IST after 2 ablations?

[Eve2317]

IST after 2 ablations?
by Eve2317, Oct 25, 2009 07:59PM
Tags: Ablation, IST, arrhythmia, tachycardia
Hello and thank you for taking my question. I am a 40 year old female, and I have had two ablations, first one in '04, and second in '06 for "true ectopic atrial tachycardia"-I was told that this type of SVT is quite rare-only 5% of SVT are this kind. Ever since the last ablation 3 years ago I have been dealing with an elevated heart rate. I just finished wearing an event monitor and it showed my heart rate to run 95-140 while resting-the average rate was 118. It rises quickly with any activity. I believe that it was a sinus rhythm throughout except for one run of a 4 beat V-Tach. My GP and cardiologist have beem concerned with the heart rate over the past 3 years, but the EP that performed the ablations said it was o.k. (he still needs to review the event results). My cardiologist and several of his colleagues say it is not o.k., and if the EP still feels it's fine, they want me to go to a new EP because I may need another ablation. My questions are 1) is having this elevated heart rate o.k., 2) could this be IST? (thyroid is fine and pheocromocytoma (sp?) is neg)  3) could this be a new arrhythmia? 4) does this really require follow up, or are they just overreacting? Thank you!

[Eve2317]

Thanks ptadvoc8!  Are you sure you're not in the healthcare field-lol! Great advice and information-thank you! Yes, it has been three years with this elevated heart rate...I am going to a new electrophysiologist next week for an evaluation.

I have tried various CCB and BB without any change in the rate-I'm assuming they will offer the modified sinus node ablation. This is definately having an impact on my life. I have a 10 year old and a 13 year old and I am unable to do many things because of the heart rate. I am also so tired all the time.

Thank you again for the great information as well as your opinion.

[ptadvoc8]

I'm not a medical professional and it is impossible for me to know if this is or isn't IST, or whether or not is could be a new arrhythmia, but if I were you I would definitely be looking to get a second or possibly even third opinion about this -- preferably from a couple of specialists at one or two highly respected facilities. At only 40 you want to be in the best shape you can be and 140 for a resting pulse rate is usually considered too high in most cases -- but not in all cases, so don't panic...

A temporarily (lasting one week to several months) elevated heart rate is actually quite common following ablation, but an elevated heart that lasts beyond several months is generally of concern requiring more studies and is indeed one of the known problems or complications of the procedure. Certain types of ablation in certain areas, or a very high number of different "burn" spots, seems to result in higher incidences of permanently elevated heart rate and/or IST than others.

There is pretty strong evidence that sometimes ablations may cause IST as the heart seems to be extremely innervated and in addition to the "natural" pacemakers and gatekeepers (SA and VA nodes), and any potential accessory pathways or arrhythmogenic foci, they are only just now learning there may also be important connections to the parasympathetic nervous system and possibly even the vagus nerve, running through the heart in various places. When these are unintentionally "ablated", along with the intended arrhythmogenic tissue targets, it can cause disruption in communications between that part of the heart and other parts of the heart and/or the heart and other major organ systems in the body causing a temporary or permanent disruption in the heart's rhythm and/or rate. In addition to IST, there is evidence that Heart Rate Variation (HRV), another important measure of heart health, can be negatively impacted by ablation.

Some people seem to do just fine with an elevated heart rate while others really feel the symptoms. Overall, they generally do not like to see a heart rate as elevated as yours for such a long time for fear it might be hard on your heart long-term. They will often try to get the rate down with various meds or may even suggest another type of ablation to "modify" the sinus node or put in a pacemaker.

IMHO, I do not think you or your GP are over-reacting and at this point with two ablations behind you and some real concerns expressed by your cardio and your GP, I would definitely want to go to one of the top facilities and get another opinion. One important question is how do YOU feel about this? Are you comfortable with your current condition? In good shape? Able to live life the way you want to? Concerned about any of this? Concerned about the fact that your GP is concerned? Whatever you decide to do, ask questions and get the kind of answers and care that not only addresses the concerns your GP and cardio have expressed, but that also meets any needs or concerns YOU may have about this. Best wishes and good luck!