To EP, or not to EP

[Linda123]

Dear Doctor
I have posted here before and much appreciate this service.
I have had various sorts of arrythmia since my teenage years and I am now 46.  I am certain that I have had 3 episodes of SVT the last one occurring 20 years ago.  I think I have also had a few episodes of atrial fibrillation.  Mostly now I get random pvcs and runs of fast heart beats which do not feel the same as SVT, as these fast beats feel as if they are coming from a lower place in my heart.  Can SVT manifest itself in different forms?  Can my SVT have 'changed' into a-fib, the 'different' fast beats, and pvcs?
All heart tests have shown my heart to be normal.  I have only managed to catch extra beats coming from the right ventricle on a heart monitor.
As I am having quite a lot of pvcs/fast beats at the moment, especially when I lay on my side in bed at night, and feel strange in my chest a lot of the time, I have arranged to have an EP study, but after learning about what occurs in this study I am feeling a little concerned.  From what I have told you do you think an EP study is warranted in my case.  I understand there is a risk attached to this study.  Also, is it true that one can be left with an arrythmia for a while after having it?  I find my palpitations frightening and so am worried about 'keeping it together' whilst the test progresses.  I would be prepared to have an ablation if it is possible.
Beta blockers have never worked for me.
Apart from this arrythmia I am in good health, I am not over-weight, do not smoke or drink.
Thanking you in advance.
Linda

[Linda123]

Hi Karen
Just seen your message - sorry for the delay in answering.  I was awake for the EP study - but they did give me a pre-med of valium and also topped it up during the procedure and this helped me enormously.  There can't have been anybody on the planet as worried as me about having the EP study but it was bearable and all the time it was happening I kept thinking things like "now come on, you aren't having palpitations in the supermarket, or down the street, or in the middle of nowhere, you're surrounded by professional people who are out to help you and won't let anything bad happen to you".  The other great thing was they can stop the palpitation just like that.  My procedure took two and a half hours and, amazingly, the time just flew by.
Best Wishes to you - and try not to worry too much - (from one who did).

[KarenSA]

Dear Linda
It is good to hear your positive words about the EP.  I am in South Africa and have been referred for an EP to determine the cause of arrythmias I have had since my mid 20's.  I am 40 now.  I am wondering if you stayed awake during your procedure or if you chose to be anaesthetised?  If you stayed awake, how did you find the procedure?
Regards Karen

[Linda123]

Well, here I am posting a message under my own question - but I thought others who read the forum might be interested.
I DID have my EP study after very much agonising and soul searching.  I am SO glad that I had this procedure as I now know, after 30 long years, what is wrong with my heart.
I have had numerous different experiences with palpitations over the years which had me and doctors baffled. The EP study found that I had an abnormal area in the upper chambers of my heart, quite near the sinus node, when this area was stimulated a rate of 230 beats per min set in.  My cardiologist who performed the EP was truly amazed to find this area as we had no idea it existed - and I would never have known about it had I not had the EP study.  I do not have accessory pathways, something I always wondered about, and the area causing me the problem is scar tissue which he thinks may be the legacy of a virus I had in my youth (probably an Asian flu I caught when 16 which made me very ill), so I suppose I have a form of heart damage although the cardio would not agree to use the word "damage".  I can have this area ablated but this is for future discussion and decision.
I had lots of spontaneous palpitations coming from my ventricles during the study, and these are the ones that bothered me by far the most.  My cardiologist could find no real cause for these palpitations - no focus, damage, etc. and therefore says that my ventricles are just irritable.  There is a possibility that there may be a link between the abnormality found in the upper chambers and the irritability in the lower chambers.  However if there is no link it looks as if I am stuck with the lower chamber palpitations.
To any of you out there who are terrified of having the EP study (as I was) then I would say that it is bearable and well worth doing in order to get some answers.  I have wondered and wondered and wondered what on earth was the matter with my heart and now I know and just knowing brings so much peace to my mind.  Now my local doctors can no longer roll their eyes at me and think I am neurotic, family & friends know I am not insane, indeed I have wondered myself if I was crazy but I now know - and for that I am truly grateful.
Best wishes to all, Linda

[CCF-M.D.-RCJ]

Linda,

Thanks for the post and vote of confidence.

It is difficult for me to determine if the EP study is warranted or not without talking to you.

You need to balance the risk of the EP study against your continued anxiety/uncertainty about your chest symptoms.  The risk of an EP study is quite small -- most labs have had very few complications from EP studies.  If your life is interrupted by the symptoms, then you may wish to proceed.  You should know, however, that you may not get all the answers you wish.  

I think it is appropriate to learn coping skills to deal with the palpitations, as many people cannot be "cured" entirely from their chest symptoms.  Some examples of copin mechanisms include biofeedback and yoga, among others.

Good luck.