Scheduled EP Study / Ablation for SVT & IST

Hi everyone!

A lot has happened since my last post.  A little background; I am now 27, under 115 pounds, and generally healthy as can be --- minus some crazy heart-pounding, fatigue, chest pain and intense dizzy spells.  I've scheduled an ablation for my SVT .. and I have a question about that -- (that I'll be asking my cardiologist, but in the mean time ...) both my holter reports and a hospital ECG show SVT (up to 9 runs in a 24hr period, the longest being about 700 beats long on a holter monitor, and just under an hour at the ER @ 230bpm), but I still am not sure what type.  Is that something I should have asked the EP Dr?!   will my regular cardiologist be able to tell me by looking at my ecg from the ER?!  I always mean to write down all my questions for doctors, and never do.  I assume I'll remember everything and blank out EVERY TIME.  I thought SVT was the arrhythmia, but after researching, I now know that there are multiple forms under the umbrella SVT.

Anyway, the EP Dr is also going to see if he can "modify" my sinus node, since I have inappropriate sinus tachycardia on record up to 205 bpm (according to the hospital! I never knew it went that high! holters have only shown 190 something)  So I left the EP Consult / scheduling thinking, awesome! finally, it will be fixed.  Of course, days later, I'm thinking things like, what if he can't replicate my crazy arrhythmia? how will he know what to ablate on my sinus node?!  has anyone had their sinus node modified?  or unsuccessful induction of SVT, IST?

if there is no underlying cause for my IST, and the symptoms are bad enough, should I be open to a pacemaker? The high rates honestly do not bother me.  I can't differentiate between 140 and 205 -- in my hospital report it says "patient is quite unaware of palpitations" .... and I was, then.  Why do I notice pounding sometimes, and others, I'm oblivious?!  it's the dizziness that bothers me most.  I get so close to passing out, and it happens every day, starting with getting out of bed.

I'm on a BB and CCB and they make my blood pressure bottom out (70/40) so I'm water loading and taking salt tablets per my cardiologists instructions till the ablation and my blood pressure is still low.  I cannot wait to stop taking medication!!!

[michellepetkus]

In general they can give a guess what type of svt you have if they can see how it starts and what it looks like to some degree.  I have an svt avnrt that required the modification of my avnode which is the point in the heart where the signal is distributed as opposed to the sa node where the beat is generated.  I have not heard of too many cases of an sa node modification beyond it being actually eliminated and a pace maker put in. That said, my avnrt would register at 230bpm so I wonder if it is possible your doctor meant avnode as opposed to sa node?  As with modifying the sa node there is also a chance for a need for a pacemaker with avnode modification though they know what to look out for and will immediately stop burning if it appears as though the node is in jeopardy or if they won't ablate at all if they know for sure the accessory pathway is too close to the avnode.  In general for most people it is not but some have not had their svt corrected due to those types of issues.  IST though is a bit harder to ablate as the mechanism that causes it is generally outside the heart so there isn't much to ablate.  Sick sinus syndrome is usually when they ablate the sinus node and is characterized by the heart rate changing pace between fast and slow if I understand correctly.  What I will say is I had avnrt that was corrected.  But I also have pacs and pvcs which would throw me into the avnrt episodes and I also have some IST mainly after a night of drinking hard liquor but the tachycardia from that mostly just feels like a fast beat as opposed to the manic feeling I use to get from the avnrt   Obviously for me it is easy to not fall into IST so long as I don't drink.  For others they have issues everyday.  That said, but the beat difference is around 150 for IST but around 230 for avnrt so I wonder if you possibly have both as well.  It would not be unheard of and it is possible if you had avnrt and they fixed it that the IST would stop as well due to the heart having a chance to rest and get better.  But I do not know everything there is to know about SVT and so there is very likely other issues out there around the SA node that can cause IST that I am not aware of.  Hopefully if this is the case with you that they can correct your issue without the need to put in a pacemaker.  But you may need to decide if you are OK with one before you go in for your study. I would say ask your EP what they think you have, everything you have, what they intend to do when they do the EP study and maybe even what they intend not to do and what your chances are for a cure or even needing a pacemaker.  As for whether or not to get  pacemaker that is totally up to you.  You are the one who has to live with it so you really have to be the one to decide.  I would say evaluate how you feel now and if you are willing to be beholden to having a little box ensure you heart keeps beating the rest of your life.  You are very young but having tachycardia everyday must be very rough on you as well in the long run it may very well tire out your heart since you get it everyday.  When I am stuck with a tough decision I tend to try and center myself and let it all go then sit with each choice.  One choice will feel more right then the other.  It will give me more of a sense of calm then the other choice and sometimes the other choice will actually make me feel agitated.  Then I know for sure I should go the other way but the bottom line is go with the choice that feels the safest to you in your gut and you can't go wrong.  You will know you made your choice from your heart.  I wish you the best of luck with whatever you decide to do.  My hope is that it can be corrected without you ever needing to be considered for a pacemaker.  Please do let us know when you are having it done and I will send prayers you way.  Take care and stay strong.

