I am a 41year old chinese male, 80kg, 1.74m, living in Singapore and in need of advice if I should go for one more try of ablation versus oral medication.
My medical conditions are vasomotor rhinitis and hypersensitivity to topical iodine.
Notable medical history is severe hayfever in the UK for 4years treated aggressively with tefernadine. This was 18 years ago.
16years ago I was diagnosed with Right Bundle Branch Block.
7years ago I was admitted for tachycardia and had partial ablation done. It was partial because my reentry points were in the lateral and anterior wall, but the hospital I was admitted to only had machine to ablate the posterior wall. The diagnosis then was Idiopathic Fascicular Ventricular Tachycardia. After ablation, I was put on oral Verapamil.
5 years ago, I learnt I have sleep apnoea and I have since started on CPAP.
4 years ago, I underwent elective ablation when they had the required machine. The outcome was supposed to be 90% successful, but the tachycardia returned 2 days post-op. Instead on 1 pathway, I ended up with 3. I was obviously disappointed, swore off ablation and opted for oral medication.
2 years ago, I woke up one morning with tachycardia again. Was admitted. I opted for ablation as oral medication was not as foolproof as I thought, but the outcome of the ablation was worse. 3 pathways have now given way to multiple complexes in the anterior, lateral and posterior walls and the apex. The ablation was pretty extensive and the scars that formed after the procedure are actually visible under MRI, but the re-entry points are all over the place. My condition was then managed with Verapamil 40mg 6hourly (I could not tolerate the slow release).
All these while, my blood vessels and muscular (EF 55%) were within the normal range.
Unfortunately, 1 week ago, my tachycardia returned despite strict compliance to my medication and I had another emergency admission. This time round Verapamil did not work, as did a number of emergency intravenous medication. They had to do cardioversion on me (50J, 50J, 70J) on me the first time to regain sinus rhythm. A few hours later the tachycardia returned even though I was on iv esmolol and another cardioversion was needed (50J, 50J, 70J, 150J). To avoid further cardioversion, a temporary pacemaker was inserted to support their trial usage of iv amiodarone. Amiodarone did the trick, my condition stabilised and was sent to the general ward where my Dr started me on Sotalol 80mg 2times a day as he was concerned amiodarone is too aggressive and took away the option of ablation which he is strongly recommending.
2D Echo from this admission now showed dilation in both atrium and the left ventricle. My EF is now 30% as my heart is no longer contracting in synchronised rhythm. Therefore, my heart function has severely deterioated.
Looking at my medical history, it should be obvious why I am conflicted between ablation and medication. Neither has worked well in the long term. Looking back, if I had not gone for the elective ablation, I would have been in a better shape with oral medication, but the draw of living life without medication was something I could not reject then. I will not cry over spilled milk. What I need to decide on, given my current heart function, is whether I should give ablation another try or stay with medication and see what comes. I would appreciate your views, and advice where possible.