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2084975 tn?1332547956

ablation for left-sided atrial tachycardia

I'm a 24 year old, female, 5'4, 128 pounds, and in good health. About 7 months ago, I started having episodes of palpitations and was told they were brought on by panic attacks, and not by there being something wrong with my heart. To make a long story short, I had multiple doctor visits and EKG's and they all came out normal. It wasn't until a month ago that I had an unbearable episode of palpitations and I called the paramedics. I was taken to an ER and was informed I had an episode of AFIB. I was released only to go to another ER, where I was under observation for the night and given a diagnosis of Atrial Tachycardia, not Afib. About 2 weeks later, I was able to see a cardiologist, who looked at all my ekg's and said that in fact, according to the readings, I had episodes of atrial tachycardia and ectopic atrial rhythm. I was put on a 2 week event monitor. He referred me to an electrophysiologist and he reviewed my ekg event monitor readings and said that some episodes were just rapid heartbeat in normal sinus rhythm (possibly caused by panic attacks), but there were also some episodes of atrial tach, which he says are left-sided. I have been on metoprolol, but it only lasts for about two hours. I'm very symptomatic: lightheadedness, headaches, shortness of breath, chest pain. The EP mentioned that the best option would be to get catheter ablation for left-sided atrial tach. He said I could also be on medications for life to control the episodes, but that probably wouldn't be the most convenient option. I'm just a bit startled, since he pretty much said ablation is the best fix and said someone would call me to schedule it soon. It has all happened so fast that I really don't know what to make of it. Any input, suggestions would be greatly appreciated.
Best Answer
1124887 tn?1313754891
Hello, sorry for a late reply. I didn't see the replies until now.

Success rate often depends on where the tachycardia origin. To explain the pulmonary veins, the pulmonary veins (which bring oxygenated blood back to the heart) actually contains a bit of atrial tissue (heart muscle) for an unknown reason. This tissue sometimes have a "wild" behaviour; it can fire one or more electrical signals independent from the rest of the heart, which may trigger or cause a variety of atrial arrhythmias, where the most common is atrial fibrillation, but also runs of atrial tachycardia (which in some cases initiate atrial fibrillation). They can also produce a fair amount of PACs.

The upside is, we don't really need this tissue connected to the heart for the heart to work properly, so people with atrial fibrillation or atrial tachycardia can just have the pulmonary vein atrial tissue isolated from the rest of the left atrium, and no harm is done. That's why, when atrial fibrillation is seen, it doesn't have to be triggered during an EP study, as most atrial fibrillation origin from the pulmonary veins anyway.

The doctors can, when your tachycardia is registered on EKG, estimate where in the left atrium it origin (from looking at the shape of the so-called P waves which are markers for atrial activation, and looking at which way the electric current moves).

If the tachycardia does NOT origin at the pulmonary veins, the exact spot must be found, which is not always easy. It's also important that the ablation does not destroy any of the natural pathways in the atrium (which would be very bad). This is not an issue with the pulmonary veins, as those electrical pathways can be destroyed anyway with no harm done..

There are several mechanisms of atrial tachycardia, where some people have a so-called re-entry circuit for some reason, where an impulse short-circuit and travel around and around a spot, causing a fixed heart rate, say 180 bpm, and then return to baseline instantly. In atrial tachycardia, this is highly troublesome, as it will not respond to "normal" SVT treatment like Valsalva, bearing down, splashing water in the face, etc, this will only help towards tachycardias that involve the AV node. As your heart rate is variable, it sounds you have the other variant, where you just have an abnormal "extra pacemaker" somewhere in the left atrium, which can produce lots of arrhythmias, from PACs to "outrunning" the sinus node at different heart rates depending on how irritated the spot is. We all have PACs, so we all have spots with the ability to act as an extra pacemaker (which sometimes is beneficial, if the sinus node should fail). Your extra pacemaker just sounds extra grumpy, so as I said, maybe it's a good idea to consider removing it if possible.

I have an MSc but not in medicine. I'm just really interested in heart rhytms.

