ep study at age 24?

[youngandignored]

hello to all. i have been suffering from some sort of svt for about 7 years now. i saw an ep doctor in march who did blood work and ordered a 3 week event monitor and found that i had 'some inappropriate sinus tach' and put me on nadolol 5 mg a day to basically put a lid on my symptoms. after about a week, the medicine would wear off too quickly so he upped me to ten mg daily. then to twenty daily. the medicine was fine. it almost completety stopped my racing heart and gave me my life back. i could have tea and an occasional beer without a single problem, which i couldn't do before. now for the past few weeks, i suddenly started getting my old symptoms back and can no longer have any caffeine again. my heart randomly bursts into tach again but its not as bad as it used to be. my next appointment is in january and my question is, instead of fighting new medications or higher doses over and over again, should i bring up an ep study to find out exactly what kind of svt i have and properly treat it?

[youngandignored]

i can't believe that..lol you're right. with all the upgraded technology, right? goodness..but i'm glad that you got through that and its over now! that had to be terrible. i don't like that idea and from what i understand, over here, you HAVE to be sedated for the scope to go down your throat..so more power to you for at least attempting lol. i just really can't wait for my appointment so we can get this all out and get moving already! i kinda wish it moved quick for me so i wouldn't really have time to think about it either. boy were you ever lucky

[Janpes]

it is a wonder with technology these days that the catheter that goes into the veins to the heart are super thin, but with the gatroscope it is major thick!!!! you would have thought that they would make it smaller and easier to swallow...but noooooooo it is the thickness of a finger...lol...now for that I had to be twighlighted, no way was I getting that thing down my throat without being under sedation first...lol

I also spoke about it with my hubby, I think I bored him to tears about it...lol  BUT we got through it together and are now on the other side, giving advice and hope to others.
Don't let what horror stories you read on the net upset you, it doesn't turn out like that for all of us!

[youngandignored]

yeah i really have a hard time accepting things so this is something new. me and the husband have been sitting at the kitchen table at night talking a lot about this procedure and it does help to talk about it. even if i have to sometimes say the same things since i'm not too sure how to talk about it. i love to read up on it and see pictures so i won't be completely crazy when i get in that lab. just to familiarize myself. i showed him a picture of one doctor holding the catheter and said 'LOOK AT HOW BIG THAT IS! CAN YOU IMAGINE?!' lol i get to laugh about it if i crack jokes, even though that doesn't last long either. but! like i told him, it really could be worse than this. it's not going to kill me, and hopefully i come out of this with a perfectly functioning heart. so we're keeping our heads up while preparing for the discussion with my doctor.

[Janpes]

I had my laptop and my mobile, but still I was bored to tears....Infact when the 6 hours were up I almost jumped outta that bed to go to the toilet. I say almost as the pain in my groin put a swift stop to any jumping ;)
Advice to you is go to pee before the procedure...lol...nothing worse than a bed pan and a nice looking male nurse pressing on your groin to make your pee go shy...lol

You will be fine, remember to take deep breaths and relax. I know it is easier said than done, but once your in there everything will work out fine. We are all scared of the unknown, but knowledge is power and the more you know before the procedure helps to settle the nerves.
I watched an ablation online and trolled the internet for answers to my questions. This site has been of tremendous help for me and has got me through the rough times.

Take care

[youngandignored]

lol long as i have somethin to keep me occupied i should be alright :)

[Janpes]

The worst thing is laying totally still after the procedure is over, now THAT is a serious challenge ;)

[youngandignored]

the reassurance is wonderful and i can't thank you enough! but you all know, i'm still gonna be freaked out until its over haha! i actually do love to google everything, so yes i have seen just about every arrhythmia i can think of. i know, thanks to that, that it is definitely some kind of svt, and as far as the avnrt, i think i'll start reading up on it a little more and become familiar with its qualities as well. i'm a book worm and especially when it comes to anything close to what i have. i really just can't believe that mostly all of you had this done with no sedation and LIVED lol but i need to quit being a baby and suck it up for my family..really REALLY not too sure how i'd feel laying on a table watching this take place. yeesh. but if its whats best, i'm all for it.

[joshuamom]

Hi there.  I had my ablation 11 days ago, and I am so glad I did, I really am.  I was terrified, and thought about backing out a few times, but I couldn't deal with the frequent episodes of SVT anymore.  I was wide awake for the whole thing.  I would rather that, and know what is going on than be under.  It makes recovery quicker to.  It was definitely not the best experience of my life, but it certainly wasn't the worst either.  It was uncomfortable for sure, but nothing you can't get through.  Believe me, I was absolutely terrified, but it was ok!  
It is certainly a tough decision to make, but one that I am very  happy with.  I am still tender (where the catheter went in), but I am working, and doing pretty good!  
Take care, and all the best!

