Catheter ablation

[s1993]

Hi :)
I was hoping someone could help me out. I had my first ever attack of SVT a year ago and my heart was racing at 265 beats per minute!! i was rushed into hospital and had the ablation done 2 days later. The whole procedure took 6 hours to complete and even during the procedure my heart rate raced at 300 beats per minute. Since i have had the ablation done i feel well however sometimes i feel my heart rate is not "normal/regular" it doesn't beat fast but i can feel skipped beats and irregular beats. I have spoken to my cardiologist and he is certain its nothing to worry about and he thinks that its more psychological and that i have anxiety attacks :/

I just wanted to know if those who have had svt and had an ablation did you feel the same way? or were you more prone to focusing on your heart beat and picking up on every little thing? its really stressing me out.

Hope someone can help :)

Thanks x

[researcher09]

Great that you had a chance to review your ablation with the specialist.  Best wishes to you for getting to a settled heart.  FYI, right sided tachycardia can be triggered by PV located in the left side.  Hopefully, that is not you have.  However, if things don't get better, you may want to consult with EPs that are skilled in complex ablations.  Sabine Ernst at Royal Bromptom gets many thumbs up in the UK in the AF forum that I belong to.

[s1993]

Hey!

I totally get ur concern! But i did fire those questions at my cardiologist and he explained why it took so long, its because each time they would give me more adrenaline and my heart rate would increase there would be more places he had to burn so he kept doing it until no path was left :) He specialises in EP and arrhythmia's and is one of the best cardiologists in my city as well as throughout the UK! He's Fab :)

Thanks for raising the concerns! x

[s1993]

Hi tom :)

Thank you so much for replying! Iv read your journal section and its been really helpful with your updates of how ur feeling! I think the reason as to why i was operated on so quickly was because we have a family history of heart related problems and my cardiologist thought it was better to do it now than later, which im SO glad about because i don't think i could ever live with having SVT attacks so often its so scary! I just think that it will take me time to get back to my normal self and with time i should hopefully get used to the occasion fast beats lol. I hope one day i can be completely normal and nt have to worry about this! Thanks for ur support x

[researcher09]

Tom, I think those "typical" times that you recall is around one standard deviation higher than the 2 hrs I know about.  My son's closest friend had his done in Feb.  That took 2 hrs total including 30 min wait time when the EP used adrenaline to challenge the heart after she completed the RF.  Another friend of my son had AF ablated late last year by the same EP.  His ablation took 3 hrs but AF is a much more complex procedure than SVT, AVNRT, WPW or AVRT.  All I am saying to those that are seeking ablation to pay attention to how skilled and practiced the clinician is.  IMO, the cutoff needs to be around 100 ablation procedures/year, preferably double that.  That number is what the Heart Rhythm Society guidelines indicate.  I do acknowledge that there is a problem with getting the best experts as they are usually doing the most complex cases and leave the less complicated procedures to EPs coming up on the learning curve.

[tom_h]

It's been my experience monitoring this forum for the last 5 years that typical electrophysiology procedures last from 3 to 7 hours.  Most sites, such as hospital sites, if they give a length of time for the procedure will state that it's around 4 hours.  My left sided AVRT procedure with ablation lasted 4.5 hours.

I would not get yourself worked up about this. You probably WILL continue to feels skips.  You probably WILL feel short runs of SVT.  As I mentioned today in another post, if you had AVNRT, you had two pathways, a slow and a fast.  The slow one is usually targeted for ablation.  What that means is that they only sever the path.  It's like snipping a wire with cutters.  The wire still there.  But the signal can't get from here to there.  The electrophysiologist doesn't burn away all of the conductive muscle tissue.  He merely burns open the circuit until it no longer conducts.  My electrophysiologist said that in the case of my AVRT, it was like connecting the dots; 17 burns overlapping each other were required to bridge a wide accessory pathway.  In bot of our cases, the path remains.  There's merely a roadblock preventing the signal from reaching its destination.  Sometimes, a teeny-tiny thread of conductive tissue remains that supports occasional, feeble conduction.  That may be when you feel a short run of SVT.  Sometimes, the barrier heals over with fresh, conductive tissue cells.  Once again, full conduction resumes, and back comes your SVT.

So I don't think this is a big deal.  If indeed your procedure was a failure, it was mostly because not all of the circuit was completely bridged.  This DOES happen on occasion.

If I could find any fault in your "path to ablation", it would be that your situation was acted upon much too quickly!  You said above that you experienced your "first ever" SVT episode, and they rushed you right in for an ablation.  In my opinion and experience on the forum, this was much to soon.  I and people like MichellePetkus are at the extreme other end of the scale.  I experienced hundreds, perhaps over a thousand episodes of sustained SVT before doing something about it.  You see, you might have gone years before experiencing another one.  I think anyone who closely follows SVT thread here on the forum will tell you there seems to be a direct correlation beteen the frequency of episodes and the ease of finding the source of the problem during the ablation and eliminating it.  SVT in most cases is not a dangerous event. It feels scary, and it may feel a bit uncomfortable and anxiety provoking.  But it's usually not dangerous.

