamines) use of certain perscription or over the counter medicines, and too much caffeine or nicotine so there you have it probably already metioned but just a reminder also metropolol should not be used if you have asthma in which i do thats why they tell me to take as needed there i will leave everyone alone for now lol!

[richtemp]

I just got out of the hospital and was looking up proxysmal superventricular tachacardia in which i had (hopefully i'm cured lol) But i was told 3 hour procedure it took 6 hours fro what i understand i had to have 18 to 20 ablations in which the doctor had told my mother and wife i still havn't talked to him to be sure. They were on the right side of the heart and had to poke through the septum to get to the left side of the heart to do some there and guess on the outside of the heart for some. (now with saying this my wife and mother told me this and the doctor told them) I hope this is over for me because he also told them i might have more he is not sure on the last one my heart came out of a tachacardia attack and he tried to induce again but wouldn't tachacardia again in which is good! He did state however we would know in about a year from now. This started when i was 13 years old mildly. They were never quite sure which form of tachacardia it was till about 22 when the cases started getting worse. Now every one with this might agree that it is hard to really know which one it is unless they actually catch it in the act. This also is hard because by the time you get to the hospital you usually can convert yourself and by then EKG thinks everthing is normal which made me feel like an idiot as you might expect. Well 2 weeks ago i had to call a ambulance out to my home because after 20 minutes i couldn't convert myself and they had me try in the ambulance and i still couldn't my heart rate was 255 beats per minute so they gave me adenisine which there was a delayed reaction but it stopped thank GOD. After being observed in the E.R. for about 3 hours i was released went home went to bed woke up maybe 30 minutes later with another full blown attack i waited for a long time to call this time lol i felt kind of imbarrased but i called the E.R. nurse and they told me to call 911 again well this time they got it on EKG only this time it was 247 beats per minute so once again they administered the medicine and it was another delayed reaction. Back to the E.R. 3 hours released saw cardiology or Electrophysiology and set up the procedure. Now to tell you the truth they really don't know which tachacardia it is until they actually go in because i was diagnosed with SVT and ended up being PSVT and they really don't know how serious it is until they go in in my opinion! Now the procedure was painful for me and i can stand pain by the way i'm a healthy 28 year old male. But i would never want this procedure done ever again. Maybe the reason why it was difficult to diagnose me was because i showed signs of alot of the different tachacardias. I only remember 20 minutes of the 6 hour procedure! If you are only having a mild case of tachacardia then i suggest not the ablation unless your doctor ensures you this is the right thing to do in your case especially if you are young. But the downfall of the medication is that you will have side affects and the medication is only 50 to 60 percent effective. Now the way i got my arrythmias to stop was by laying on the floor breathing in for 10 seconds then holding my breath and baring done as hard as i could for 10 secounds this usually got rid of the problem within 5 minutes of doing this. When you come to a point when you a passing out from this then its time for the ablation! But this is just me so i say good luck to all you ablation patients because it wasn't that great for me and i would never want it again but on the other hand i can hopefully say that i will never have another attack so pick your evil lol!

[pg1949]

Weeks ago you asked me to keep you posted.  I had my ablation on Tuesday, with Dr. Dresing at the Cleveland Clinic.  It was indeed AVNRT, but with currents circling in both directions. They said my situation was a challenge and it took 7 hours.  I feel great and have not one skip, flip or flutter.  You are right.  They are great there.  It could not have gone any better.  I am off my Cardizem, hopefully for good.  I want to thank you for being at this forum for all us of who suffer from all types of arrythmias.  I feel like a new person.  Thanks again.

[Michael J. McWilliams, M.D.]

Neither one will hurt you if you have a structurally normal heart.  SVTs tend to be relatively easy to fix, NSVT can be quite difficult to fix.

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[sophie2005]

I have been diag with atrial tack - Had an attempted ablation & the doc told me he could not get my heart to go into tack. I have tried inderal, toporal, arithymal - nothing works. Does anyone have a problem when you are taking a nap or falling alseep for that matter with your body jerking & waking you up? I am so depressed about these attacks - as one person said their attacks come on at anytime as mine do. This has affected my life. I hate that it has this kind of control over me.

[Smitty150]

My situation was this: bothersome Paroxsysmal AF for 15 years getting progressively more annoying and with more-frequent episodes. PIP did OK but it took 4 hours and the meds wiped me out. My local EP told me I was moving toward Chronic AF. I then failed suppressive meds and decided to go for the PVI BECAUSE the success rates are high when one is still in Paroxsysmal AF but much less so when one has progressed to Chronic.

