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SVT and cardioversion
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SVT and cardioversion

HX is MVP repair with Maze procedure 11/06. In Afib for 2 months on Verapamil 360 bid for the two months then finally auto converted to NSR.  OK until 9/11/07 when started Atrial Flutter at 130 BPM.  EP study and Ablation Oct 25.  only one burn required. OK for two days until last Sunday when HR went to 170 BPM and noon. Took high dose Beta Blocker(Zebeta-also have Asthma) no help and went to ER. They tried Adnosine which did not work and then cardioverted me required 50 J.  HR went to 30 BPM because of Beta blocker, but now back to 50-60 BPM resting.  EP doc says to wait and see what happens and remain on 2.5 mg ZebetaBID. On Coumadin and at  2.0 INR or better. If it happens again (and everyone thinks it will), go  to ER and cardiovert.  Healthly 62 y male in good health except heart. Questions are:
1. How many times can you be cardioverted before they are not effective?
2. How many SVT events before going in again for more EP study and more ablation.
3. Is Verapamil the best drug for treating this condition i.e.as a protection drug?
4. Are there any triggers(over work or stress or high temp) that cause the SVT?
5. What are the dangers of an SVT at 170 BPM, and what is the probability of going into VTach from the SVT.

Thanks very much for the help
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1. How many times can you be cardioverted before they are not effective?

Believe it or not, there is no limit to the number of times you can be cardoverted.  It is almost always successful.  The question is how long it will last.


2. How many SVT events before going in again for more EP study and more ablation.

The typical approach after an EP study/ablation is to wait about three months to see if it is still there when the scar heals (the scar from the previous ablation).

3. Is Verapamil the best drug for treating this condition i.e.as a protection drug?

The goal is verapamil is rate control.  It does not suppress PACs or SVT.  There are other classes of medications that can try to suppress the SVT.  The medications you can take depend on your kidney function, if you have coronary disease and your asthma.  You could probably try a medication like flecainide -- you must not have coronary disease or you would have been bypassed with your MVP repair.

4. Are there any triggers(over work or stress or high temp) that cause the SVT?

The triggers are usually extra beats in the atrium.  I have met a few people that could identify triggers like stress, caffeine, fatigue -- most people do not have triggers.

5. What are the dangers of an SVT at 170 BPM, and what is the probability of going into VTach from the SVT.

You didn't list any risk factors for VT.  Conversion from SVT to a VT is a rare event even with people at risk (previous VT, history of large heart attack).

Post MAZE flutters can be difficult to treat and sometimes require very experienced hands to figure out the circuit.  When i tried at the cleveland clinic, our typical approach was to re isolate all the pulmonary veins and if the tachycardia persisted, we would try to localize the individual circuit.  It is a long procedure.

I hope this helps.  Thanks for posting.
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