why is my rovt playing up lots at the moment?

[kezza351]

Last year I had a hysterectomy and I woke up in ICU after I had gone into sustained vt during my operation. For a few months I was going into sustained vt quite a few times and was in and out of hospital like ayoyo. I had an ablation and it didn't work as the spot they needed to get was to deep. They want to do another but it through an artery instead of vein with twice the risk and only a 50% chance in working. I have been unconscious quite a few times when I have gone into vt. I recently had a couple months where it had settled and I only had a few minor issues but over this past week it has got dramatically worse and I have found myself fighting to stay conscious with these episodes. I want to avoid going back to hospital if I can cause I am terrified about the other ablation they want to give me. And i dont want or can afford to be off work again. And to be honest I terrified in general about the entire thing. Has any one had there vt settle for a while and then play up again? I'm unsure what to do? I should also mention I have a prolonged qt as well. Any help or advice would be greatly appreciated thanks

[researcher09]

The reason you were put on flecainide and verapamil is to reduce the risk of VT/VF so I would consider what you have as serious and not benign.  Perhaps your doctor don't want to stress you out by telling you it is benign, but then he has you taking drugs that don't work well and have potentially bad side effects.  You shouldn't stress about it and treat it like a mission.  A mission to get well and you can be treated successfully.  Just not at Christchurch.  The compromise solution that you will be offered is an ICD implant but those have complications of their own and you will still want to have the VT ablated whether you end up with an ICD or not.

[kezza351]

Oh God pretty much all of that doesn't make a whole lot of sense to me! But thanks heaps will try reading it a few more times to try make sense of it. There was one word in there that scared me a bit though malignant , is my heart problem not as benign as I thought? Or was that reffering to something else?I'm starting to get the feeling I am really uneducated about my heart and I should be doing more to understand what's going on? Also thanks so much again you have been a great help

[researcher09]

Below was an important study done a long time ago by Haissaguerre's group and Prash Sanders took part in it.  He is your best choice in my opinion unless you want to fly to Bordeaux.

http://circ.ahajournals.org/content/108/8/925.full.pdf

[researcher09]

Sorry.  I missed your reference to long QT in the first post.  Flecanide is contraindicated for long QT so I would ask your EP to get off of that ASAP.  Anesthesia during your surgery could have triggered your VT.  I think it is important for you to get to a top center and have your RVOT trigger ablated.  Christchurch is probably not a good choice given what has happened thus far.

[researcher09]

You hadn't mentioned prolonged QT until the last post so I am a bit confused.  Do you have LQTS and if so, how long have your doctors known?  That's really important given your symptoms and RVOT trigger.

[kezza351]

I'm currently on fleconide, aspirin and verapaml. However it does not seam to help. I was on metoprol but as I needed max dose I didn't handle it very well and was practically a zombie. I normally quite fit and my heart rate sits around 50 beats a min at rest so with the metoprol it lowered my heart rate to much expecially while sleeping was getting into the early 30s when I was getting monitored in hospital. They don't seam to think the hysterectomy was related to why I have it but it is when it started. There is no family history with heart rythom problems and there isn't even any family history with my prolonged qt either but apparently it cab happen in rare cases. Could these 2 things be related? Also when I was first diagnosed with rvot I was told it was benign cause it had not made me unconscious but it has a few times since then, does that mean it might not be benign? I'm also only 31 feel a bit young for all of this :) . thanks so much for your help!

[researcher09]

Medication doesn't work well in preventing progression and side effects are bad.  Did your EP explain his opinion of why you ended up with VT as a result of hysterectomy?  Do you have relatives that have VT or suffered SCD?  Without that information, it is hard to tell whether you can modify your risks without medication or ablation.  With regards to ablation, there is a very wide range of outcomes out there and most of it depends on whether the EP has the skills already or whether he is still on the learning curve.  RVOT ablation is considered one of the easier VT to ablate.  I would not hesitate to get it done if I have access to a top center that does 50 VT ablations or more a year.

[kezza351]

Is there anything other than ablation that could help though? I could go to the best centre in the world and still feel extremely anxious about it. I know I might sound a bit silly worrying about it so much but I have had quite a lot of operations due to other health problems and I haven't had a lot of luck with things going right in surgery and complications afterwards.

[kezza351]

Is there anything other than ablation that could help though? I could go to the best centre in the world and still feel extremely anxious about it. I know I might sound a bit silly worrying about it so much but I have had quite a lot of operations due to other health problems and I haven't had a lot of luck with things going right in surgery and complications afterwards.

[researcher09]

I agree with your EP that it needs to taken care of.  Christchurch is probably the top hospital for ablations in NZ and your EP probably trained in Australia.  The top center closest to you in Australia is probably U of Sydney - Westmead hospital and then Royal Adelaide.  Prash Sanders is the top expert in your region and he is at Adelaide.  I don't know how health coverage works in NZ and it depends whether you have to pay out of pocket or not.  VT ablation is a risky procedure in unpracticed hands so I hope they understand and help your desire to seek a high volume center.  

[kezza351]

I live in Invercargill new Zealand. I went to Christchurch to get my ablation done by the top guy in new Zealand that does them. My first ablation was ment to have had over an 80% chance of working but apparently it was to deep to get and would have to try through an artery instead of vein and would have to be done under a general as well. I'm terrified to do it I would rather try something else but I getting to the stage where I don't have an option as my vt has been getting a lot worse of late. Is there anything else I could try?

[researcher09]

The hospital that did your hysterectomy is not necessarily experienced and skilled in VT ablations.  To qualify for the STAR-VT trial, as an example, the hospitals have to do a minimum of 50 VT ablations a year and there were only around 3 dozen in the whole nation that made the cut.  You can compromise and set the bar at 25 per year but I think the best thing to do is to get the most skilled center in your region.  That way, your RVOT ablation would have greater than 70% success rate with significantly lower complication risk compared to your "convenient" hospital.  Where is your closest major city?