Unusual Arrythmia?

[PATTY]

Hi, and thanks for your forum.  Ive been patiently trying to post for several months and finally have got a chance. I just would like a more thorough explanation of the arrythmia i am experiencing. I have been diagnosed with---Right Ventricular Outflow Track Idioventricular Rhythm with a bundle branch block. I understand that this rhythm is unusual but totally benign.  I was originally taking Toprol XL for it but i felt so lousy on it and when the dose was decreased i began to have break through palpitations, so now im taking Verapamil SR with success so far. When i have the palpitations it feels like my heart is beating up in my throat, my cardiologist has tried to explain the physiology of why it feels this way, but even me being a nurse, i dont quite understand his explanation.  So, my questions are:
1.) Can you please explain the physiology of what is occuring when i go into this rhythm?

2.) Why is this arrythmia difficult to map for ablation?  I have been told ablation isnt an option right now due to the difficulty mapping it out.

3.) i have a brother who had Wolff Parkinson White Syndrome who had a successful ablation.  Is there a relationship in the fact that 2 siblings have an alternate pathway arrythmia?

Thank you in advance for any info you can give me and Happy Holidays to all at the Cleveland Heart Clinic

[Cleveland Clinic, MD]

Just a comment - It is possible that what appears to be RVOT could be coming from the left side of the heart also.  We have had success with several cases of RVOT VT that had failed ablation at other centers. I believe that almost all focal VT can be ablated with some work at it.  If you have failed ablation at another center and would like to consider a repeat ablation I would highly recommend Dr. Andrea Natale here.  His success rate is very high.

[Julie]

Thanks for that bit of info Ben.  I'm not sure what bigeminy is, is it when you get a pvc every second beat?  Sorry the ablation didn't sort you out as I understand having an ablation is not very nice.  Are you on any meds?  What helps you?  Any advice welcomed!
Best Wishes
Julie

[Cleveland Clinic, MD]

Dear Patty,
I'm glad you finally got to post.  A right ventricular outflow tract (RVOT) ventricular tachycardia (VT) is a fast heart beat that originates the the area just below the pulmonic valve in the right ventricle.  RVOT VT is not generally life threatening but it can be highly symptomatic.  This is because the heart does not beat effectively at high rates and the upper and lower chambers of the heart are not synchronized.  This can result in blood being pumped backwards up the neck.  Also the rapid nature of the beats causes a feeling of beating hard.  I don't think there is a relation to your brother's condition as WPW and RVOT VT are two separate conditions.

I'm not sure why your doctor told you this was difficult to map for ablation.  We perform RVOT VT ablations routinely here at the Cleveland Clinic.  If you would like to be seen here for a second opinion you can call 1-800-CCF-CARE and ask to see one of the EP doctors such as Dr. Schweikert or Dr. Saliba.

[Julie]

I'm over in the UK and have various arrythmias - my cardiologist says that he thinks I probably have 'right ventricular outflow focus' - I am wondering if this is the same thing as 'right ventricular outflow tract', probably so.  I am wondering if you, Holly & Ben, have all have different sorts of irregularities too - or are your irregularities always the same?  I currently am having no treatment for my heart problem.  Trigger points for me are indigestion (hiatus hernia) and stress. - Sometimes of course - as you will all know - the attacks come for no reason at all.  Ablation seems an attractive option for me - I think I'd consider just about anything to get my life back.
Best wishes to you all.
Julie

[VTBen]

Yes, I it is the same thing that I was talking about.  I get lots of PVC's and non sustained VT from it.  I also get Bigeminy.  Most of my PVC's feel the same to me.  I've had 4 ablations, and still have this.  Not because they couldn't find the spot(they found it at the mayo) but because they couldn't burn it without causing heart block.

Good luck

[holly]

Patty, I also had right ventr. outflow tract arrhyth. and they had no problem mapping that out for treatment with ablation. (it was semi-successful). I think you have to get yourself to Cleveland or another large city hospital where they have good equipment and staff. I went to a large university hospital. Verapamil had ceased working for me and beta blockers were not an option due to asthma. Find yourself some EP doctors who do this all of the time and see tons of people!! Good luck.

[VTBen]

I also have idiopathic right outflow track VT, and I've had ablations done.  Mine have not been successful, (only partially) but I know that the Mayo clinic does do ablations for this.  You need to go to a large facility like Mayo or Cleveland heart center, if your interested in ablation.