Ablation now for NSVT-- Second opinion

[ebmiller35]

I underwent EP ablation for AVRNT March 2007.  Did well afterwards and now only have occas. PVCs/PACs.  I underwent the first ablation after being refractory with Toprol XL, Digoxin and Cardizem and being 28 weeks pregnant in the ER with a HR of 280 bpm.  I have been doing well and it has been over 1 year now since my ablation up until last week when I was at work and thought I was going to pass out.  I felt a few palps AFTER feeling light headed.  I am a Physician Assistant and have experiency in cardiology so I called my Cardio and did a 24 hour holter which showed a run of 5 PVCs, NSVT.  I had a little bit of fluttering, lightheadedness and some chest pressure with the episode that lasted just a few minutes.  They now want me to have a second EP done at a bigger institution for 3D mapping and stereotaxis that was not available at the smaller facility where I had the first one done.  I am now taking lopressor 25mg BID which of course makes me feel crappy with a baseline HR of 60 to begin with.  My HR droped in the 40's during sleep on my holter and that was before the beta-blocker was started.  I would like input and a second opinion on some issues. If anyone has any answers I would be very greatful to hear.  This has consumed my life and definitely am worrying about this 24/7.  My echo came back fine and I do understand that this is benign with a normal functioning heart.  I can't help but feel overwhelmed each and everytime now I have palpitations and feel like "oh my gosh am I going to die".  This is taking over my life and that is why I feel like I should go forth with the second EP.

Is the risk of the procedure greater than me living with this?
Could this NSVT be a result of the first EP?
How long do I have to wait to get pregnant after EP and can I get pregnant without having EP?
Is ablation of NSVT higher risk than ablation of AVRT?
Could I have always had this and just triggered the AVRT to kick in with a few beats of NSVT?

[Michael J. McWilliams, M.D.]

Is the risk of the procedure greater than me living with this?

You have risk of complications with your EP procedure and virtually not physical risk to the PVCs themself.  If the emotional stress is worth the risk, then yes, if you are worried about sudden death and you have a normal heart, your risk of major complications is greater with the EP procedure.

Could this NSVT be a result of the first EP?

very unlikely.

How long do I have to wait to get pregnant after EP and can I get pregnant without having EP?

You don't have to wait.
If you have a normal heart, there should be no problems getting pregnant.

Is ablation of NSVT higher risk than ablation of AVRT?

Yes and it has a lower success rate as well.

Could I have always had this and just triggered the AVRT to kick in with a few beats of NSVT?

That is very possible.

Remember, this is only advise because I don't know your whole case.  In general, the least invasive approach is better for PVCs/NSVT unless it is very frequent, you can't live with it.  If they are right ventricular outflow tract PVCs, they are easier to ablate than PVCs from other locations in the heart.

[ebmiller35]

By the way I am 29 years old and female.  I did not mention that