SVT and preparing for ablation surgery

[mreilly82]

I have some questions about my newly diagnosed SVT and the ablation. I am a pretty active person in my job and go to the gym 3 days per week. About a month ago I experienced an high HR about 200bpm and went to ER as I have never experienced before. They pushed adenosine which didnt work then cardizem which did. They referred out to cardio and cardio has said I have SVT and since it is breaking through the cardizem referred me to EP which he wants to do ablation. I am ok with this but have been wondering why all of a sudden the SVT showed up? It started with 1 episode every 3 days now it can be 3-4 episodes per day everywhere from a few mins each to a few hrs. Now the EP has told me not life threatening but man this gets annoying. As for the ablation what can I expect before during and after the procedure since I have never seen an operating table before? Thanks for the help.

[mreilly82]

Thanks for the replies. They found this in the Right Atrium he said about 3 cm away from the AV node which he says was a good thing. Means completely treatable is what he said to me. Those sedation drugs were good, wish I could remember more of the procedure tho. I guess those bumps and skips I am feeling are from the inflammation of the procedure the doctor says. Not bothersome for me but sometimes if I am paying attention to it when it happens It makes me think "What was that?" No SVT thankfully.

[MichelleP_3811]

Actually I think I need to correct myself.  I think it has to do with the placement of where the pathways are, antegrade and retrograde being something akin to front and back.  Where typically the slow pathway is in one particular spot but with you it was swapped around.  Or again in other cases there are 2 slow pathways.  So not sure which atypical situation you fell under.  Anyways, I think that is more accurate though I am not a doctor so don't quote me.

[MichelleP_3811]

With avnrt there are 2 pathways into the avnode a slow (secondary) pathway and a fast pathway and as such under certain circumstances like throwing a pvc or pac the signal on the secondary pathway makes it all the way into the avnode.  Usually the slower path doesn't  make it all the way in but is blocked by the fast pathway signal so the beat stays normal but if the signal on the secondary pathway makes it all the way into the avnode it can then exit out the fast pathway thus causing the signal to loop around the avnode.  This is typical avnrt.  Atypical means that the signal is switched and the issue is kind of backwards.   Or there could have been 2 slow pathways.  So essentially it is a bit of a rarer situation.  Also while most people are triggered by pacs some are triggered by pvcs.  I don't think that is necessarily relevant for the difference between typical and atypical but considering they were mentioning pvcs to you it seems as though you may have been triggered by them instead of pacs.  You will likely feel your pvcs and pacs more for at least 3 months.  Mine actually took a year to truly settle down.  But you may never actually fully get rid of them.  Some do but some don't.  But as you get farther away from the ablation you won't feel them as much but for your peace of mind, except for some extreme circumstances with a unhealthy heart, ectopic beats are really very harmless.  Your best bet is to try and ignore them as best you can unless they get crazy bad but in general your heart should heal.  It may be slow but it will keep improving so just rest as much as you can and try to not overdo your cardio or stress.  Take care.  I am glad to hear it all went well.  

[abc85]

Typically when they refer to atypical AVNRT, it means that anterograde conduction is through the fast pathway while the retrograde conduction is through the slow way.  For typical AVNRT, this is reversed.  So basically, it means that the signal is going in a different direction than normal.  You can look at it as clockwise vs counterclockwise type of thing.  Did they find the pathway in the right or left atrium?  Your groin will be sore for a few days but should subside and the soreness shouldn't be too bad.  I do have to say that every now and then I get kind of an aching feeling in that spot although it's been a year since my last EP study.  Fingers crossed that this was a successful procedure and you don't have to worry about anymore SVT!

[tom_h]

Congratulations on taking your life back!  that's wonderful to hear.

The leg pain will subside over the next few weeks. in a couple of days, all that will be visible will be a red dot from the puncture.  Just keep the area clean!  You should be able to shower today or tomorrow, and the "saranwrap" covering if it's there will peel off.  Don't be afraid to walk around a little.  A local mall is a good place to stroll and get a bite to eat.  Makes you feel normal and alive again,

It's very common to feel some blips, jumps, and even some short runs of SVT.  The burn wounds must heal and build scar tissue to form a barrier in the accessory path.  Once to three months is optomistic.  It's not uncommon to feel them for up to 1 year.

Atypical AVNRT could just mean an uncommon location, a place where it's not usually found; perhaps some type of odd septal accessory pathway location.  Perhaps you can ask on your followup.

It's great that you went into SVT so easily. I had similar circumstances going into SVT while under general sedation as the catheters were just entering the right atrium.  This happened to me back in 1971 when I had a then leading edge cardiac catheterization, but decades before the ablation process.  I was very conscious then.  Alarms went off, blood was spurting from my arm like a fountain, and they were charging defib gear to shock me back into NSR.  I asked if I could sit up and Valsalva which I did,  and was successful in converting it.  A scary experience which has remained with me.  So I was relieved when my EP told me that I would be asleep.

Again, contgratulations.  Now get out there and live it up!