[melephant]

thanks for the detailed reply!  After checking my hospital records, there are three tachycardias listed, "PAT" (it says PEDIATRIC?! I'm 27....) AVNRT, and inappropriate sinus tachycardia.  This is from my regular cardiologist, though, not the EP Dr.

With my last holter, I kept a journal of when I got the most dizzy and they freaking lost it (the whole practice moved the day after I turned it in).  So I don't know which is causing that problem ... with your AVNRT, did you get dizzy?  I don't want to get worse, to the point of actually passing out.  I've been very lucky, in that when it happens, I've always had something (or someone) to reach out and hold onto, or I think I would pass out.

I might have misunderstood what "node" is going to be modified, but we were talking about my IST at the time, so I'm not sure.  I have another appointment with my regular cardiologist, and my pre-registration (pre op) appointment for the ep study/ablation on the 18th, so I am going to be making a list of questions this time.  Any suggestions?! What did you ask?!

I've been thinking a lot about a pacemaker, and I still don't know.  I like the idea of fixing problems versus taking drugs for the rest of my life, but the maintenance and doctor visits involved with a pacemaker make me wary.  I drink maybe 4 times a year, do not drink ANY caffeine or take any kind of stimulants.  I also have absolutely no anxiety issues.  In fact, when going to the ER, I'm always very calm and just want them to get me back into sinus rhythm so I can go home.  The nurses are more worried than me. I'm such a mellow person, that you'd never know my heart is 150 when walking slowly, unless I was hooked to a monitor.    

At the end of the day, the thing I cannot live with is the dizzy spells.  So I think whatever it takes to fix that, I have to jump on it.  My GP mentioned my low blood pressure in correlation with the dizziness, but this has been happening for MONTHS, way before I was put on any beta blockers or calcium channel blockers.

[michellepetkus]

I believe that PAT is really another term for SVT, it stands for paroxysmal atrial tachycardia and the types you have are AVNRT and IST.  I would definitely bring this up with the EP doctor that you have been diagnosed before as having avnrt.  Maybe they can try and fix that first and see if that would help clear up the IST so they don't have to mess with the SA Node.  I am not really sure if that is possible but it is definitely worth asking to try and avoid needing a pacemaker.  

I would definitely get dizzy, lightheaded and short of breath when I was in avnrt.  I could not stand long or feel as though I would pass out.  It is rare though for a person to actually pass out from an atrial tachycardia.  That usually only happens with ventricle tachycardias.  I would ask the doctor what he plans to do and what he thinks your chances of needing a pacemaker are and whether or not you need to decide on having one before you go in for the study and ablation.  I would also definitely mention about having the avnrt and if it could be contributing to the ist because that may be an easier fix than trying to fix ist.  But then again if you are constantly in ist and rarely have avnrt then you may need to have them do what they need to do to fix the ist.  But definitely make sure you are clear on what he intends to try and fix and whether or not you will be coming out with a pacemaker or not at the time of the ablation so you don't come out surprised and upset.  My EP actually showed diagrams of the heart. what my heart was doing and what he planned to do to fix it.  Hopefully yours does the same but you can ask him to diagram it for you if he doesn't offer it up.  Ok, good luck.  Let me know how it all goes.

[michellepetkus]

I just saw another post about someone who had ist and they were initially going to have the sinus node ablation but tried the  Stellate Ganglion Nerve Block first.  You might want to ask your EP about that.  They also had avnrt and had that ablated as well but it appears as though they may still need the SA node modified for the ist.  You may want to write to Jen34IST.  She appears to be dealing with ist as well.

[melephant]

ahhh! that idea scares me because I already have Chiari Malformation and some nerve / cervical spine issues because of it .... but I'll definitely add it to my list of questions!  

[michellepetkus]

Oh well I would definitely mention that to the EP because maybe that means you would not be a candidate.  If it makes you feel wary then maybe just avoid it all together.