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Still having runs of SVT after ablation.
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Still having runs of SVT after ablation.

I had an ablation for AVNRT 6 weeks ago.  About a week after the procedure I started having short runs of svt.  They are slower than what I used to have, but other than that feel the same.  They start and stop abruptly and I can feel them in my throat.  The longest they ever last is 2 minutes, but that's longer than what I've understood to be normal during recovery.  I went to my EP and he has me on Metoprolol.  It keeps them from happening as often, but it doesn't stop them.  He said it could be irritation from the ablation or it could be they need to go back in and do another.  He's giving me a month and then he'll reevaluate.  Has anyone else gone through this and what was the outcome?  Is it possible that it is just irritation?  It seems unlikely to me.  I feel like I'm worse off now than I was before.  
Tags: AVNRT/SVT
23 Comments Post a Comment
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1807132_tn?1318747197
I am not a doctor but it is possibly what you are experiencing is something other than your svt.  I am not sure the dynamics of what occurs after an ablation but I know the path around the avnode is very short for one to get avnrt in the first place so I question if the pace is slower if it would still be the avnrt or something else like a run of pacs.  I get those from time to time though mine only last a very short few seconds not minutes.  I also know junctional rhythms can occur after an ablation but considering your doctors saw it on the monitor you can probably rule it out. I also noticed after my ablation that I can get simple sinus tachycardia after a night of drinking so it is possibly you have had this other issue going on undetected because it was masked by the avnrt.  I would say try drinking lots of water and see if that helps.

If it does turn out that there is still some sort of residual path that the signal is finding its way around it isn't anything they can't fix.  In the long run it is very likely it was a very good idea you did the ablation.  Being young our hearts can handle tachycardia but as we age it gets worse having more frequent longer episodes and you would run the risk of having heart failure.  I do wish the medical community would take that into consideration more when they talk of svts being benign.  Maybe in the short term they are but not in the long term.  That doesn't mean everyone with svt will fall into heart failure but I think our odds go dramatically up if we have it.

I will say 6 weeks is not long enough for your heart to recover from the trauma it has been put through.  I had all sorts of skips, jumps, runs and such after my ablation and it took a good year or more for it to fully settle down.  I would say try giving out some good coughs when you notice a run jump in and see if that breaks up what is happening.  But no matter what do not lose hope.  It is a long process to get our heart healed from svt and yours appears to maybe have a little bit more complication than most but I am sure your doctors will get you straightened out so hang in there and just keep focusing on your heart being rid of the svt one day.  Take care and keep us posted on how you are doing.
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1423357_tn?1373023915
(Copied from my comment on another thread)

