ablation risks

[kris]

I have been told that I have AVNRT.  I am currently on digoxin for it, but have had break through episodes.  I would really like to get an ablation for this(rather than lifelong drug therapy), but am scared because of the small risk of death (we have two small children).  We live in a small town in the west, but have access through insurance to either go to the EP lab at the University of WA in Seattle, or to a Dr. Goldberg in Spokane, WA.  My questions:



In weighing my risks, is my risk of death or serious complication lessened if my arrythmia is AVNRT and if I am young(30) and healthy?



In considering drug therapy (ie. digoxin, beta blockers), are there actual risks from long term use that I should be considering?  Are there statistical "risks of death" from medication that I could compare to the numerical "risk of death" from an abaltion?  And are there any studies of just continuing on having episodes of AVNRT and the risk of accidents and injurys that can happen from the dizziness, etc.?



Do you know any  EP doctors in Washington that you'd recommend?



I'm trying to make an educated decision and a well thought out one.  Thank you for your time and input!  

[CCF CARDIO MD - CRC]

Dear kc,



AV nodal reentrant tachycardia (AVNRT) is a common cause of tachycardia in young people and can be treated with either drugs or ablation.  The decision between which treatment will depend on the patient and doctor's personal preferences and well as a weighing of the benefits and the risks.  



The benefit of ablation is that the problem can be cured in >90% of cases and there is no need for continued medication.  The risk of death during an AVNRT is very, very small but is still possible (perhaps 1 in 10,000 or less).  The more common complication with AVNRT ablation is the risk of a pacemaker.  This is more in the neighborhood of 1% nationwide, although at centers with more experience it may be lower.  



There is virtually no risk of death with digoxin, (except with an overdose), beta blockers or calcium channel blockers (all commonly used drugs).  If you required a stronger medication such as flecanide there is a very small risk of death.  The disadvantage is having to take life-long medications.



I don't know the physicians in WA but there may be some other readers who can post the results of their experiences.   Best wishes.

[Carol55]

dear kc

would you mind letting us know what AVNRT is, and what symptoms you have?  is it something like psvt, which is what i have.  and i too, am considering ablation, but am also leery, and frightened!

thanks,

dlt

[kris]

AVNRT stands for atrioventricular nodal reentry tachycardia and it is, from my understanding, one of the varying forms of PSVT.  My rhythm is usually set off by a jump, burp, or if I quickly bend over to pick something up off the floor.  I will have palpitations from the movement and then "click" into a fast heart rate, which for me is between 160-180.  If I am not able to convert the rhythmn by holding my breath or the valsalver (sp?) maneuvers, I go to the ER and am administsered adenosine.  This doesn't happen every time I bend over, jump, or burp, but I never know when it will.



From what I've been told AVNRT is a non-life threatening rhythm, but it does affect quality of life because you never know when it will happen, and I don't think it would be good for the heart to let it continue on for hours and days.  I feel weak and very anxious when I am in the rhythm.

[VTBen]

Ablations are pretty safe.  I've had four of them.  The risk of death is very small.  My last ablation was at the Mayo Clinic, and I asked them, "How many people have died during one of these procedures?"  They said nobody has ever died in their lab.  They have done  a lot of these procedures.  My first ablation was for AVNRT, and I was cured of that problem ever since. But there is a risk in any invasive procedure, but if this condition is life altering, I would think ablation would be just as dangerous as life long medication.  Good Luck

[Carol55]

kc,

this is incredible.  you've described exactly what happens to me.

sometimes the breath holding helps and sometimes it makes it worse.  sometimes the valsalva works and sometimes not.  what did your doctor tell you to do.  like how long do you wait til you need to go to the e.r. and have the med they give you?    and this never happens to me unless i bend over, just like you said, to pick something up.  is that what's called psvt?

i'm just assuming because a family physcian is who told me i have this.  i've done treadmill stress ekg, echo, 24 hour holter, the only thing showing were a few pac-s,  and with the echo they found i have mitral valve prolapse.  do you mind telling me more?

do you have mitral valve?  and what tests or procedures did they do to find you have this, because like i said, it's amazing how you said it hits when you bend over. i've told so many people this , including doctors, and they look at me like i'm crazy!   and i know what you mean, i don't faint or anything, but it's so fast and i'm so shaky.  how long is the longest you've had this rhythm last.  so far i've never gone over 10 minutes.  the longest 10 minutes of my life.  it seems slowly drinking ice cold water slows it down.  then you can actually feel it "click" right back into normal rhythm.  weird, isn't it?  thanks for letting me share!

