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unneeded shocks from ICD after ablation
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unneeded shocks from ICD after ablation

I have had events of vetricular tachycardia for over 29 years.  The first event occurred in August of 1980. At the time I was a decent competitive runner (31 min for 10k). It took about 6 years to get a proper diagnosis and in 1986 I was cardioverted (while conscious) on 3 separate ocassions for V-tach and eventually studied in an EPS lab.  At that time, the drugs available were not very good and an ICD was not prescribed.  The episodes of V-tach became less common and disappeared completely for a few years until 1997 when they recurred multiple times daily (all resolved spontaneously).  Most, but not all of the episodes occurred during exercise

Another EPS study was done and an ablation was attempted, it was deemed not completely successful and an ICD was implanted. I was diagnosed with Arhythmogenic Right Ventricular Displacia  The episodes of V-tach largely disappeared and the ICD shocked me only a few times over several years (most due to having the maximum rate set too low).  The ICD was replaced more than once due to bad capacitors and dead batteries.  The later ICDs are more sophisticated and do a better of of identifying V-tach correctly and attempt to pace me out of V-tach before shocking.   In the course of replacing tone ICD, I got an infection and the ICD and leads had to be removed and placed on the right side.  Through all of this, I continued to exercise, but gave up competitive racing.

In the last couple years, the V-tach returned about 1 or 2 times per month.  I have also complained about occasional high heart rates ( a step increase of 30 to 60 BPM that would suddenly drop by the same amount after a few minutes) this was most noticeable when lying quietly or during the first 10 minutes of exercise. The Dr. suggested another attempt at ablation (this time guided by an MRI to better identify the problem areas).   It was determined that the issue was on the outside of my heart in the epicardium and an epicardial ablation was done.  That was tested and the V-tach could not be induced afterwards.  However, I did have upper chamber generated arhythimias when given adrenalin.  I was released from the hospital 2 days after the ablation.

Unfortunately, on the Saturday after my ablation, I went into some combination of atrial fibrillation, atrial flutter and/or atrial tachycardia which fooled my ICD (heart rate 170 - 190 BPM)  and I was shocked multiple times (the single lead ICD does not work to stop atrial driven arhythmias) and taken to the emergency room awhere I was given intravenous amiodorone and metaprolol orally to lower my heart rate to around 140-150. (Post-event analysis of the arhythmias indicated that 9 of the 10 shocks were clearly not V-tach; there was a difference of opinion regarding one, that is, it was not clearly not V-tach).  I stayed in atrial fibrillation for about 40 hours before I was cardioverted (I was placed on intravenous Heparin and Coumadin orally to prevent clots and a trans-esophigeal echo-cardiogram was done before the cardioversion to check for possible clots in the atria that might be dislodged during the cardioversion.  There was a roughly 2 hour bout of atrial tachycardia of about 140 BPM a few hours after the cardioversion which was resolved by performing a Valsalvo.  I was placed on metaprolol and Rhythmol to help prevent arhythmias and  I stayed in the hospital until my Coumadin levels were sufficient to prevent clots should the arhythmias recur.  

It was 3 weeks ago that i received the 10 shocks. In another 4 weeks I will visit the Dr. to discuss when/if to end the anti-arhythmics and the Coumadin as well as to discus if an ablation for A-fib and A-flutter are in my future, or if the spate of upper chamber arhythmias were just physcian induced events that have resolved on their own.  In the meantime, I am walking about a half-hour per day.

Despite having lived with some level of arhythmias, taking beta-blockers and having an ICD over the last 30 years, I'm still here.  The spate of shocks was no fun.  An occasional shock or getting paced out of a rapid rate is never fun, but that string of 10 and the ambulance trip was a bit unsettling.  

Any idea what awaits?
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Avatar_m_tn
Were these inapropiate shocks or did you need them ? If I hit my cut off rate the ICD fires mine being 180.  You may be having a ventricular response to the A-Flutter, Like supraventricular tachycardia. My device will pick up SVT and V-tach or V-fib only. you may need to have some adjustments in your settings or maybe give the beta-blockers time to take effect. It sure isn`t fun being shocked hope your doctors can figure it out.
You are the first person I have seen who has had an ICD longer than me, my first implant was in 1991. BEST OF LUCK TO YOU.
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995271_tn?1408549100
Hi Dennistoo,

I've read and have been told that ablation can take months to settle out, other arrhythmias that were never seen before may spring up spontaneously.

ARVD is a tough bugger to offer long term prognosis.  Though I've not heard of it advancing into the atriums.
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1137980_tn?1281289046
Wow i was pretty impressed reading your post.....1981 you had an ICD implanted?  Wow that is totally amazing to me me and obviously they had the medical forsight to know that it would still cont. to do its job 30 years later w. minor adjustments along the road.  As far as an ablation for atrial fib/flutters, etc.  trust me from someone who knows that ablation will be a heck of alot easier on you than being converted or even the trip in the ambulance.  I would do my homework and read up on as much as you can about the procedure but to me it is a no brainer because from my understanding the orginal concept came up for the ablation with the atrial fib/flutter in mind by Drs. Natale and Scheinmann and i believe that is why it is so successful.  Itdood is def. right tho it can take up to 6 months for your heart to revert physically and electrically to the procedure and generally speaking my heart doc told me if its going to fail in 80 % of the cases it will fail within a short time of the procedure and generally within 90 days.  Good luck....
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Avatar_m_tn
Thanks for the comments.

Apparently I was a bit unclear.  My first V-tach was in 1980, I was studied, but no ablation or implants in 1986.  It was 1997 when I got the first ICD (now on the 4th) and when the first ablation was attempted.

At least 9 of the 10 shocks had no V-tach component, the Medtronic tech and the doctors can only say that one of the 10 might have had some ventricular component. but the peaks were all narrow, not the wide form typical of V-tach.  (With only one lead, it is impossible to be certain, but some of the shocks came while I was on a 3 lead EKG in the ambulance or the ER, and for those it was clear the shocks were not appropriate.).  Some of the time while I was in A-flutter, my vetricle contracted on every atrial contraction instead of the more usual every other, so I was closer to 280 BPM that 140-150 BPM which is, I think, more typical of A-flutter.  However, I remained conscious and able to enjoy every second of it.
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1137980_tn?1281289046
Hey Dennis....i didn't realize that you had a Medtronic Vascular ICD and now you say its your fourth.  You may want to check and be sure that the current one or the past ones that were removed are not on the Medtronic "watch" list for the recalls....i do know that part of the suit that was filed against Medtronic was due to alot of what you are explaining...for giving un-necessary shocks because of the leads in them.  I don't mean to be the bearer of bad news with this but we have to all watch out for one another on this site.......sounds a little suspicious to me.....good luck.....
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Avatar_m_tn
The first ICD I had was recalled due to  a bad batch of capacitors.  Medtronic provided the replacement for free and paid my part of the installation cost.  
The first lead I had was  one of the older thick ones, not the thin ones which came later and that others had fail.
The second ICD lasted 8 years before the battery was exhausted.  
The 3rd was in only for a couple months since its insertion along with a new lead resulted in an infection, that was treated with Cipro to hold the infection  at bay until it was a more convenient  time for me to have  the removal done.
The 4th ICD and a new lead(the 3rd) were installed on the right side after the 3rd ICD and both sets of leads on the left were removed.  It has worked properly, but of course was not  capable of discerning the high superventricular tachycardia from ventricular tachycardia reliably at over 170 BPM and cannot treat A-fib or A-flutter.
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