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Avatar universal
Hello!
I know this is an old column but I figured I'd try to reach out. I also have atrial tach but mine is different in the sense it is brought on by an allergy i developed about 4 years ago to MSG, artificial flavors and colors, and artificial sweetners. I was out with my friends eating sushi and on the way home my heart started beating extremely fast to the point I thought i was dying. It was very scary and the paramedics rushed me to the hospital only to be told that I had suffered a panic attack- which I knew wasn't the case. I continued having episodes of headaches and irregular beats and palpitations but the cardiologist I went to see brushed me off because he said I was way too young to be having heart problems. I later went to an electrophysiologist who was able to diagnose me with Atrial Tachycardia but put me on medication. I'm currently on Metropolol XL which helps but not entirely. I am extremely careful with what I eat make sure I don't have anything artificial, MSG, sweeteners- I basically have to make all my food because eating out is always a risk and even though i strictly ask for only salt & pepper sometimes the food just has something that will give me a headache and make my heart beat very fast and give me chest pains for days. Last year I went to the Cleveland Clinic to get a second opinion and that Dr. did recommend an ablation but I was pregnant so I couldn't do anything. Now that I have had the baby I am going to go back to try to get the procedure done because the medicine helps with the fast irregular heart rate slower but I still constantly have chest pain and it's so annoying and scary. I don't know if the procedure will work for me because in my case it's brought on by my food allergies but I guess its worth a try and hopefully makes me feel better.
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Avatar universal
Glad your ablation went well. Sounded like quite an ordeal. Feel better!!!
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Avatar universal
So glad to hear all went well with your ablation.  From experience, I can tell you your life will definitely change for the better.  Congrats!!
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1423357 tn?1511085442
Ah! That's great to hear, congratulations!  It's over, get better, and get on with your life now!
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2084975 tn?1332547956
Hello Everyone,
Today is day 2 of my ablation..It was definitely a very nerve-wracking experience, but worth it..The procedure itself was a success! Doctors are very pleased and so am I. Doctor put this on my discharge instructions: "Specifically, your diagnosis was a left atrial tachycardia. there was a cluster of cells in the left atrium that were overly active. The region was between the lower left pulmonary vein and the mitral annulus."
-During the procedure, I was completely awake and didn't even receive a mild sedative until before the actual ablation. It was painful, more than I expected. They burned 7 areas. The doctor said the cluster of cells were dominating my heart rate and not allowing it to beat in sinus rhythm most of the study. It lasted 5 hours. Both groin areas were used.
-I was so relieved once it was over and had to stay overnight, since I got a transeptal puncture. The doctor the following morning said my heart had not gone into atrial rhythm during the observation period..
-Currently. in recovery mode, but I am doing well. I do feel occasional PAC's/skipped beats, but that's normal. My insertion sites have closed up with minimal bruising. The most discomfort I've felt is chest, back pain, and muscle aches. The only medication ordered is aspirin (need to take for a month) and of course some pain killers. No more metoprolol! My resting heart rate is in the upper-normal range 80-100 (the doc said my heart is just naturally faster). I hope to feel better every day..I'm pretty excited for the future and am so glad it all turned out well. This is the best decision I could've made, although I don't think I would want to got through it again. Thanks for all the good wishes :)
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1423357 tn?1511085442
Good for you.  Best of luck, and let us know how it went.  We're here for questions if you have any last minute ones.
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2084975 tn?1332547956
Thank you all for the support during this difficult time. I am scheduled for my EP Study/Ablation on the 26th..I can't believe it's almost here and let me tell you I am very anxious..Hope it all goes well. Wish me luck :)
Helpful - 0
1903111 tn?1333213054
Just want to encourage you again today.  Seems like everyday I feel better. Although I still have anxiety... :( Not sure why?
Maybe that will go away in a month.  I think anxiety has a memory and I revert to it often.  Gotta get that in check!
Just did another ekg follow up to my ablation and had some pacs durring the ekg. I felt them and tech saw them happening.  Frustrating but when I was going over results with nurse she said those should get less and less as your heart heals. MUSIC to my ears.
I really understand the panic anxiety and have had anxiety since my first SVT attack a few years ago.  Try to reframe your thoughts.  (my counselor shared this with me)
Think positive and give your self a break.  Dont fight the anxiety.  Just say of course I am anxious, this stuff is hard.  You have an experienced Dr that does this all the time and "fixes" people.  Chances are that you are going to be healed of this. Get excited about getting it behind you.
Dont let it rule you.  Let it be and then let it go.  Take many deep breaths.  Rely on your friends and relatives that love you.
Find reasons to laugh.  Look up comedians on utube.
My favorite Tim Hawkins.  See his skit on "products" He has one that talks about drug side effects that makes me laugh so hard I cry....

Hang in there.  I KNOW where you are emotionally. :D
Its tough being so female sometimes, and I have a hard time being objective at times.

