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Rare NSVT - EP Study Worthy?
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Rare NSVT - EP Study Worthy?

Hello,

I'm a 29 year old male. I've had a rough couple of years in terms of chest pains/sensations. Some which feel harmless, others which feel like they're going to kill me.

Luckily, most of my pains are sudden and disappear as quickly as they appear. I've had just about every type of pain. Jabs, jolts, twinges, spasm-like, squeezing, shooting, stabbing, you name it. Mostly in the center chest/sternum area. But also in the upper back.

The pains/discomforts aren't so frequent that I worry so much anymore. What worries me more are the occasional arrhythmia's that have popped up. The most concerning being NSVT. The first capture was a 7 beat run while sleeping.

At one point I ended up buying my own holter monitor and wearing it for 3 months. I was getting tired of getting these terrible chest sensations and not knowing what they were.

It took me almost 3 months of nothing but rare PACs, PVCs, and occasional short bursts of SVT before I ran into something significant. More NSVT.

I captured the following image from my holter software. Note that this was at complete rest while sitting down and working at a computer:

http://i.imgur.com/FsacnWr.png

I also captured this image during the same month. Looks like a slower form of NSVT while sleeping:

http://i.imgur.com/wy8njlR.png

I saw an electrophysiologist who saw the first image and recommended an EP study just to be safe. I've been postponing it for months and I constantly ask myself if I really need it. It's hard to say yes when I'm in normal rhythm 99% of the time. Is it really worth it in my case? My NSVT is very rare so I have my doubts. I'd appreciate any guidance on whether or not to go through with it.

Tests I've had:

Echo - Normal
Stress Echo - Normal with a mention of mild MVP (my cardiologist kind of brushed this off like it was nothing)
Cardiac MRI - Normal
Countless EKGs - Normal
Bloodwork (electrolytes, thyroid, D-dimer, CBC, cholesterol ...) - Normal

Thanks,
John
4610897_tn?1393869202
John,

Thank you for your question and the details you have provided.

This is a common problem encountered in the clinic. First, in patients with symptoms (palpitations, atypical chest discomfort) and the type of arrhythmia you have described (PAC's, PVC's, NSVT), a beta-blocker like metoprolol tartrate or metroprolol succinate is often prescribe. This can sometimes decrease ectopy (PAC's, PVC's, NSVT). You should ask your physical about this.

In terms of evaluation, a normal ECHO and cardiac MRI signifies a structurally normal heart. The good news is that implies a very good prognosis among patient's with ectopy. A normal stress test implies no evidence of cardiac ischemia (lack of blood flow to the heart).

The question you should ask your electrophysiologist is how an EP study will change your management? If he or she is able to "map" your VT, what would be the next step? Would he offer you an ablation (another invasive procedure). Is the risk of such a procedure worth the benefit? What is the success rate of ablation if he maps the VT?

These would be good questions to ask.

Thank you,
Dr. S
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