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VT on Holter
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VT on Holter

Greetings from Australia.

I am wondering if you can help me with an opinion regarding VT captured on a recent Holter. I'm a 40 year old woman, pretty healthy overall, overweight but active. I have been having PVC's for about 5 years which have been managed with B-Blockers PRN. I hate them but manage to live with it. I have had a few echos – always fine.

I regularly see a specialist Electrophys. Cardiologist. Over the last couple of years the PVCs have become a bit worse and I've felt what I think are runs of something (which aren't associated with any activity in particular and self revert) but, until recently, nothing had been captured on any investigations. When I was having a "bad" time with the ectopics I had a routine follow up Holter (in Feb). On it, along with the usual PVCs (polymorphic, about 2000) was a 9 beat run of VT (at a rate my cardiologist says was about 200-250). He is concerned about this and thinks I need an EPS. Of course this is making me quite anxious and I'd appreciate some clarification re the situation.

Also I should mention that my father died at 71 suddenly with no documented history of IHD and my uncle, his brother, has just had an ICD inserted for ?VT.

So my questions are
1. Is this what you would call non sustained VT or is it something else? I read this forum and a lot of people talk about NSVT and imply it's nothing to be too concerned about.
2. Is the rate something to be concerned about? Is the prognosis different for VT at different rates? The cardiologist seemed to think it was an issue.
3. Do you think I need an EPS and what information will it provide?
4. Could there be a genetic link?
5. Should I be worried?

Thanks so much for taking the time to answer my multitiude of questions.
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1. Is this what you would call non sustained VT or is it something else? I read this forum and a lot of people talk about NSVT and imply it's nothing to be too concerned about.

That is technically non sustained VT.  NSVT is defined as ventricular tachycardia lasting less than 30 seconds.  NSVT with normal hearts is usually nothing to worry about.  There are times when you see  something on a holter or other monitor that concerns you more and you have to break outside the typical dogma and recommend more invasive testing.  If you are uncertain, get a second opinion.  I trained with an excellent electrophysiologist that lives in Australia.  Her name is Dr. Karen Phillips.  I am not sure what city she practices in though.


2. Is the rate something to be concerned about? Is the prognosis different for VT at different rates? The cardiologist seemed to think it was an issue.

There is not really any data to suggest that faster is worse.  It honestly is a gut feeling from looking at it and deciding if looks like more than typical NSVT.

3. Do you think I need an EPS and what information will it provide?

I would need to see the strips to comment.  I have not done a EP study on someone your age for this reason but I have done it on some older people (50's).  If your doctor thinks  you do and  you are confident in their judgement, it is probably best to proceed.  If not, consider a second opinion that can review the records and see the Holter.

4. Could there be a genetic link?

There are genetic causes of polymorphic VT but it does not sound like you have strong family history of problems.

5. Should I be worried?

I would either do the EP study or get a second opinion.  If your doctor was very worried, they would have admitted you to the hospital. You should find some comfort in that.

I hope this helps and good luck.
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