The week before was probably the hardest for me.  I cried a lot.  I was so scared.  But its all over now and I am still here!  LOL

Take care.
Helpful - 0
612551 tn?1450022175
COMMUNITY LEADER
Wishing you the best possible outcome from your ablation.  Your EP has the level of experience that gives one confidence, let yourself be confident and optimistic.  I am sure you will do find given your young age and general good health.

I am much older, but my concern about selecting a heart surgeon for my mitral valve repair was driven by two factors:  Lots of experience (but still under 60 yo), and "in-network" for my health insurance.  

I note there are many types of ablation, as there are heart surgery.  My heart surgeon headed the heart center at the hospital I had my surgery done, and while many of his surgeries were by-pass, very different than mitral valve repair, I still counted the many times per week in surgery as a plus.  He also did many valve repair and spoke of his pride in his valve repair skills - good "bed side maner" mostly, I will guess.
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2084975 tn?1332547956
I truly enjoy reading your posts! You are so knowledgeable and explain everything in such a way that is easy to comprehend. From what you are saying, it is possible that the origin of my tach is the pulmonary vein, since I also have been having a lot of PACs or possible the "extra pacemaker" you also mentioned, since my heart rate fluctuates a lot. When i'm in sinus rhythm, my heart rate moves around from 75-100 constantly. I agree whatever is going on in there is grumpy or as I like to call it, likes to do the jiggles a lot. Like I have mentioned before, I am really nervous, but starting to get excited because I know this may be my cure! I need to stay positive and my EP is highly experienced (he does 5-8 ablations/week).

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2084975 tn?1332547956
Hello Kim,
Sorry for the late reply. It's comforting to know that there is someone out there going through something very similar as me. Fears definitely develop with conditions like this. I'm constantly wondering when an episode is going to happen. It's a vicious cycle of fear, tach, panic, and trauma. My episodes come suddenly, typically for no apparent reason. My heart just starts pounding, which is very uncomfortable and there is also a feeling of fluttering in my chest. There have been times when I have become lightheaded, almost to the point where I feel faint. I also have constant runs of ectopic atrial rhythm and it just feels that my heart jiggles with every movement I make, super distressing!

I'm glad that you're doing well post-ablation. Mine is scheduled for the end of Abril and I am honestly a nervous-wreck! I know it's the best thing I could do, since I also don't like the meds and I want to start a family in the near future. The meds have completely destroyed my hair and make me lethargic. Also, I want to continue enjoying my life like any young lady my age should. This condition has interfered with my life, to the point where I couldn't attend class and I am scheduled to graduate in June. I am also getting married next year and I want to enjoy everything that is part of that.

The most difficult part for me is staying relaxed. I am constantly anxious and have had panic attacks. Hospitals make me beyond anxious. I honestly think i'm traumatized after so many visits.

Wish you the best. Keep me updated. Thanks :)


Helpful - 0
1903111 tn?1333213054
I have exact (almost) same  thing -atrial arrythmia and as "is something wrong" states it's very difficult to diagnose and catch and is similar to afib but not.  "is something wrong" seems to really have great knowledge here.
I also was misdiagnosed w anxiety panic disorder. I have to say the panic comes after the heart starts flopping around!
Before diagnosis of atrial tach arrythmia- after having an episode I would be anxious for weeks wondering what the heck that was and was it going to happen again. Fears developed.
How would your episodes feel? Did u get faint?
I am post op 7 days!
Had Pulmonary Vein Isolation ablation, my EP says atrial tach and arrytmias often hide once they are in there and the pvi takes care of it 80-85% of time.
I am 41 and tried many meds and did not like them and side effects.
I am recovering nicely at home have some discomfort but nothing Motrin does not help.
I am a total baby when it comes to medical stuff.
If you trust your Dr I say go for it.
The main reason I did ablation is because of the faint type episodes I would have and they were very chaotic as my EP would describe. Heart rate all over the place. BP up and down. They were just horrible and interrupted my life greatly.
I am on the recovery road and look forward to washing my hands of analyzing my heart all the time.
Best wishes in your health journey.
Kim
Helpful - 0
2084975 tn?1332547956
I am amazed that you went that long before discovering you had SVT. In all honesty, I suspect I've had a faster heart rate (80-100s) my whole life, but there is no way to prove it. It wasn't until I started having the palpitation episodes, that I become hyper-aware of my own heart beat. My particular case isn't AFib, but the doctor explained to me that often times it's confused because the ekg readings look similar and it is easily misread by people who aren't cardiologists. So, no blood thinners for me thank God!! The EP talked about the pros/cons and the pros definitely outweigh the cons. He said atach is non-life threatening, but very bothersome. I've had about 3 episodes in the last month or so.

