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Sustained V Tach (benign) - is catheter ablation a good idea?

Hello, a little background first - i'm a 27 yr old male, athletic, and in very good shape.  For the past 9 years, I have noticed what I called a "funny" heartbeat that would kick into high gear as a result of excitement or adrenaline combined with some sort of exertion.  A typical occurrence would be at a softball game, running bases.  It would go away on its own, so I just didn't worry about it.  It also does not phase me whatsoever.  About six months ago, it kicked in & I pointed it out to my fiance, who freaked out and thought I was having a heart attack.  

Long story short, I go in for a physical and tell the doc about the "funny" heartbeat.  I end up wearing a holter monitor for a softball game, and capture the heartbeat.  Two episodes were captured, both lasted roughly 2-3 minutes & showed a heartbeat in the 260/minute range.  All tests (cardiac MRI, stress test, EKG(?) are 100% normal). I have a healthy, strong heart apparently.

That said, my doctor gave me an optoin to A) do nothing B) take meds or C) consider an EP study and potential ablation procedure.  I tried to choose nothing, but was swayed into taking some meds.  I'm currently on 25mg metoprolol & 100mg flecainide (twice a day).  With the meds, I've not had an "episode" in 1.5 months, but I definitely have some anxiety, a few heart pains throughout the day, and a couple of pvc's (that I've never had before).

My fiance and family want me to go forward with pursuing an ablation procedure, but I'm uncertain.  I'm currently seeking a 2nd opinion from the Mayo Clinic, as a coworkers Dad had a procedure there for A-Fib & had an excellent experience with Dr. Munger.

I guess I'm just a little weary, and am wondering if anyone out there can relate to my situation or offer any insight.

Anything you all can provide is much appreciated.

Thanks, Joe.
11 Responses
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1423357 tn?1511085442
Hi Joe.  I've been following this closely, but since SVT is my niche, I've been keeping my fingers off the keyboard up to this point.  Two things that I wanted to comment on though. One: You have to remember that what you have, be it VT or SVT, has no bearing on how physically fit you are.  You can be an elite athlete with a healthy, structurally sound heart, and still have electrical issues within it.  I read about it almost every year with players in the NBA; someone leaving the court with a "rapid pulse". Two: your fiance' is very wise in coercing you to see a physician, it not for your heart issue, for your general health. Remember guys like Lance Armstrong who were at the top of their game, a physical specimen, no reason to see a doctor for anything, then discovers he has testicular cancer. Regular health screenig, even at 27 is a great idea.

I've been looking at the rate you mention, 260.  That is extremely fast for an adult of 27.  Typically, you'll see rates in the low 200's at that age.  I had rates in the low 300's as a child, but as I aged, the rates fell rapidly into the 200-225 range.  If it's SVT rather than VT, I'd guss and say you have a AVNRT form, and becasue of the high rate, is close to the AV node; pure guess though.

I would definitely see and EP.  Messing with different meds at different strengths to find which one works, and dealing with the ancillary side effects is a pain and carries risk as well.  The procedure will keep you in the hospital for a day, and out of work for perhaps a couple more.  Normal activities can be resumed within in a couple weeks.  I was fully sedated, so consequently my experience was extremely positive; I remember getting on the lab table (barely), and waking up in the recovery room, nothing else.  On the other side of the coin, we had a unsedated person on here who had the procedure stopped and rescheduled with sedation because she was shaking so badly from fright.  The idea of sticking "wires" into your heart sounds a bit unnerving, but it has become a routine procedure to map the hearts electrical system, and to eliminate the accessory pathway(s) that might be causing the problem.  I'd say go for it, and best of luck.
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Avatar universal
Thanks for all of the in-depth info, Lisa.  I really appreciate it!!!

Thanks, Joe.
Helpful - 0
967168 tn?1477584489
Joe, you just call in their office and tell them you want copies of your files, including test results etc for your continuing medical care.  

