treatment for IST

[triacting20]

Hi I'm a 21 year who was diagnosed with Innapropiate Sinus Tachycardia this past November and have been on 25 mg of Atenolol ever since. The problem I'm having is that I'm constantly tired and the past few months I've been getting pain in my left arm and the upper portion of my left back I'n which I had a Echo test done and a Ct angiography which both of them showed everything was normal. The two questions I wonna ask is:
1)I was interested in the Sinus Node Modification and was curious as to how successful this procedure was for Inappropiate Sinus Node Modification. I looked at alot of people's anwers on the heart forum for this procedure for IST who did not have that much success but I'm assuming the technology has improved for this procedure.
2)Since I had a echo and a ct angiography done which showed everything was normal, can I rule out any artery blockage that can be causing my pain in my left arm.

[Forum-M.D.-MJM]

Hello,
I am sorry to hear about your diagnosis.  IST is a very frustrating condition when it is symptomatic.

1)I was interested in the Sinus Node Modification and was curious as to how successful this procedure was for Inappropiate Sinus Node Modification.

The success rate for sinus node modification is around 50-60% and even then it depends on the end point.  For severely symptomatic patients, extensive ablation can lead to damage to most of the sinus node sometimes requiring pacemaker. This is never the goal of the first or second procedure.  We do not like putting pacemakers in people unless absolutely necessary, especially young people like yourself.  A higher dose of beta blocker may help and is probably worth trying as a next step.

2)Since I had a echo and a ct angiography done which showed everything was normal, can I rule out any artery blockage that can be causing my pain in my left arm.

A CT angiogram should rule out coronary anomalies and if done correctly coronary artery disease.  The odds of a 21 year old having coronary disease in the absense of significant family history or other out of the ordinary risk factors is very, very low.  I doubt coronary disease is the problem.

I hope this helps.  Thanks for posting.

[calico1]

If you could learn to tolerate the side effects of your meds, that would be better considering the alternative. Ablation of the sinus node (heart's natural pacemaker) is a tricky business. If the procedure fails, you could potentially end up with an implanted pacemaker which can bring in more problems than solution like infections, body pain, etc.

In my case, the first 2 months or so of taking Toprol were awful because of the side effects - fatigue, cold extremities, sluggish mind, breathlessness, etc.  My doctor didn't want to take me out of it.  He told me to take the med at night instead. It has been 2 years since then. My body has adjusted and those side effects don't bother that much anymore.  Good luck!

[Forum-M.D.-MJM]

People with IST tend not to like beta blockers at first but if they stay on them, they learn to tolerate them -- just as Calico1 described.  I agree that medications are always the first option, ablation is a distant second option.