About the ablation cost, I am not worried about it. Thankfully, my insurance pays most of it and it will take place in Los Angeles. Even if I had to pay, I would without even thinking about it.

Thank you for replying and I will keep you updated on my case. :)
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2084975 tn?1332547956
I do feel I was misdiagnosed with panic disorder. There is no lie that this condition has caused me to be in a heightened state of anxiety, thus causing panic attacks; yet, what I was feeling was not just panic. It is a constant battle with doctors trying to tell them that what is happening wasn't normal. It was extremely frustrating to be treated like a "crazy" person. in my case, doctors tended to brush me off telling me, "You're way too young. Don't worry about it." In a sense, it was a relief to know that there was something caught to prove that I wasn't making it up. Now, i'm just faced with a difficult decision, but I got an answer.

Regarding the metoprolol, I take the tartate form 2/day and it seems to be working a little bit better after a few days on it. I have requested to get a prescription for the extended-release form, which would probably be more effective on me.

I sent an email to my EP regarding the risks of a left-sided ablation and he said the risk is bleeding. He still feels it's the best option for me and does about 5-8 ablations a week of his own and assists in about 10-15. He is well-experienced. I am more nervous than anything, but I think anyone in my situation would be too.

Thank you for your reply!
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2084975 tn?1332547956
Thank you so much! Although you mentioned you're not a doctor, you seem to really know what you're talking about. What is your profession if you don't mind me asking? The EP did say the procedure is 80% successful in eliminating atach, so in the medical field, that's a pretty high number. At this point, I am really looking forward to living my life without meds; that sounds so amazing!
Helpful - 0
1807132 tn?1318743597
I grew up with svt but actually thought it was normal or that I was just hyperventilating so I didn't do anything about it until I reached my 40s but once it was diagnosed it did go very fast and kind of threw me into a bit of an emotional panic.  I was never afraid of the svt but the prospect of having the ablation put me in a near panic.  That said, the svt condition will not go away.  At least that was the case with my type.  I am not totally familiar with your type, atrial tachycardia.  Mine was the more run of the mill type, avnrt that is fairly easy to ablate and has a high cure rate, close to 98%.  From what I understand about your type the dynamics of it are closer to afib and as such the success rate for an ablation is only around 80% but if you really think about it 80% is pretty high.  That said, it is a more difficult condition to ablate so the procedure will likely take longer than mine did and you are in an even more complicated spot with it being on the left side.  They will need to punch a hole through a membrane to get to that side if you don't have an opening already, some people do.  But if you don't your healing time will likely be a little more involved than my avnrt ablation was.  This all said, it is doubtful your svt will go away.  With my type there was no need for me to ever go on medicine, my choices were live with the svt or do the ablation.  However, I think it is possible in your case that you may need to go on blood thinners due to the type you have.  Whether or not you would need to be on anti arrhythmia meds is something I am unclear of with your type but the bottom line you have to weigh the prospects of being on meds your whole life to try and control something that is very difficult to control or give an ablation a shot.  No one can make that decision for you but take some time to do some research and read up on your condition and the ablation.  The ablation in general is a procedure that is really almost a piece of cake for the patient.  That said, all medical procedures have risks so just weigh the pros and cons and go with what feels the most right in your heart and you can't make a wrong decision.  

One word of caution, you live in the States and as such the procedure is very expensive.  Mine cost about 50,000 but I was in and out pretty quickly.  Others here have had a bill upwards of 70,000.  So it isn't cheap.  My out of pocket was 4,000 for the year so by the time the doctors bills pilled up I really only paid about a grand to have it done but it isn't cheap to do unfortunately.  I don't say this as a means to deter you from taking care of your health.  I personally beleive money should never be a consideration when deciding what is best for a person's health but I felt it is best you know ahead of time just so you aren't taken by surprise by a large bill.