Some places make you pay per page but it's normally $1 per page, but if you have them fax to another doctor say your primary or 2nd opinion they will do it free of charge BUT some dr's get their toes stepped on so to speak, if you seek a 2nd opinion and drag their feet about forwarding the info; so call well in advance if you choose to have it faxed.  Another thing is I have had some doctors make me send in a written request or sign a release form they send.

It's always good to have your medical files in your possession in case of emergency, especially now you have a problem with the electrical part of your heart.  I took my files wrote down dates and symptoms noted on the dr's files then put DX: [list it here] and then if it has impressions or notes on it.  That helps new doctors or emergency help to know quickly what's going on.

Either way, SVT or sustained VT, it would be a good idea to get a 2nd opinion and if you're near Mayo - it's a great place, as well as Cleveland and Vanderbilt.  

An EPS or electrophysiology study is where they go in and check the heart's conduction system and in heart muscle cells.  It sometimes is done with no sedation, just a numbing agent or can be done with Versed (twilight sedation) which is what I chose and you really don't feel anything but you can still hear what's going on and talk.

During the EPS, if they find anything then they can ablate (burn) or freeze whatever pathway it is they find.  The length of the EPS all depends on what they find and how successful they are in recreating your arrhythmia.
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Avatar universal
Thanks for all the input - in hindsight, and trying to remember what my doctor last told me, I'm thinking you guys might be right in the fact that it's Supra VT - I'll have to clarify with him.  I've had about 4 total visits in the last 5 months or so.  I'll admit that I assumed what I have was "sustained" based purely on the length that it would occur for.  I had thought that sustained meant in excess of 30 seconds......

I also have never told my actual electrophysioligist the technique (that i now learend is Valsalva maneuver :) ) that I do to help rid the episodes.

This might be a dumb question, but I've literally never been in a doctors office prior to this (I didn't even get a physical in the last 7 years until my fiance forced me to because of this heartbeat thing) - can I just simply call into the office and ask for copies of any results they have?  Do they fax them over or do I need to pick them up?  I imagine these items (cardiac MRI, stress test results, holter results) would be needed when I get a 2nd opinion.

I'm thinking it might be a good idea to consider an EP study (??) or whatever it is called where they sedate you and go in through the veins to see if they can find the issue.  I know there's risk with everything, but is this a pretty routine thing?  I imagine it is done just to see if it's even worth considering going all-in with the ablatoin....

Thanks!

Joe
Helpful - 0
995271 tn?1463924259
To further evaluate the risk/benefit of an ablation I would want to find out what type of v-tach and where it's coming from.  If the v-tach is coming from a single area of the your heart muscle it probably will lend itself well to the ablation.  This is called unifocal or monomorphic.  I'm thinking this is what you probably have going on.  I'm also thinking that your source is probably the right ventricular outflow tract (RVOT).  I've heard of RVOT v-tach before in otherwise healthy hearts.

If they are RVOT unifocal I'd go in and buzz those crappy cells out of there.

You're doing the right thing, get more opinions before you pick your next step.
Helpful - 0
967168 tn?1477584489
I would definitely get a copy of my test results and make sure you understand what you have, then you know what you're dealing with. It's possible you have SVT (supra ventricular tachycardia - meaning 'above the ventricles'; some I think is associated with WPW) or you do have Sustained VT and we're going to learn something new =)

When I'm in an episode of NSVT or non sustained VT that is >200 bpm; there is no way it will terminate by doing stuff you've listed - but as Bromley says SVT will be converted by doing those things.  

I've been here 2 years and haven't heard anyone say anything about converting sustained VT; Normally with sustained VT especially with high HR's, the ventricles quiver and cease to pump blood and get all funky and a person faints.  However, anything is possible and we're just patients here =) so I'm very interested to find out.

I've had arrhythmia's and fainting since age 9, finally at age 42 they found out I had Polymorphic VT/malignant arrhythmia's that make me faint and my heart stop; so it is possible but your dx wouldn't be benign unless I am completely misunderstanding what's going on - I'm still learning daily about arrhythmia's and symptoms and things we patients go through.

btw...that thing you do is called Valsalva Maneuver [sp] which causes vagus nerve stimulation; used by many of us here to convert heart rhythms - what it does is decrease HR and BP.  