Hang in there.  I had shorts runs of SVT along with skips for almost a year and a half.  In fact8 months after my ablation, I had a terrible week of jumbled up arrhythmia and runs of SVT which disppeared as mysteriously as they appeared.  I still get an occasional brief run of SVT; perhaps 6-12 beats here and there.  Remember, the path ithat causes the SVT s still present and that it has only had a barrier placed across it.  If the path isn't totally severed, or if conductive muscle forms over the barrier, you can get it again.  But for now, I think you need to give it lots more time.
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Avatar_f_tn
Thanks for the encouragement.  I know it can take time.  I'm not totally sorry I had it done.  It is a relief that it doesn't go up to 240 anymore.  I don't think,however, that this is an old problem that was masked by the other.  My svt used to be more severe, but it occurred much less often.  Once a month at its most frequent.  These runs are happening every day several times a day.  I surely would have noticed that frequent of an issue.  It's in this respect that I feel my problem has become worse.  Before the ablation, it was infrequent enough that I could live with it without medication.  Now I have to take medication and it still doesn't keep the episodes away.  It just keeps them from completely taking over.  I'm waiting for the doctor's office to call me back this morning and I hope they will have a plan of action.
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Avatar_f_tn
I should also add that the doctor told me after the EP study that the pathway had been very close to the av node.  He had been cautious not to go too close to it and for that reason couldn't be as sure that he got all of it.  He gave me a slightly greater chance of recurrence than he otherwise would have. 5-10% vs 3-5%.  I wasn't thrilled to hear that but still considered it to be good odds.  I do think it's likely I'll need to do this again.  I really am just curious if anyone has had a similar experience.
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1807132_tn?1318747197
The path being close to the avnode may be the issue.  If the scar tissue is blocking something a bit it could be your heart reacting and going into junctional rhythm or a run of packs jumping in or just your heart trying to speed up to compensate.  There is likely some inflammation that could be aggravating things for you that the doctors are probably hoping would go down.  Unfortunately that is the biggest risk with avnrt, the pathway being too close.  Mine was pretty far they say but I still had lots of skips and jumps after the ablation more so than before and still get very short runs of something like I said before. I had one in the car this morning but mine only last a few seconds so no big deal.   I know I was very stressed about the whole thing for quite some time afterwards because of all the jumpiness thinking the same thing it may have not been a good idea but it did eventually sort itself out well enough. But I also know stressing about it was probably making the situation worse as well.  Easier said than done when you don't feel well but  I will send prayers your way that things settle down. soon  Worst case is you would need a pacemaker but still hold out hope that that can be avoided.  Keep us posted on how you are doing.
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Avatar_f_tn
I just spoke to the nurse this afternoon.  My episodes seem to be just like the ones I had before the procedure only not quite as fast.  She says right now the doctor is leaning toward the thinking that there is some tissue left that did not get ablated.  I will probably meet with him one more time and most likely schedule another ablation.  I have a lot of questions for him before this and I hope it is the answer.
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1807132_tn?1318747197
Good luck.  let us know when it is and we will hold good thoughts for you.
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1423357_tn?1373023915
You won't be the first one here on the forum who has had to go back km for another. Hope all goes well for you!
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Avatar_f_tn
So I'm going in Tuesday for a repeat EP study.  I think I'm more nervous than I was the first time.  I have to stop taking the beta blockers 3 days before and that has me a bit nervous too.  They've been happening so often when I do take the meds I'm really not excited to see what will happen without them.  Oh well.  I'll get through it  Just want this to work and to put this behind me.  
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1807132_tn?1318747197
Well the good news is being so active should make it easy to map.  I wish you the best of luck today.  My thoughts are with you.
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Avatar_f_tn
