Several different rhythms - structurally normal heart

[Hiker in Hawaii]

A Holter monitor study in Sept. 2012 showed i have had sinus rhythm along with junctional rhythm....In 2010 i had an event monitor that showed some parasysmal atrial tachycardia....In past, i use to have more episodes of rapid heart rate, but in last year it seems to have subsided...Now, i experience more skipped beats type of feelings, BUT the rapid heart rates and anxiety seems to have disappeared....I don't know if its coincendence, but i seem to have gotten a piece of mind (so to speak) when i had a normal cardiac MRI last fall...I also had 2 echos done, one in 2009, and one last year, both were normal...The EP thought that the MRI was justifiable since my father died of a heart attack when he was 48 (I'm 43 now)...

1. In the prescence of a NORMAL cardiac MRI and/or echo, can skips and certain rhythms be ignored without any treatment...I really, really, really don't want to take any medications or go thru an ablation unless there is some significant benefit to be gained...

2. Ablations are risky for junctional rhythms are they not?....If the procedure would go wrong, wouldn't the end result be needing a permanent pacemaker?...

Thank you!

[CCFHeart MD23]

Hi Hiker in Hawaii,

I'm first going to focus on the positives: your echos and MRI are normal and your anxiety is less of a problem for you than it used to be. Your family history does put you at higher risk for future heart disease but other factors need to be considered when comparing risk among family members (such as being a smoker, diabetes, alcohol, hypertension).
Moving on to your specific question about ablation...The current indications for patients with atrial tachycardia are that ablation should only be performed in the presence of atrial tachycardia that is drug resistant or where the patient is drug intolerant or does not desire long-term drug therapy.

Ultimately the question about which treatment is best for you will depend upon the benefits and risks of each treatment option. You have the choice to (1) do nothing and observe (2) take medications to suppress the atrial tachycardia (3) have an ablation as an early intervention because you do not desire long term drug therapy (4) only have an ablation if drug therapy fails.

Ablation of atrial tachycardia is successful in approximately 75% of patients (see Scheinman PACE 2004). The rate of major complications (including pacemaker insertion and stroke) is less than 1%. Although this risk is low you do need to consider what such a complication would mean for you and how that compares with a more conservative (low risk) alternative such as taking meds.

I would recommend discussing these options with your EP. In the absence of any history of collapse or complications other than palpitations, it is important to remember that you can take time to make the right decision for you.

Take care and good luck.

[tickertock]

The only thing that would concern me is your family history  that of your father dying at 48, I'm 48 myself and have suffered most of my life with tachycardia, PVCs and such, personally I learned to ignore them move on, with the testing you've had an angiogram probably wouldn't be recommended , but its the only test that can clear you 100% of significant CAD, other than that it would seem to me that you're preoccupied with your heart and I can tell you from personal experience it is not a good thing and destructive mentally and physically in the long run.