You can't take back what has been done already, but I'd sit and I'd wait.  I would try some drug therapy.  I would keep track of the number of (if any) full blown SVT episodes that you experience.  I wouldn't be so quick to rush back in for another one.  it's not because I don't trust the procedure, but rather if they're going to go back in, make it count this time.

[researcher09]

I am glad you made it through a 6 hour procedure.  The length of that procedure would be of big concern to me if it was me.  Something obviously went wrong because 1-2+ hours is more typical for right sided mapping and ablation.  So the concern would be (1) what happened? (2) were the problem(s) really fixed? (3) do I really want to use this EP and center again if I need a repeat procedure?  IMO the ablation failed.  Those are my thoughts.  

[is_something_wrong]

Yes, extra beats from the top chambers are PACs. Almost always benign, but may trigger SVT if you have the predisposition for SVT. After your ablation, you should likely not have that predisposition anymore.

Looking forward to visiting UK next weekend, by the way :-)

[s1993]

Oh! i should be ashamed considering i'm a pharmacy student i had no idea what WPW was haha, no i didn't have that. All i remember is that my cardiologist said that the extra beats were coming from the top chambers of my heart? So i'm guessing it is the one you suggest? wow i didn't think there were so many different kinds (shocking). Thank you for all ur support it was really helpful i know a lot more than i did before :P I just hope i never EVER have to deal with it again.

[tom_h]

WPW is Wolff-Parkinson-White syndrome.  There are two common forms of SVT, AVNRT and AVRT.  WPW is in the AVRT, or AtrioVentricular Reciprocating Tachycadia family.  I actually did not have WPW, but another form of AVRT.  WPW has a small, but dangerous element to it if the conduction is in a particular direction.  The though of having A-fib never occurred to me, nor was it ever brought up.  My form of SVT was always thought to be WPW as there was a slight telltale slur on the upstroke of the R wave.  It was extremely subtle, but it looked like it.  It wasn't until during the electrophysiology procedure that classified it as something else; Circus Motion Tachycardia.  I didn't even know CMT existed up to that point.  s1993, you didn't say what kind of SVT you had, but given that you're listed as female, the odds are that you had AVNRT, AtrioVentricular Nodal Reentrant Tachycardia.  This is the most common form of SVT and favors females to makes.  Both feel the same and both respond to the same to efforts to slow them.  I suppose that's more than you ever wanted to know about SVT, but obviously, it's something that's very near to my heart.  (did I just say that?....sorry!)

[s1993]

Wow! thats such a long time to deal with something so scary! I only ever had it once and had my ablation done the same week! sorry whats WPW?

[is_something_wrong]

Didn't you fear atrial fibrillation while you had WPW?

[tom_h]

I had SVT for 54 years; 6 to 60.  As I aged, it became more frequent and I was finally coaxed by my cardiologist into getting the ablation done.  Until that happened, I just lived with it and accepted it as part of my life.  It was probably the primary reason I let it go on so long; I just dealt with it.  Getting it done was perhaps the best decision I ever made aside from my choice of a mate.  It has renew my life and now even at 64, I can give every ounce, every last drop of what I have in me without fear of SVT.  That single thing is a wonderful feeling and was totally worth it.

[is_something_wrong]

PACs and PVCs are usually normal phenomena. They don't kill us, but everyone gets them from time to time, so it's important (however not necessarily easy) to learn how to live with them. You probably had them before your ablation too. I started to notice mine back in 2009 but for as long as I can remember, my heart "skipped" an occational beat while I was checking my heart rate. At that time I had no idea what it was and I didn't care so much about it. I wish I could do the same now :-)

[s1993]

Wow 4 years ago! How did it feel when you had it done newly? was SVT something that you had for a while before the ablation or was it a random attack like mine? The past year has been a tough one for me! i wake up during the night shaking thinking that i'm having SVT but when my mum checks my pulse its normal between 60-80 beats. Its so SCARY :(

Thanks for your reply x

[s1993]

Thank you so much for your reply :) its always reassuring to hear it from someone else! i think i am just a lot more conscious of whats going on and this triggers anxiety. I'm hoping that its something i get used to!

Thanks once again :) x

[tom_h]

I had mine done over 4 years ago, and even today get skips and occasional 6 to 12 beat runs of SVT.  What you're feeling is very commonplace.  When you had your ablation, a thin line of scar tissue is the only thing that prevents conduction.  The reentrant circuit or accessory pathway (Depending on what kind of SVT you had) remains in place. I would think that occasional conduction across the scar tissue barrier could occur.