One episode SVT & Ablation?

I am a 70 year old woman who enjoys good health, never smoked, drank, exercises aerobically everyday.  Several weeks ago I had an  episode of SVT.  Heart rate was 180, brought down in the ER at the Dayton Heart Hospital after about 1-1/2 hours with Adenisone.  I was referred to an Electro physiologist who suggested an ablation.  When asked the questions about recurrence, this physician stated that there was an "80% to 90%" chance that I would have another episode of svt.  

I don't want to take medication for the rest of my life.  On the other hand not too sanquine about having an episode on an airplane or freeway.  My doctor did not discuss the "pill in a pocket" treatment to bring down the heartrate.  He alluded, briefly,  to the various maneuvers but seemed not to give them much credence.  My question:  Is it standard practice to recommend an ablation with just one episode of svt?  By the way, just a day prior to this I had been  taking over the counter meds for a cold - both Sudofed and Afrin for four nights in a row.  

Thanks for your input

Sharon

[Michael J. McWilliams, M.D.]

excellent, I haven't seen "sanguine" used in a sentence for a long time.

If you had an episode of an narrow complex fast heart rate, just, the truth is that you are likely to have another one, especially if it broke with adenosine.  The maneuvers do have a fairy high success rate of working.  The one that I think works the best is to have someone push hard on your stomach while you resist. This is the same as the breath hold and push (bowel movement) maneuver, but if the person pushes hard it really forces you to bare now.

Option 1:  No medication and be ready to try a maneuver if /when it happens again
option 2: carry the medications (beta blocker or calcium channel blocker), take it with the SVT and try the maneuvers
options 3: ablation.  People like yourself have an over 70% chance of having AVNRT -- easy to ablate, less than 1% risk of major complications, no medications.

Don't take the cold medications again.  If you have never had it this before and were taking cold medications with sudofed, this almost certainly contributed to this episode.

I saw a patient just like you the other day.  He chose to wait.  I think he will be back, but he might not.  Time will tell.  If you have no other cardiac signs/symptoms, it is unlikely this will be more than an inconvenience if it happens again. If it does, you will just have to decide how you want to proceed.

I hope this helps.  BTW, I love the fact that you are 70 and posting on a forum.   Your grandkids will be proud.

[ireneo]

Of course the doctor is right. From my own experience with SVT cold medicines are off limits. The valsalva maneuver (take a breath and bear down) has been wonderful, I've used it for years. A little trick to it: once you bear down holding your breath, don't release it in a sudden rush. Too often the tachy will come right back. Release it slowly. That seems to work the best. And sometimes I have to do valsalva 2 or even 3 times to break the tachy. Oh, and don't let the tachy go on for 20 minutes before you do the maneuver. The longer it goes, the harder it is to break. I may wait a minute but no more than that. I've had a lifetime of arrhythmias, finally had 3 ablations (stubborn heart!) and still have some brief PSVT (140-198 bpm) but these are so manageable now. If I was you, I would wait and see but I'm so used to these that I'm pretty good at ignoring them now. It depends how you feel.

[EmpressofQ]

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[kurnia]

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