PSVT & ablation

[sandiegoblue]

I wss diagnosed with PSVT today by a cardiologist following two recent episodes of SVT (no other history).  He had "great news" that it can be fixed surgically with ablation.  Has anyone had this?  What should I expect and can this cause permanent damage (like if they burn too much or the wrong area?)?

I'm scared it will be painful and might cause more problems than it fixes.

Thanks!

[SillyHeart]

Vagal maneuvers help me almost every time, if I use them SOON after it starts.  Once it really takes off it's too late.

[frenchie47]

Hi~
If I have an SVT episode that doesn't stop right away (within the first 2 or 3 minutes) I take an additional 1/4 of my tenormin and it stops it.  I normally take 1/4 of a 25mg of tenormin daily to keep the tach, svt and pvcs to a minimum. Sometimes I get breakthrough episods and the extra 1/4 takes care of it.  I only get svt episodes about 4 times a year  (the bad ones that take off at 220 beats/min with pvc's thrown in as well.

[sandiegoblue]

I see an EP on 8/28.  You have ALL given me great questions to ask.  I, too, am surprised that ablation was the first line of defense after only two episodes.  I don't want them to do ablation simply because "we can" rather I want to feel comfortable that it is the right treatment route given my specific case.  

Follow up:  When having an SVT episode, how many of you have found vagal maneuvers successful?  Also can taking beta-blockers at the start of an episode have any effect?  I'm just wondering if there are less invasive methods to deal with this, particularly if I am not getting them frequently.

[va_tony]

As Sillyheart pointed out, ablations have their risk.  Even the EP on the medhelp Ask-a-Doc board has pointed out a risk of 1-3% of a serious complication with ablations. I frankly don't see how your cardiologist can be so sure that an ablation will cure your problem unless he is also an EP and an ekg has revealed that the particular type of SVT you have is usually easily treated.  The success rate depends critically on the type of SVT and your age and general health.  In the case of afib, aflutter and WPW, I think the success rates are normally about 85-90%, depending on the Hospital and EP (the more experience they have, the better off you are).  Some forms of SVT, especially those involving the SA node (sinus tachycardia and IST) are very tricky and have lower success rates. I know I wouldn't want the EP ablating near my SA node. I think you need to discuss this with the EP who will be doing the ablation.  Hopefully, he'll have answers for you.  If your SVT has been diagnosed (by ekg) as aflutter, then the odds of success are indeed good.

Personally, in any event, I would prefer to give meds a try and also to try to reduce stress in your life.

[rosetoes]

I have had two episodes of SVT and I'm now on a low dosage of Beta Blockers.  I am going to see what happens now.  My episodes were 20 months apart.  If I have another episode while on the beta blocker and I can't convert doing the vagal manuever, then I may seriously considered the ablation.  
  

[ireneo]

I remember your story now from another post. Having PSVT for hours is no fun. I may be wrong but if they're  going to the right atrium they'll use the femoral veins, not the arteries. As for pain, what little I remember of the procedure, they numbed the area in my groin first, then made the tiny incision to insert the catheters. I didn't feel a thing. Plus they gave me some meds to relax me so I was just floating along. I did feel some of the arrhythmia but it wasn't any different than what I felt before and at that point I didn't care all that much. For the ablation part they gave me more/different meds so I don't remember it. I woke up in my room, flat on my back. End of story.

I suppose there is the risk of ablating the SA node if they're working very close to it but they're very careful to avoid damaging the node. My doc's attitude was that he would back out and possibly leave some irritable tissue than risk ablating the SA node. It's really up to you and your doctor.

[SillyHeart]

Ablation can cause permanent damage if they burn the wrong area.  A small minority of people end up needing a pacemaker.  It's rare, though.  In most people the procedure is curative.

But if you've only had 2 episodes of SVT, I'd be very wary of jumping straight to ablation.  It's not worth the risk if the SVT is barely affecting your life.

[sandiegoblue]

I have only had two episodes.  First in November '06 as they were prepping me for joint replacement surgery.  They thought, at the time, they had inserted the PICC line too far in and irritated the heart.  Told me it would never happen again as long as they were careful with the PICC insertion.  Incidentally, I had the other joint replaced 5 weeks later without incident.  The second episode happened 10 days ago while I was sitting at my computer (relaxed and sedentary).  Both episodes lasted several hours and only converted after administration of adenosine.  Doc says it can be brought on by stress.  I have been under constant stress for the past year because of the joint replacement surgeries and complications which are now resulting in having to do two more surgeries in the coming months.  I guess they are figuring why risk additional episodes when it is so easy to fix?  Easy for them to say since they have not had to do it.  Doc says the meds (beta-blockers) can cause weightgain and will not eliminate the risk, only reduce the chances.  He was pretty pro-ablation.

I am concerned about the pain when they insert the catether in the femoral artery.  The PICC line is probably similar, not sharp pain, just dull aching and pressure.  Anyway, I am also worried about the feeling associated with speeding up and slowing the heartrate to isolate the specific tract, in addition to the burning pain when they finally zap it.  I am supposed to have my next joint surgery in a month and they seem to think I can have the ablation the week before and be ready for the joint surgery.  That seems too close together?

Thanks in advance for your insight...I am very appreciative.

[ireneo]

Many people on the board have had ablations and can tell you the procedure is not as bad as it sounds. The doctors are not going to go in there with guns ablazing, zapping here and there. They carefully trigger the arrhythmia to see where it's coming from (EP study). Then they ablate that tiny little area (talking millimeters now). They'll test it again to see if they can trigger the tachy. If not, then there's a good chance it's all gone. I've been in 3 times (just because I have several arrhythmia issues). The first time was the hardest only because I didn't know what to expect. But they're very good at watching you, making sure you have just enough meds to keep you comfortable. I remember very little of the procedures. Afterwards I had some bruising in the groin area, just wore soft boxers for a few days. Except for a bit of tiredness I was back to normal in no time.

Just curious - how often do you have PSVT episodes? How long do they last? They must be fairly frequent for the doc to recommend an ablation. The other choices are to live with it or take meds - and they often have side effects. Talk it over with your doctor but don't avoid an ablation if s/he says it would work for you.