V-tach-Should I get a defibrillator?

I have recently been diagnosed with ventricular tachycardia and ? cardiac sarcoidosis. MRI showed changes to the basal septum, PET scan normal, CT coronary angiogram normal, echo and stress normal. I may have had mediastinal lung sarcoid last year but it has since resolved. The biopsy was inconclusive. The ablation last month showed multi focal ventricular ectopy, far too many for the Cardiologist to ablate.  He could not initiate any sustained tachycardia. I have had a previous (10 years ago) episode of atrial fibrillation. I am a 58 year old very healthy and trim female but I have had ectopic beats for over 30 years. They have become quite severe over the last year. Sometimes I feel like someone is punching me from the inside. My doctor wants me to have an urgent defibrillator fitted. His colleagues (8 opinions) are hesitant but he wants me to have it for "insurance". I take Propanolol when they get severe. I have over 15,000 extra beats a day and ~ 10 +runs of VT on the halter monitor.
Questions are: can constant ventricular ectopics and tachycardia damage the heart (except for the dreaded ventricular fibrillation) and has anyone had a defibrillator fitted or know someone who has and how has it been? Many thanks.

[is_something_wrong]

Hello.

I'm afraid this question is far too difficult for us to answer. When your cardiologists (that are doctors specialized in heart disease/rhyhtm) are uncertain, and they have seen your test results, it's really not easy for us, that aren't doctors and haven't seen your test results, to give a qualified answer to a question as important as this.

I can try to give you some arguments in each direction, though:
- It doesn't affect the PVCs
- It doesn't affect the nonsustained VT
- It's an invasive procedure, with risks, though the risk is really low

- It's a great insurance
- It will decrease your stress levels and through that, possibly the PVCs

I don't know if several PVCs can damage the heart. It's some theories that 15%+ PVCs can cause cardiomyopathy in some people, but I'm not sure if this is just a theory or proven. Lots of PVCs can make the heart pump less effective, but it should resolve when the PVCs aren't present. I think Lisa on this forum knows this better than me.

If the heart is structurally normal, ventricular fibrillation is extremely rare.

Best wishes, I hope you make the right decision.

[Mom2four85]

I'm curious about something - "The ablation last month showed multi focal ventricular ectopy, far too many for the Cardiologist to ablate"  

Did the dr say 15,000 was too many to ablate? 15,000 isn't the highest amount of pvc's I've seen ablated. Others such as myself here, have had 15,000 - 50,000 pvc's daily and had ablations for various reasons, some including VT runs.  Normally dr's won't even look at ablation until a patient is at 15-20% of their total 24hr hb's daily.

It's good he couldn't get the sustained VT to trigger, mine did 3 times during my procedure which stopped my heart, BUT the scary thing is you have cardiac sarcoidosis which is one of the infilitrative diseases I've been cautioned I may have (testing was inconclusive).

I've been told and read dr's say anything  >15% of your total daily heartbeats can lead to pvc induced cardiomyopathy.  There's just no guarantees who will develop it, but there is new research from March 2010 that says CM can happen at >4k pvc's. (http://emedicine. medscape.com /article/761148- followup)  There are some of us who have developed CM; which normally reverses when ablated or treated.   "The clinical significance of PVCs depends on their frequency, complexity, and hemodynamic response."

I had roughly 50,000 pvc's and VT runs that were dx as long runs of polymorphic VT that were ablated.   Because of this, I had a pacemaker/icd implanted; which was pretty simple but you have to make sure you follow directions after about no lifting, arm down etc. However, after the ablation I developed PAC's and PSVT and my PVC's/VT returned within a few months time.

If it is cardiac sarcoidosis causing the problem, then it may worsen. I personally would get an ICD - it will help if you have a sustained VT run and if they choose the right one, it will pace your heart down if you go into VT runs.  I have a a boston scientific Teligen 100, which has a Quick Convert that delivers a burst of ATP in the VF zone to avoid painful shocks for pace terminable VTs below 250 beats per minute, plus it's really small =)

You can visit http://www. icdsupportgroup. org/ board/ (take the spaces out) where the members all have pacemakers/icd's or just ICD's.

I'm just a patient who has a rare, complex case and been through the ringer with dr's, treatment, mis diagnosed and the gambit of arrhythmia's most patients go through.

You can try the expert forum here under heart disease and ask one of the MH dr's their opinion; sometimes it does take a few tries at different times of the day to get your question in though, so keep trying.

Feel free to pm/message me if you want to talk =)

[bbxx]

seacay- How can your echo be normal if you have sarcoidoisis? I thought this disease
     caused scar tissue type buildup on the heart.

Lisa-if you had your dangerous vt ablated, why did they put the icd in you?

[Mom2four85]

My EP found that my PVC's/VT were malignant, unknown origin. He ablated the 3 areas that showed during the EP Study here I went into long runs of sustained P-VT.  Once they ablate one section, more cells can change and misfire.

The AICD was placed as a Prophylactic against sudden cardiac death, should the pvc's/vt return in another site (within a few months they returned and VT ensued) for some of us, ablation has to be repeated, sometimes numerous times for it to work completely.  

My EP Study said this: Indications: Highly symptomatic PVC's and NSVT; with a lifelong history of syncope.  The PVC's were that of a Left bundle inferior axis with a notched QRS complex. This patient had an abnormal TTT and recurrent syncopal episodes, profound bradycardia; as well as NSVT, which worsened with exercise.

Catheters were placed with 1 pacing drive cycle and 1 stimulus the patient was induced into long runs of polymorphic VT, which became sustained and required a 360j counter shock back to sinus rhythm. Several RF lesions were delivered with a decrease in the incidence of the PVC's, although they soon returned. Two other superior sites were performed, which eliminated the PVC's.

Given the easily inducibility and reproducibility of her VT, at this point we felt that AICD would in all likelihood, be indicated and no further attempts at induction of VA were performed, we must consider conditions such as ARVD or Cardiomyopathy as a potential etiology for the above findings.

The day after my ablation,  I had a cardiac MRI which was inconclusive for infiltrative diseases and 2 days later I had a cardiac catherization that showed I had developed non-ischemic Cardiomyopathy, mild Systemic Hypertension and moderately elevated Left Ventricular End-Diastolic Pressure at (34) which can indicate heart failure.

btw...no clue how things like this don't show up on echo's - my echo was "normal" also and I've questioned this since my surgery - in my journal is a post called "One Size fits all Echocardiogram", very interesting info and I still have no answers.

[seascay]

Thank you to those that responded to my questions about the defribrillators.

I have to admit feeling very disappointed that my "Specialist Cardiologist" has given up on me. I have read where it often takes several ablations to help settle the VT's. I asked him if he could at least try a few more times. I think he is being cautious by recommending a defib for me. Meanwhile my main Cardiologist has just had a triple by pass so I have to start all over again. My husband is a surgeon-I call in the "Doctor's wives syndrome".

[Mom2four85]

seascay VT can be very difficult to ablate

here's an article in my journal with some info a dr gave me:  http://www.medhelp.org/user_journals/show/228899/VTACH---VT-?personal_page_id=861727

you may want to try and post in the heart disease expert forum and ask one of the MH doctors their opinion or find another dr who is at a large practice near you; sometimes the physician and their skill and background can make a difference in the treatment you get