I had the procedure at CC with Dr. Walid Saliba. He asked to use the robotic options (for positioning the catheters) and I agreed. The procedure itself was a breeze and boy does it feel good to be in a "production line" of patients being prepped for the EP Labs!

Yes, my local EP offered to do the procedure, but he's the Lone Ranger in my town. How well does the hospital staff assist him when they do relatively few procedures? What does he do if he gets in deep doo-doo and can't page Andrea Natale for help?

I am 2+ months down the road and have no symptoms and am taking no meds. I send the CC an EKG FROM MY HOME PHONE every week. I go back in November for an Echo, an EKG, and a CAT plus a meeting with Dr. Saliba. Yes, all these are very common tests but I think the technicians giving tham at CC and the doctors interpreting them will be tops.

The PVI procedure is "mature" in the sense that many local and regional centers can perform it. On the other hand, it is by no means an institutionalized one.

If I need a suit I may go to The Ajax Discount Men's Store, but if I am going to meet the Pope (and not Saint Peter), I'll go to Brooks Brothers!

[heartysue]

Thank you for your good wishes, I just love your expression "you're gonna knock the AF outta the park!!  "

I will hold on to that thought lol!

[Momto3]

Good luck in December!!!  You've got a great attitude and seem like you're gonna knock the AF outta the park!!    

I also ended up with 2 ablations...I thought the 1st one worked well enough, but the doctor didn't agree.  So, it was back to the "table" and I must say, she was right!!  It has been about 4 years and I'm still just getting occasional blips. Hope you have great results with the upcoming ablation (an early holiday gift perhaps...)

[heartysue]

Have found the posts here very touching to read..

I had an AF ablation in May of this year - all was well, apart from the odd missed beat, for about  10 weeks, and then the AF attacks returned, for 1 hour, 3, 4,6 and unfortunately I have had several now, lasting 20-22 hours :( - the ECG shows that as well as AF, I now have Atrial Tachycardia.

I return to my hospital early December for a touch-up ablation (which has an extremely high success rate) so am praying I will get fixed then.

Like someone said earlier, I too want my life back, having these attacks every 36 hours at the moment is no fun and quite exhausting.

Have been offered Flecanide as a pill in the pocket - that strategy hasnt worked yet, and I can, if I want to, start to take 2 x 50mg of Flecanide daily up to the operation date - I am not sure what to do, as at least the days between the attacks are good and I can carry on doing my walking to get fitter..

FYI I have had different arrythmias for about 12 years now, I am now 46, and am looking forward to my next 'go' at being fixed :)

[kellebelle4]

All I can say is wow...after reading all these posts. I like you suffer with nocturnal tach. I am scheduled for an ep studay/ablation on October 9th. Of course the last couple of nights have been quiet. 2 weeks ago the paramedics caught svt while I was hooked up to the 12 lead montior. I spent a couple of hours in the er was sent home an told to check with my cardio. I waited a few days called the nurse at my cardiologist didn't hear back.

Finally after another horrible night I walked in with the ekg strip the paramedics left at my house. In a nutshell I finally saw the ep specialist he was very informative and decided it is time to try an ep study...... I am praying for an answer. I have been having these epsiodes since 1995, would eat dirt to make it stop. My hearts and hugs go out to all of you.......Kelly

[moe6668]

I have had atrial tachycardia attacks for the past 3 years.  They have progressively gotten worse in the last 3-6 mos.  I recently attempted an ablation this past 14-sep=07.  It was unsuccessful as I went into the arrythmia with no drug s given and then broke in 30 sec.  They tried Isuprel drip, pacing at 300bpm and eventually used adenosine... it was the only drug to push me into the arrythmia, but it wouldn't last for longer than 15-30 sec intervals.So, no ablation after 5hrs in the lab.  I have felt like **** since the procedure.  I usually get these attacks when I'm sleeping...it wakes me up from a sound sleep.  They have since left me on Cardizen CD 240mg/day and added Norpace 300mg/bid and I take Inderal 40 mg prn for the attacks.  Are there any other options available to me at this point?  Furthermore, these attacks seem to be hormonally related to my monthly cycle:  worst time is from date of ovulation through my period.  I'm 39 yrs old, never been pregnant.. would like to be but really scared given these attacks knowing they could worsen during pregnancy.  I'm a recovery room RN and eventhough I have worked in critical care for years, I still get scared with these attacks.  I had one episode when I was in college where my hr was 220+ and I went to the ER.  Told me I had MVP and panic attacks.  Was worked up by cardiology and heart function was ok.  Shortly after that episode, I went on the bith control pill.  Never had another problem with it until I went off it 5 yrs ago... progressively getting worse along with my periods.  I'm not a candidate for the pill anylonger, due to age, high BP etc.  Could this be a real cause of these attacks?  Any suggestions would be greatly appreciated!  I'm in the Phila area and I love my DOC.  Just disappointed and frustrated!