So I'm home recovering from this second ablation.  They say it went well and so far I feel better.  The doctors were very capable.  I saw a different doctor than the first time and I'm glad.  I did a lot of research and think I was in better hands this time.  This doctor commented that he could see what led the first doctor to his conclusions but that he interpreted the data a bit differently.  There was a rather large area that was missed the first time.  One unexpected event was that right as they were finishing up there was some brief activity on the left side of my heart.  As they explained to me, they were not set up to go to the left side safely and we will wait to see if it manifests into a problem.  It may not as they said it was very weak.  Seems that having a pathway on the left side is very rare and this doctor has only treated it one other time in his 20+ years.  Yay me!  I thought it was just my personality that was unusual.  So one day I may have to go in for ablation #3, but maybe not I hope.
They put me on Rythmol for the next few weeks while I recover.  They tell me that's just to help lessen the symptoms.  I'm nervous about whether this is giving me a false sense of security.  I don't want to come off of the meds and find that my svt isn't really gone.  I don't know if the Rythmol would really cover them up that well as I've never taken it before.  I was on Metoprolol before the EP study and that seemed to do very little.  But all of this is teaching me patience.  I know I can't do anything but give it time.  
Thank you all so much for your encouragement and your good thoughts.  It's so nice to know there are others who can relate to this.
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1807132_tn?1318747197
Well I am glad to hear you are home recovering and things went well.  A bit worrisome about the left side activity but hopefully it is just that your heart is so worked up right now  with 2 ablation so close together it really needs some time to recover.  That said it isn't unheard of for people to have more than one extra pathways and it sounds like you found a really good doctor who would be very capable of fixing the left side if necessary. Well rest up and keep us posted on how you are doing.  I send good thoughts your way that you are really are svt free.  Stay strong.
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1423357_tn?1373023915
I had a left side ablation for near lifelong AVRT.  Standard procedure to get there is by transseptal puncture.  Mine was a very wide conductive area which required 17 connecting burns to bridge it.
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5342561_tn?1366668482
Hello, I to have had two ablations for AVNRT although mine were 12yrs apart. I just had my second one done this past May. I will say that this one was harder to recover from than my first one. My doctor said I presented with AFIB and Atrial Flutter during my EP study, (left side) but he said he felt it was medically induced and that he isn't too worried about it (wish I could stop worrying!). I will have to see down the road if it turns into anything. I am now almost 3 months past my ablation and I am taking a beta blocker called Carvedilol and it has helped me return to an almost normal life. I just saw my EP last Thursday and he is increasing my dosage as I am currently on the lowest dose, and said he wants me to stay on this med for at least a year. Every month I am feeling better and better. Our hearts just need time to recover and settle back down. I hope you recover good as new. Keep us posted:)
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Avatar_f_tn
So I go back to the doctor in a little over a week.  I have started having short episodes in my sleep again.  They are creeping back gradually just like they did the first time.  At first I would feel like they were about to start and they didn't.  I took this to be a good sign.  Now they are developing into brief runs that are close to 140bpm.  I don't know if this is the irritation they spoke of.  They start and stop suddenly just like psvt and I feel the heaviness and shortness of breath.  They happen when I am lying down and there is always heartburn with them.  The heartburn has always come with these even before my ablations although no one has told me why.  I can't stop thinking of the pathway on the left side that went unablated.  I will tell these concerns to my doctor and I guess they will put me on another monitor.   I just don't feel I can continue building up hope like this.  Last night I hardly slept at all as the episodes kept waking me up.  Being tired makes them worse too.  I don't know why this is happening and I just want them to stop.
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Avatar_f_tn
I keep thinking that maybe the left side pathway has been a player in this all along.  I feel like I'm losing this battle and I don't know how to come to terms with that.  I want to be able to do normal activities again.  I want to have another baby but don't feel able as long as this continues.  I'm 37.  I don't have time to wait around.  I'm losing more than sleep and money with this.
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1807132_tn?1318747197
I am sorry to hear you are still having issues.  It does indeed sound like the left side is what is causing you issue but I would think once it is corrected you would be done and clear.  That said, I did have a lot of extra jumpiness after my ablation which could be contributing to you having more issue maybe more than normal.  The more ectopics I believe the more chances of falling into svt.  Please do not give up hope.  It really is a pretty easy fix once they catch the main area that is giving you trouble.  