[mreilly82]

To everyone thanks for the replies. The doctor scheduled the ablation for yesterday which I went thru with. I had Atypical AVNRT, was ablated with 95% certainty according to the doctor. I had conscious sedation and dont quite remember a thing. The doctor said that before they got catheters were up to my heart I went into SVT without being induced(which is probably a good thing, right?). I can only remember waking up once during and I was shaking tremendously. I said to the doctor that I dont feel cold but am shaking bad. He told me i wasnt cold but shaking from the adrenaline. I said ok when are we starting? He said we were already done and started to show me the computer screen with the 5 ablation dots on it then I was out again and didnt wake until recovery room. The doctor told them I had the rare type of AVNRT as Atypical? which I dont get but he told them it is still curable at the same rate as the common type. I remember the nurse checking my leg often and when I was ready to leave she said the machine was tracking my PVCs? It said 0 PVCs over the 5 hrs I was in recovery which is a good sign the treatment went well. I went home yesterday and slept more. Was quite tired from the whole ordeal. Today I have been well no pain in chest but leg is kind of tender not a whole lot of pain. Today I have felt kind of what it felt like before SVT would start. Almost like a skipped beat. My wife says the doctor told them yesterday that I would feel these for 1-3 months because of the inflammation and heart relearning correct way for electricity to go. I am not too nervous about these beats but it does make me think if something is still wrong with me. No SVT bouts at all which is awesome. He also told them no meds other than my aspirin which started after I got out yesterday. Can anyone address what I am feeling? Anyone know what Atypical AVNRT is? The doctor told my family he showed me on a dry erase board which I slightly do remember but all I can say those drugs were good.

[tom_h]

Propofol is a pleasant way to go under.  You don't feel like you're having your conscienceness being pulled away from you.  I use to fight it, and there was a very unpleasant period where I was half in/half out. and my hearing became supersensitive.  OR personell seemed to be yelling; I disliked it very much.  With propofol, there is a brief moment of dizziness similar to overconsumption of alcohol.  Then the next moment, you're awake and hours  have elapsed.  The other nice thing about it, is you can shake the effects off very quickly.  I was awake and eating a sandwich within 45 minutes of waking up.  It's not at all like the old days when it took hours to completely lose the effects of the anesthesia.

[abc85]

I'm jealous they gave you something before you went into the EP lab.  I asked for something the first time as I got there pretty early in the morning (I think 6ish) and they had an emergency come in so I didn't end up going back until around 2ish.  It was a long time waiting in my room with my friend and since I didn't know what to expect, I was pretty nervous.  They said I couldn't have anything because I needed to be alert for when I first go in and they do their safety check of double checking pt's identity and what procedure they are there for.  The second time I ended up being the first case so I went back fairly quickly, like maybe 20 mins tops.  I will say that I don't really enjoy the "landscaping" they do down there as I'm a pretty modest person.  I tried to take care of it myself before going in and the first time, the nurse was really nice and realized I was uncomfortable to she was pretty quick and made me feel better about it.  The second time I had a different nurse who, even though there wasn't much to do down there acted like it was some sort of sr art project and really went a little overboard.  The staff in the lab said she's kind of known for that.  The staff was all very, very nice and realize that most people are pretty nervous so they do a good job of putting you at ease.  I will add that the first time I was admitted overnight for observation because I was coughing really bad when I woke up for a while.  They were concerned about bleeding between the coughing and the flailing I did when I woke up.  It was my first time having anesthesia so we didn't know the flailing was going to occur so they weren't really prepared for it.  They had pulled my caths out before I started to wake up so they were busy trying to keep me still and hold pressure.  Never had any issues with bleeding and my overnight stay was pretty boring and I went home first thing in the morning.  The second time they tried to minimize this by giving me versed as they weaned me off the propofol but unfortunately this just prolonged the experience.  They had sewn the catheters in this time (I'm not sure if that's normal or not as I was never awake when the caths were in the first time) and they left the caths in place until I was awake.  They also kept me in the lab to wake up where they had more staff available.  However, this reaction to anesthesia, especially what is typically used in this setting is very rare so you shouldn't worry about it.  I had this tone at a big, nationally ranked heart center (located in the southeast) that does a lot of procedures and they said that they have only had 2 people with this reaction in the past couple of years and I was one of them.  The good part about it though is that I never remember any of it and as far as I'm concerned I feel like I wake up quietly as that is what I remember.  I'm not sure where you live and what hospital you are going to but from what I've heard from most people is that in most places they have found that the staff in EP labs is typically really great and good at putting you at ease.  Make sure to ask them any questions that you may have even if they seem trivial.  And communicate with them about any fears or concerns you may have.  And again if you have any questions, feel free to ask me.

[abc85]

When I had my ablation, they had me completely out so I don't remember anything.  I remember lying on the table and then I blinked and it was over.  Didn't really have any pain afterwards and was back to normal pretty quick.  I had a second EP study but they weren't able to ablate anything about a year later.  Same thing, I was on table and everything started to look like it was bouncing so I asked the CRNA if he had pushed the propofol, he said yes and then it was liked I blinked and it was over again.  The second time I though I had some dull chest pain for a couple of weeks but then was back normal fairly quickly.  I think that part of the reason why I had the chest pain was because for some reason I don't wake up quietly from anesthesia and have a tendency to flail around a bit so they ended up holding me still for a while until I was aware of where I was.  However I must of put up quite an effort of trying to get up while they were holding because all of my muscles were pretty sore the next day.  If you have any questions, feel free to ask.

[tom_h]

Here is another excellent recount of the electrophysiology procedure and ablation.

http://www.medhelp.org/posts/Heart-Rhythm/Jannie411s-Ablation---Part-2--Section-2---The-Actual-Ablation-Procedure/show/1499077

http://www.medhelp.org/posts/Heart-Rhythm/Jannie411s-Ablation---Part-2--Section-3---The-Actual-Ablation-continued/show/1499079

So physicians such as mine use general anesthesia. I was given vallium shot prior to entering the cath lab, and remember nothing after getting into position and being made comfortable.  All I wanted to do was sleep! ....and I did for nearly 5 hours, waking up alert and cured!