In any event, in general svts (rapid heart rates) are generally not life threatening in an othewise healthy heart.  If you have rare episodes, like maybe once a year or so, then you really aren't in any health danger.  If you start to have frequent episodes and ones that last a long time you may run the risk of developing congestive heart failure down the road but so long and any blood clot risk is dealt with in your case there is no dire need to have the ablation done.  That said, if you gave it a try you may be cured of the episodes for life.  So take some time to let this all sink in and then make your next steps.  If you are interested in reading a bit about the ablation you can click on my name and read my journal entry.  And of course you can always ask questions here.  There are many who have been through an ablation and are happy to help.  Take care and keep us posted on how you are doing.  I wish you the best in whatever you decide to do.
Helpful - 0
1124887 tn?1313754891
A problem is that 2/3 of everyone with EKG confirmed SVT also have the diagnosis "panic disorder" according to the diagnostic criteria for this disease. The relevant question is possibly "what comes first".

A problem (that possibly do not apply to US healthcare) is that panic disorder is cheaper to treat than SVT. So in my country, the doctors almost always start there.
Helpful - 0
1423357 tn?1511085442
Yes, I agree.  I've mentione before here that there are probably many people misdiagnosed with panic disorder that are really experiencing a cardiac anomoly.  I'd add that SVT is often fleeting, and by the time the patient gets an EKG, the event has passed.  With nothing to see, the patient is diagnosed with having a panic attack.  It was good that you persevered and it was "caught on tape" so to speak.

You mentioned something though that I wanted to address: "I have been on metoprolol, but it only lasts for about two hours."
There are two type of Metoprolol, Tartrate and Succinate.  The latter is marketed as Toprol XL which is a time released version.  It is more expensive than Metoprolol Tartrate (which is dirt cheap in the US) but it may provide you with a longer effectivity.  I take the Tartrate version twice a day and have done so for years.

Left side ablation is a little more involved than right side, but unfortunately that's where the "action" is often found.  Your heart is accessed in the usual manner, up from your groin area, but roads lead to the lower right side of the heart.  The catheter is directed up through the valve into the right right atrium.  Then unlike the high tech procedure, the catheter is pushed through the partition between the right and left atrium in what is referred to as a transseptal puncture.  Once in the left atrium, the location is pinpointed and ablated.

If you're having frequent episodes, this might be the best way to go.  Many of us here have had the electrophysiology procedure, and can adivse your further if you have any questions.
Helpful - 0
1423357 tn?1511085442
Yes, I agree.  I've mentione before here that there are probably many people misdiagnosed with panic disorder that are really experiencing a cardiac anomoly.  I'd add that SVT is often fleeting, and by the time the patient gets an EKG, the event has passed.  With nothing to see, the patient is diagnosed with having a panic attack.  It was good that you persevered and it was "caught on tape" so to speak.

You mentioned something though that I wanted to address: "I have been on metoprolol, but it only lasts for about two hours."
There are two type of Metoprolol, Tartrate and Succinate.  The latter is marketed as Toprol XL which is a time released version.  It is more expensive than Metoprolol Tartrate (which is dirt cheap in the US) but it may provide you with a longer effectivity.  I take the Tartrate version twice a day and have done so for years.

Left side ablation is a little more involved than right side, but unfortunately that's where the "action" is often found.  Your heart is accessed in the usual manner, up from your groin area, but roads lead to the lower right side of the heart.  The catheter is directed up through the valve into the right right atrium.  Then unlike the high tech procedure, the catheter is pushed through the partition between the right and left atrium in what is referred to as a transseptal puncture.  Once in the left atrium, the location is pinpointed and ablated.

If you're having frequent episodes, this might be the best way to go.  Many of us here have had the electrophysiology procedure, and can adivse your further if you have any questions.
Helpful - 0
1124887 tn?1313754891
Your story is very common, unfortunately.

Atrial tachycardias are often misdiagnosed as panic attacks. Where "classic" SVT (nodal tachycardia and AV reentry tachycardia) often is easier for the doctors to diagnose (always turns on and off like a switch, and have very classic signs on EKG and can happen for no obvious reason), atrial tachycardia (especially right, but also left) can mimic a sinus tachycardia both on EKG and from the symptoms. It's also often provoked by adrenaline and can mix into a sinus tachycardia where you have some of both. The abnormal atrial "pacemaker" can also take over the rhythm with a slower heart rate than tachycardia, as you say, ectopic atrial rhythm.

The condition is often named "to have an extra sinus node".

You sound very symptomatic, and this sounds a bit unacceptable. I will never say "you should get an ablation" because I'm not a doctor, and the procedure may in rare cases have complications. But you can consider it. If they are successful (which they are in above 80% of the cases) you get rid of this arrhythmia and can live a normal life without medications.

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