[richtemp]

I could be wrong but according to the documentation given to me psvt is sudden onset arrhythmias doesn't necessarily have a trigger like my case i could be sleeping, shopping, relaxing on the couch, taking a bath, working so really don't let that worry you!
Now to answer your question on the in the ep study they can't trigger your heart don't worry my ep doc told me it is not rare to not get the heart to trigger it happens alot and not to be discourage in my case they had no problem but in alot of cases they can't trigger the heart. This just means they will keep a close eye on it. Now if you do have it happen maybe try calling 911 so they can document it either way if you are having an arrhythmia you should not drive to the hospital because if your not passing out now you will start and that is where the concern comes so call an ambulance this helps in 2 ways. One they can document the case with a EKG and two your spared from a major accident even if it quits before they get to your house you should still go and be checked out.  As far as the meds go maybe your doc should put you on a lower dose of meds? I don't know i'm not a doc but that sounds reasonable in that case just dont do it without your doc's permission first though! Now if you read above what i wrote you would see that some medications can trigger an arrhythmia so any other meds you are taking check with your EP or PCP to see if they do always ask the pharmacy to if they can e a side affect because you have psvt.  Also there's nothing wrong with a second opinion (another hospital or EP) My EP told my family that he thinks he got them all but i might have another EP study to make sure because he did see more. But he couldn't trigger my heart to that rate again so this is something if you have psvt your probably going to live with for a long time and its good that your looking into it and getting knowledge on the information. I experienced jaw numbness and dizziness which is also a huge sign of a problem with psvt. I didn't know this until the procedure lol. They told me if that ever happens go immediately to the hospital! It took 15 years of my life of pain and discomfort, two hospitals and alot of E.R. visits for them to finally give me 20 ablations on the same day and them to finally take me serious that i had a huge problem going on! Keep your head up and don't give up or be embarrased about going in they will get to the problem. good luck to you!!!

[mommyf2]

I forgot to mention that I have psvt.  I tend to have atrial tachycardia and if it doesn't stop after a while I go into atrial fib. I have been hospitalized several times for this.  The scary part is that if my heart rate continues for a long time, my heart shows signs of wear.  The first really bad episode, I was put in ICU and told I had tachycardia induced cardiomyopathy.  Since being on the medication, I have what appears to be a normal looking heart and normal sinus (unless i'm in SVT).  My EF dropped below 40% the first time.  By the way I'm 28.

[mommyf2]

Hi,
I have recently had two RFA procedures.  Neither successful in getting rid of my SVT.  I am currently on Calan 240 and HCTZ .  I have a history of high blood pressure (really high). I recently was pregnant and had severe eclampsia (seizures and all). In an episode of SVT my heart rate will hit 240-260.  I have passed out many times.  During both of my RFA procedures I went into Atrial Fib. I was awake for my second one (over 6 and 1/2 hours and still didn't show the rythm that was needed).  He did ablate two areas the first time.  It didn't help though. I have what my Dr. says is an Automatic SVT. He says I don't have a trigger to get the rythm that they need to perform the ablation.  However, as soon as I'm in the recovery room, I  start to have the fast heart rate.  Other than medication, and ablation are there any other options?  I am finding it hard to cope with this problem.  I can't seem to be sure that I won't pass out.  It is scary with having two young children.  

[richtemp]

it sounds like to me then didn't get everything while they were in the first time this i might talk to my doctor about but if you read your discharge paper work from the hospital it does say you might expect arrythmias for a spurt of 2 to 3 beats occasionally and you heart might flutter alittle these are common in some people but if the arrythmias are coming back full blown and you are passing out or can't get them to stop i might tell my EP this or if your not getting the answers from the EP consult another hospital it sounds like to me they didn't get everything if the episodes are the same and no better good luck to you!! I probably wouldn't try any other kind of therapy for this so early in this stage and taking things the doctor hasn't recommended. If you dont trust your EP find a new one don't take matters into your own hands whatever you do you never know the risk or the outcome if you do. Also do they have you on any medicines like metropolol as needed if not ask your doctor about this. they have me on this as needed because they do expect that i might have another attack and if so i need to take the med so just an example for you best of luck!!!