Michelle

[is_something_wrong]

Based on your statements above (the sudden rapid heart rate that finishes with a BAM) it's pretty obvious you have some kind of supraventricular reentry tachycardia, and an EP study is actually a good idea. Sinus tachycardia usually slows down over time. If you like to google arrhythmias (which I would advice you not to do btw), the possible ones are AVNRT, atrial flutter and ectopic atrial tachycardia (the first one by far the most likely). You can be assured that none of them are life threatening :-)

Such arrhythmias are usually easy to ablate. IST is not. IST is usually not caused by the heart, but often ANS imbalances, or appropriate causes that the doctor haven't found, and just names it IST. There are ways to modify the sinus node to make it more difficult to stimulate, but such procedures are (from what I've read) difficult and involves some risk (of destroying the sinus node, and need for a pacemaker). You can find more info by searching the Heart Rhythm Expert forum old answers, E (the old forum, not the new one...). Dr. McWilliams (electrophysiologist) there seems really clever! A shame the forum is closed for new questions.

I really hope you will be OK. Remember, if you only have IST, there are medications that can work better than beta blockers. You are only 24 years old, and I think the younger you are, the more helpful is an EP study. You don't want an arrhythmia to ruin your life quality if it can be cured.

[Janpes]

I agree with Annie, it really wasn't that bad, I have been through worse, kidney stone, gallstone, DVT and pregnancy twice!!!

[annie1724]

I was awake for my ablation.  I was totally freaked out when I heard that would be the case.  It was not decided by the insurance company, but rather by my EP.  He felt that the more "awake" you are, the better chance of getting your heart to go into its arrhythmia when provoked in the procedure.  He feels that sedation also has an effect on your heart and can keep it too relaxed and not go into tachycardia as easily.   I have read many on this board say that they were asleep and it worked fine, so I guess it's just up to the opinion/feeling of the doctor.  I was given a little something to "relax" me, but an extremely low dose.  I was fully awake the entire time.  I was also given painkiller through the iv.  As much as I hated the idea of being awake, I rationalized that if I was having the ablation, I wanted to do all that I could to make it successful and not have to go through it again. I am a "Nervous Nelly" and I survived just fine, so I'm sure you would too!!  Actually, afterwards I was amazed at how well I did while being awake on the table!  Try not to dwell on that part of it.  As odd as it sounds, it's really not that bad.

[youngandignored]

yes i feel like doing the procedure this young would be better considering i'm still pretty healthy and i would guess thats a good time to do it. as far as knowledge being power, you are absolutely right. thats how i've been presenting myself to every doctor i've seen to this date. full of knowledge. they look at me funny, and this ep dr actually asked me where i'd learned so many terms from, to which i told him i had done A LOT of research since no one ever believed me. i think he was impressed :) i would LOVE to be sedated if i get as far as the procedure, but i had no idea i had to convince the insurance company to let me do it...or however they go about deciding. thats really not cool :( i wonder if they'd even agree considering my age. lord...what are the chances that blue cross would agree? does anyone know?

[tom_h]

"......i really really hope i don't get treated like an idiot when i ask about it........"

Just remember that knowledge is power.

[annie1724]

I started with svt while in my early teens and was always just told by the doctors that it was nothing to worry about.  It got much worse during my pregnancies, but still no doctor was really concerned.  I finally saw a cardiologist who recommended an ablation, but I was too scared to have it done, and I had been convinced all my life that it was nothing to worry about.  I took medication, but was not able to drink any alcohol whatsoever and no caffiene, and still had break through episodes.  It might not be a serious, life-threatening, health problem, but it certainly does affect your quality of life.  I never knew when an episode would hit.  I finally had the ablation after putting up with this condition for years.  All I can say is, if I was 24 again, and know what I know now, I would do the ablation in heartbeat and hopefully live the rest of my life without worrying about my heart rhythm again. Yes, the idea of someone zapping your heart is scary, but ablation is not considered a high risk procedure and the recovery was not bad at all.  It was sooo worth it!  Just wish I had done it long ago!!!!
Annie

[tom_h]

The degree of conscience that you're in when you indergo the procedure is often determined by the EP that does your procedure.  Mine offered me a choice; awake or sedation.   I am choosing sedation.  I don't know what level of sedation, but when pressed by me, he said "Don't worry about it, you'll be very, very comfortable".  In recent years, I've had 2 colonoscopys.  Although he told me that I responded to commands to move in a certain direction, I only remember the assistant saying, "You're going to feel sleepy now." as the drug was administered.  I don't remember anything else.  Perhaps this is what they're going to use for my EP.

It would also be helpful to talk to your insurance carrier as they may have the final say as to when and if an EP procedure will be covered.  In my case, I've had multiple Holter's, a 30 day monitor, 2 stress tests, an echo stress, as well as years of Metoprolol.  So, it's possible that you may be forced to jump through some additional hoops to get to the EP procedure.