Please talk to your doctor if you haven't about doing this; sometimes it can be dangerous if certain circumstances happen - the increased pressure in your chest can reduce the amount of blood flow and some can be embarrassing in the bathroom - I once fainted in the bathroom at work...co-workers finding me like that was horrid! lol
Helpful - 0
86819 tn?1378947492
Joe, its my understanding VT does not respond to positional changes or as you describe flexing your diaphragm.  You might have SVT, which is something completely different from sustained VT. SVT responds to positional changes.

VT is common in people with hearts that have been injured or have heart disease. There can also be a genetic relationship. You might have SVT.  Its not the same thing, and the risks and benefits of treatment are different for the two.

Ask your doc.
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Avatar universal
Also, I forgot to mention what I would do / do to get the v-tach to regularize.  I bascially squat down a bit, and flex my diaphragm, almost as if trying to push to go to the bathroom. After a while, this normalizes the heart rate, although much faster than when it started, probably 120 or so if I had to guess.  I learned at my stress test that what I was doing was actually a trick that puts pressure on a specific nerve or something that slows the heart rate.  Kind of crazy how my body or myself was able to figure that out naturally over the years...
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Avatar universal
Jerry - good advice.  That mirrors what a lot of my friends say as well.  

Lisa - Prior to meds, I have a 100% normal heartbeat with no skipped beats whatsoever, except for the occurrences of V-Tach that typically come when there's some sort of combination of adrenaline/excitement/nervousness & physical exertion.  The recordings on the holter showed uniform beats (i think idiopathic??) and rates as high as 260bpm.  This past summer at my family picnic, I played tennis against my uncle & had V-Tach episodes on and off for about 35 minutes - never stopped playing tennis, and I was not affected whatsoever.  At this point I did not know what it was, so I stuck with my mentality of "it hasn't killed me in 9 years so it must be nothing" - a month later is when we finally captured these beats on a holter monitor, and I was officially diagnosed.

That said, I can sense that my electrocardiologist & his staff of nurses look at me & the results of the holter monitor test almost in disbelief.  At one checkup, I joked to the nurse, "so, am i a medical oddity or something?"  - she responded with, "you kind of are".

As for taking the meds, my doctor kind of pushed me to it, because of how high my heart rate was.  He said, "although it's benign and 99% not going to affect you, I'd still like to control your heart rate....it was really fast".  This was after I said I didn't want to take meds, and wasn't ready to think about looking into ablation.  Now I'm starting to weigh my options....

Is it possible to develop v-tach later in life or is it something you're born with?  Reason I ask, is that I was a competitive wrestler on a strenuous training program through age 18, and could never recall episodes of what would have been v-tach.  The first occurrence I can recall, was a semester into my freshman year in college, where I ran to class after a night of drinking becuase I was late, and I remember feeling it as I sat in my seat waiting for class to start...

Thanks for the input by the way.  It's amazing how good it is to talk to people about it, becuase I've been spending the last several months just reading internet articles...
Helpful - 0
967168 tn?1477584489
I'm confused, you had 2 episodes of Sustained VT lasting 2-3 minutes each and did not faint or have to have be revived? or am I misunderstanding and you're talking about SVT?

Maybe I'm a bit groggy after just waking up, but I didn't think a person could have sustained VT at those rates of 260 bpm and last 2-3 minutes w/o some sort of intervention.

sorry if I'm confusing what you've put down; I know with my VT I faint even when it's less than 30 sec which is non - sustained VT.

If it is sustained VT, please get that 2nd opinion from Mayo - sustained VT can be life threatening, especially at rates of 260 bpm can lead to ventricular fibrillation.
Helpful - 0
612551 tn?1450022175
COMMUNITY LEADER
At your young age you should seek a cure, not a medication symptom regiment.  That said, I have no knowledge (nor does anyone else on this forum) what the "odds" are of an Ablation being effective.  I understand an EP study will put some number on that.  If the study says better than 75% chance of success and less than 1% chance of serious complications I think an Ablation would be a good idea.  Hope you have insurance.  
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