SA Node Ablation

[pumpbumps]

Hi-- I had posted a week or so ago re: ablation vs medication (mine was the very long post--I'll try to be shorter this time!) I went for the EP study/ablation yesterday and the MD told me that it wasn't AVNRT but turned out that I had 2 SA nodes, one of which he ablated. Since the procedure, my HR has been high (90-100 resting), but I had been on atenolol 25 mg BID for tachycardia.

What does this mean--Why would i have had 2 SA nodes and will this return?
Will my HR eventually go down without atenolol, which I stopped 2 days ago, or will I have to go back on it--what should I expect here?

[Michael J. McWilliams, M.D.]

The versed they give you during the procedure makes you forget the procedure and usually the conversation with the doctor soon after.  If you call their office, hopefully they can tell you the diagnosis and explain it a little better.

[pumpbumps]

Agreed. I took a peek at the EP report and it turns out I had sinus node reentry tachycardia/atrial tachycardia. The EP did ablate the site and repeated the study and found no inducible dysrhytmias. From his dictation, it seems that this is an unusual arrhythmia (I guess not what he expected--i.e., AVNRT or WPW re-entry). I don't know if this is a transcription error but he said that "It is entirely possible that with adjunergant (?) stimulation she could have very (?) heart rates secondary to an atrial tachycardia"...

According to my family, he was very confident that the problem was fixed, but I'm not clear on that. I do have follow-up with him in a couple of months, and did restart atenolol at half the previous dose, which makes the recovery MUCH more comfortable.

I do so appreciate your insight during this time. I am actually a clinical pharmacist in the hospital where I had the procedure done, so I see a good many post-procedure pts--had never seen one of these before!  If there's anything I should be looking for in the report, I'd appreciate a heads up (I admittedly don't understand the significance of the lengths of the paced cycles and other technical information here.)

Thanks again for all your help.

[pumpbumps]

Thanks for your comments Dr. McWilliams. I appreciate your time and apologize for not having more precise information to give. The EP told me all of this shortly after the procedure and my attention span might not have been at its best! Hopefully after I take a peek at the procedure report it will make more sense to me.

[Michael J. McWilliams, M.D.]

What does this mean--Why would i have had 2 SA nodes and will this return?

I haven't heard of two sinus nodes before, he might have been trying to simply the discussion.  There might be an area near the sinus node that is an ectopic source of a faster heart rate.  Only time will tell if it will return.


Will my HR eventually go down without atenolol, which I stopped 2 days ago, or will I have to go back on it--what should I expect here?

It is hard to say.  It depends on the mechanism of the tachycardia.  If it was a single ectopic focus, it should go away after the ablation.  We usually stop medications like atenolol after the ablation.  If it comes back, you will likely need to restart the medication.  I am afraid I don't have enough technical information about what the cause was to speculate on recurrence.

I hope this helps.