SVT after Catheter Ablation

I am a 48 year old female with 23-year history of SVT''s and PVS's.  I wasn't diagnosed until I found a good EP doctor in 2006.  I had surgery on October 1, 2007 for a catheter ablation.  The surgery went well and I can't tell you how much relief I felt both mentally and physically.  I still have PV's, but I can live with them.  The EP doctor said I definitely had SVT, it was easy to find and easy to fix.  This past Sunday night, 11/25/07, I had another full-blown episode of what I think was SVT, just about 2 months after my surgery.  Lasted about 25 minutes.  Sometimes my SVT's would start with a PVC's, sometimes not.  This one did not.  I went back to see my EP after this episode, and he doesn't kow if in fact it was SVT.  I am going to wear an event monitor and keep wearing it until I have another episode so the EP can see what this is.  My questions are:
1.  Does this mean that my surgery was not successful?  The EP said he only found one bad pathway, fixed it, tested it, etc.  Is it possible to have an episode like this break through, and then never happen again?  Or, since it did happen again, am I likely to get them again?  Could it be possible that this was another parthway that wasn't found during the surgery?  Or, could this SVT have snuck through the ablated pathway?        
2.  This episode felt no different than my previous ones.  The EP wants to make sure this was in fact another SVT.  I think it was.  Could this be something else, like atrial fib? I have never been diagnosed with artial fib before.   My heart was beating very fast and regular, over 200 beats per minute.  The beats did not feel irregular.  
Thank you for your response.  
   Hug4Me

[Michael J. McWilliams, M.D.]

1.  Does this mean that my surgery was not successful?  The EP said he only found one bad pathway, fixed it, tested it, etc.  Is it possible to have an episode like this break through, and then never happen again?  Or, since it did happen again, am I likely to get them again?  Could it be possible that this was another parthway that wasn't found during the surgery?  Or, could this SVT have snuck through the ablated pathway?        

The answer depends on the mechanism for the tachycardia.  If it was AVNRT, the ablation was probably not successful.  If it was AVRT (an accessory pathway) it was either unsuccessful, the pathway recovered, or there was another pathway that is now causing the tachycardia.  If it was atrial tachycardia or a pulmonary vein based tachycardia (like an atrial tach, flutter or atrial fibrillation), more tachycardia could mean recovery of the vein that isolated or it could be a tachycardia related to scar from the procedure.

the question is difficult to answer without knowing the mechanism of the tachycardia that was ablated.


2.  This episode felt no different than my previous ones.  The EP wants to make sure this was in fact another SVT.  I think it was.  Could this be something else, like atrial fib? I have never been diagnosed with artial fib before.   My heart was beating very fast and regular, over 200 beats per minute.  The beats did not feel irregular.  

I agree with your EP doctor in that I like to see the tachycardia so I know exactly what I am dealing with.  The answer is usually in the rhythm strip.  It could be any of the above: recovery of the old tachycardia, a different tachycardia, or rarely an episode of sinus tachycardia (I have seen it).  Even in the best hands, no procedure is 100% successful and recurrence is possible.

I hope this helps, thanks for posting.

[hug4me]

I just read my post, and I see that I misspelled some things....in the beginning, Italk about SVT's and PVS's - that should be PVC's.