As for the heart burn, from what I have learned though my own research the going theory is that heart burn and acid reflux irritate the vagus nerve which sends signals to the heart causing it to act up or throw off extra beats.  It is usually the pause after an extra beat that allows the extra pathway to complete it circuit thus causing the heart to race.  I would maybe try and address any acid reflux you might have and see if that helps.  Maybe try some antacids for just a little bit to see if that relieves the stomach issues and puts less pressure on the heart.  Being you just had an ablation, 2 in a short period, your heart may be jumpy regardless but it might be worth a shot to see if it helps.  

Well hang in there.  I send well wishes your way that you will get this fixed for good in the very near future.  (((HUGS)))
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Avatar_f_tn
How did the 2nd ablation go? I seem very similar to yourself I suffer from RIGHT ATRIAL TACHYCARDIA which is just one abnormal cell rather than pathway (much more tricky to ablate as it is tiny) like you I would suffer at the very most twice a month but this would last 1-3 hours but only reached 170bmp had my 1st ablation in jan which made everything worse! I then began to suffer daily although only reaching 130bpm but I was in and out of A&E the consultant thought he had possibly touched upon the cell but not completely got it therefore agitating it. I was put on fleckinide until my 3d mapping procedure in may. They were again adamant they got rid of my svt this time and they did a fab job but unfortunately I still seem to be having short runs when trying to sleep which is really annoying but soo much better than before, recently had a holter monitor that noted something in the p wave which my nurse says is consistent with RAT but the longest was 39 beats so now I have the option of another ablation, tablets or just wait to see what happens I really didn't like the ablation, sedative didn't have any affect on me so felt/saw it all and really don't want a 3rd attempt incase it makes it worse again, really confused any advice appreciated (24 years old and feel this is just unfair)
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1807132_tn?1318747197
The only thing I might consider it giving your heart a bit of rest and see if that clears things up.  Ablations agitate the heart and I actually had worse ectopic beats for a whole year after my ablation and it really took 2 for me to have them be almost completely gone.  I am not sure with your issue if it will continue but since you have had 2 ablations in a 6 month period I might wait and see if your heart will calm down with a little distance from all the excitement especially since you aren't having super long runs that are disrupting things too much.  Time will tell but your heart has been through quite a bit it may just need a rest to improve.  I wish you luck and try to keep your stress down as that will make things worse.  Hang in there.  I send well wishes your way that you get this cleared up.
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Avatar_f_tn
So I had my follow-up with the doctor and he wasn't thrilled to hear I was having some runs.  He brought up the left-sided pathway and said I could stay on the rhythmol if I want, but it might be masking what's going on.  I told him I would rather come off it and find out if things are really better.  Since it's not a dangerous rhythm, he said that was fine.  So 2 days later I had about 5 episodes during the night.  None of them really severe or long.  One thing I noticed was that a couple of times while it was going fast, there were skipped beats in there too.  I never noticed this before in SVT.  I'm wondering if it really is just sinus tachycardia and just a sign that my heart needs more time.  I will do a 3rd procedure if necessary, but I don't want to rush into it.  So I think I will ask for another monitor.  I want to be very sure.  It also only ever happens when I'm lying down putting pressure on my chest.  I will of course bring all this up with the doctor.  Right now I'm trying to relax, get some exercise and sleep and see how this progresses.
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1807132_tn?1318747197
Ablations tend to annoy the heart and I had a lot more pvcs after my ablation for quite a long time afterward.  They also were felt stronger.  With a little distance hopefully they will go down for you maybe even lessening the amount of runs you are having but you likely had the pvcs before you got ablated. I know for me I thought everything I felt was svt related not realizing there are other conditions and pvcs are actually a trigger for one to fall into tachycardia but also may help you bounce out as well.   Well hang in there and keep us posted on how you are.
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86819_tn?1378951092
Hi. Im sorry to hear that your recovery is dragging out.  I did have something similar happen to me following an ablation.  Eventually things settled down a bit,  but for a while there it was pretty nerve wracking.  I feel for you.

Concerning your diagnosis before and after the procedure,  I would listen to the explanations and consider getting a second opinion. Not that the first opinion isn't any good,  just for making sure everything has been considered and communicated to you more than once. These things are complicated and making informed decisions can be daunting without lots of good technical support.

Also,  I think your idea to get rest and exercise is a good one. It's easy to get sucked into depression.  Don't let that happen. You ll need your witts for any decisions.

Keep in mind that the heart is more of an amorphous blob, not an assembly with well defined structures.  So ablating is not always an exact science having strictly predictable outcomes.  Although there are probably conditions that can be treated reliably,  some can not.  For example,  a left side pathway is usually regarded as reliably treated.  I suggest taking care with less distinct conditions for which statistics aren't available for understanding prospects for success.  Here,  a second opinion based on lots of experience would be helpful.

Best of luck.
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Avatar_m_tn
I feel I am worse after my surgery on Nov. 12th! Just got out of the ER tonight! Still running in every month but they are not as bad! Not 260 like they use to be! Still frustrated!!!!
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