[youngandignored]

:) thank you so much for talking with me about all this. mind you, i'm scared to death still. but it feels so nice to meet other people who went through the things i am about to go through. it gives me a general idea on what to expect and thats just relieving! i really really hope i don't get treated like an idiot when i ask about it..i don't think he realizes quite how much this all affects me as a person. sigh...man...do any of ya'll have facebook? i'd love to keep up and keep you posted as i go along. and the emotional support would be wonderful. i always need to talk lol

[Janpes]

I think I went so quick from diagnosis of SVT (AVNRT) to EP study and ablation that I didn't really have chance to think it through.
The doctor didn't even offer me meds at all, phoned two days after my attack and chemical conversation and said he would get all the papers ready for an EP and ablation. Couple of days later was in stress test and then few days after that in ultrasound. After that got a date and time and there it was.
I just went with the flow and actually felt quite calm after the initial fear hit me when walkiing into the cath lab.

You will do fine, you have been through so much already that this will be a walk in the park :)

[youngandignored]

ok good. one of those 'if i can give birth without a single drug, this is nothing' kinda things? i can handle that. just makes me nervous but thats something i'm gonna have to just get over. because the more i talk about this to you guys, my husband, and my friends, the more i'm sure i'll be asking about the study when my appointment comes around.

[Janpes]

unpleasant I mean -  it is not the best thing in the world, but in my opinion it is not the worst either. To me the gatroscope was terrible, I would rather go through an EP study and ablation instead of that again.

[youngandignored]

sorry i forgot that part. before the medication, it would last anywhere from a minute or so to a couple of hours. i actually had one episode last from about noon until six or seven in the evening. that was my breaking point, by the way. i was so fed up with being told nothing was wrong, i bought a heart rate monitor and wore it religiously for a few weeks just to prove to myself that i wasn't crazy :( i had bent down once to get my little boy's clothes and it kick started and didn't stop for a good thirty minutes. then i felt a huge BAM and it was over. things like that..now, my episodes when i do get them last for a few seconds, starting and stopping just like before. its frustrating to say the least. i did alot of research and honestly, i'm with you. if its not psvt i'll be surprised. and janpes, what do you mean unpleasant :( i may be a bigger sissy than you haha

[ireneo]

That sounds more like PSVT - paroxysmal supraventricular tachycardia. It starts and stops suddenly like that. I've had that all my life so I'm a bit familiar with it.  :-)

I agree with issomethingwrong. It's hard to have "some" IST just likes it's hard to have "some" pneumonia. You either have it or not.

I don't see any place where you mention how long it lasts. If it lasts for more than a few minutes, you could try the valsalva maneuver. When the heart starts racing, take a breath, hold it and bear down as if you're having a b.m. I hold it about 10 seconds and then slowly release my breath. Usually that will kick the rhythm back to normal. If not, I might have to do it again. The real catch is don't wait through 15 or 20 minutes of tachy to try it. It's very difficult to stop it then.

[Janpes]

Don't worry about the procedure. Like I said I had it 5 weeks ago and there is no bigger wimp than me...lol

I felt more conforted because I was awake and was able to tell the cardiologist if it hurt or not.
The procedure is unpleasant but it is tolerable without medication too.
You can read my experiences about the procedure in my journal.

[youngandignored]

yes i agree that the ep study is the way to go. i'm just so used to being told that whatever it is that i have is not a big deal. i guess i felt like i had to convince him. my symptoms are a random burst of tach that start and stop immediately and leave me feeling tired and with a sort of dull pain in my chest. after noticing the symptoms for a long time, my husband actually listened and heard the sudden rapid beats followed by a thud and then normal rhythm. (i guess we've had alot of time to figure it out lol) but i worry for the sake of my husband and 2 children and i would rather not cover this problem up with medication without knowing for sure what it is and how to properly treat it. i'm just scared of the procedure. its the thought of being awake that gets me. any words of comfort? i'm a sissy i guess :/

[is_something_wrong]

Hello.

An EP study is a low risk procedure. The problem may be ablating the inappropriate sinus tachycardia.

Inappropriate sinus tachycardia (IST) is not really an arrhythmia, even if it's pr definition a supraventricular tachycardia. Further, it's hard to differ from the "appropriate" sinus tachycardias, which can have hundreds of causes, not just exercise, fever and anxiety.

It's hard to differ an atrial tachycardia from sinus tachycardia on Holter tests, if the ectopic focus is close to the sinus node, it's almost impossible. That's the reason why an EP study can be helpful, to rule in/rule out the diagnosis. A Holter test views the heart from 3 positions, a resting EKG from 12 positions and an EP study from up to 256 positions. It's far more accurate regarding where the rhythm origin.

You can't have "some" IST. If you have IST, your heart rate is >95 bpm over 24 hours (average), it's constantly elevated at daytime with possible "dips" at night.

Elevated heart rate at times can have many causes. Low blood pressure, dehydration, generalized anxiety and metabolism issues are the most common ones. High sugar intake (and blood sugar drops afterwards) are also common problems.

I would have accepted the EP study just to rule out arrhythmias, but this is a choice you'll have to take.