DLT

[psvt guy]

ive had this condition for years now and (and i can actually set it off sometimes by bending over and coughing!)....i did this for my GP once and he almost fainted!!!! i think it has to do with the vagal nerves and the connection to the heart, but you must have a condition that will predispose you to the fast rythm (i.e. AVNRT)....i am currently on meds. but i am also considering an EP study to see if im a candidate for ablation. if i can do it....i will have it done "in a heartbeat" (no pun intended).....to dlt...about 5 min was my longest, but it was the longest 5 minutes of my life and i did black out.

[Carol55]

Oh boy, now you've got me curious.  When you did that for your doc, what in the world did he do for you, or did you go back to normal rhythm yourself.  I guess that's my biggest question, when it races for you, are there any manuevers you use to slow it down.  You said your longest was 5 minutes!  Man, mine was 10, not a comforting feeling!  And when you said you blacked out, well, what happened?  That's my concern, because I have school age children, and husband works about 1/2 hr away, so if I go down, I'm here alone. And here's my biggest question.  I've read in all these books on panic, etc, that a healthy heart can beat at a fast rate for hours even DAYS!  Well, how much truth is there to that, before any damage is done!  I know what the books are saying, that the least nervous you get, the faster it'll pass.  But this happens with me without any anxiety at times, like out of the blue!  And boy, when she takes off, it's just like a train on a fast track!!!!!    Any advice?

DLT

[kris]

I don't have mitral valve prolapse.  I've had the rythm for periods of longer than an hour. . . that's when I go to the ER.  I've had doctors tell me not to let it go more than 15 minutes before going to the ER, and I've had other doctors say not to let it go more than an hour before seeking treatment(and even if it takes longer would, it probably not be permanetly harmful).  But I am probably different from the "PSVT guy" because I have never fainted from it- which probably means that his heartrate is faster than mine when he's in it.  Mine is usually between 150-180, but some people, from what I've read, have heartrates of way over 200.  That would be more scarey to me, I feel awful enough when I'm racing at 150-180.



They diagnosed my PSVT when I went to the doctor in the fast heart rate.  They hooked me up to an EKG machine and took a reading.



HOpe this helps!

[PSVT GUY TO DLT]

well, i converted by myself before he could get me down the hall and get the leads on for an ekg.....but he said that it was a psvt attack because my pulse was so high that he couldnt count it!!!!! he estimated it to be somwhere around 220-240 and he had me lie down....by the time they asked me to get up to go to another room it was..."ooops there it went"...and i knew i went back into NSR. that was the day that i went on atenolol....i blacked out one night while meeting with some friends at a bar....no drinking, i remember going into psvt and it was like tunnel vision that finally closed off, i got weak and shaky, and then i dont remember much, just coming to and realizing that i was back in normal sinus rythm (nsr)but beating very hard. that was the worst episode....they almost called an abulance for me!

and no, i dont have panic attacks. ive never had this happen to me in a "panic" situation. actually its always been quite the opposite. i have definately notice a corrolation between the episodes and times of stomach problems (like everybody else here from what i have read).....alcohol also used to set me off, but always the day after, because of some byproducts of alcohol metabolism from what i have read. but now, i havent drank in some time, and it seems to be getting worse.

they say that as long as you stay under 180bpm or so your ok...but over can kill you pretty quick if you dont get medical attention, because it could degenerate into regular VT or the heart could just "give out" as ive heard it put. my case called for immediate action because i passed out.....if this is happening to you....get to a doc.

hope this helps

[Carol55]

Thanks to both of you for your great input.  Today I had the event monitor "put on" .  So will see what happens.  You've both been great with my questions.  I don't feel quite so alone.

Everyone keep posting on progress and good luck.

Sincerely

DLT

[psvt to dlt]

right back atcha,

about your event monitor....dont let your cat anywhere near

the wires...i fell asleep twice to find mine chewed in half!

good luck in the future....

psvt guy

[Michelle]

I've never heard of someone dying with rates over 180bpm.  I also have PSVT and my heart has jumped over 200bpm and stayed there for about 15 minutes, and that caused no harm to my heart.  My cardiologist was also aware of this and he even said that it is not life threatening if the heart is healthy.  I also thought of getting the ablation done, but was also  leary.  I am now 4 months pregnant, and so far SVT free, I just hope the rest of my pregnancy is the same way

[Michelle]

I've never heard of someone dying with rates over 180bpm.  I also have PSVT and my heart has jumped over 200bpm and stayed there for about 15 minutes, and that caused no harm to my heart.  My cardiologist was also aware of this and he even said that it is not life threatening if the heart is healthy.  I also thought of getting the ablation done, but was also  leary.  I am now 4 months pregnant, and so far SVT free, I just hope the rest of my pregnancy is the same way