2nd EP study after being taken to ER

[stutterheart]

Hi All,
Just a post about my past 2 days in case anyone is interested.
History: 29 yo male, former athlete, 3 years of noticable runs of tachy and pvcs/pacs. Long pauses followed by fast runs of tachy in the recovery period of exercize. Structure normal. Stress test tolerated well. Insignificant echo. July 08 EP study found atrial flutter, AVNRT, wenchebach and an area of abnormal conduction (focus). Ablation for AVNRT and Aflutter. Symptoms persistant. Atenolol 25mg 2x/d for past 4 months. This week first time at rest 'flutter' of 150 or so. Was at desk on Thurs when flutter/skip/flutter started. Went to doctor at my company. EKG taken but missed the episodes which the doctor did feel of 30 second runs. Taken to ER. Put into EP study next morning by my doc (Dr Aizer at NYU...the BEST!), did 4 hour EP study with no sedation and it was absolute torture. Pacing induced tachy consistant with previous symptoms but they were unable to 'start' anyting sustained. Injected synthetic adrenaline 4 times to get heart pounding hard and had a few episodes where there were premature beats in the recovery phase. Also they noted that sinus rhythm dropped extremely fast after taken off the drug. This matches my experience with coming down from exercise. But they couldn't find anything evident. Good news was the reentry tachy and aFlutter were not able to be brought on again so looks like past ablation was worth while. They said that there is no way this turns into a ventricular arrhythmia and that I should try to bring on episodes with exercise once I heal and try to catch it on tape. This still makes me very nervous but I guess I have to do it. I think the only thing they can do now is medicate or else augment the SA node or take it out completely and put in a pacemaker which they said would be foolish now given my age of 29 and the fact that I'm not all that symptomatic. But I would like to run again and wonder if that might be an option I start to explore more and more in the coming years.
Has anyone had a similar experience with a pacemaker and/or SA node augmentation? I'm thinking that pacemakers can fail too and that if I have one that works most of the time, I might stick with it.
Other comments very much appreciated as well but wanted to just share my experience.

[stutterheart]

thanks for the input. I'm starting to accept that I'll probably not be able to be as active as before. At least my sport is golf and not track!
My doc suggested I run hard and try to bring about arrhythmia to get it on tape. He said it 100% can't kill me so I'm trusting him. Tachy is scary.
Am going to post a question on ist perhaps you could offer input on.
Thankks again!

[ireneo]

I'm going to disappoint you here - I've never had to learn how to tolerate my arrhythmias because I've had them for as long as I can remember. Ready for disappointment number 2? I've never been able to run because of the tachy. Even now, if I rush through a parkiing lot, my heart will pop into tachy. Not just the usual increase from exertion but the sudden jump from "thump, thump" to "pit-a-pit-a-pit". You know the feeling.

I completely understand your desire to run, do things as you've always done. I only dream about running (like you see in the movies LOL).

I wish I could help more. My life is just different and I'm used to it. You can still be active. My job is physically demanding at times, I work out at the gym (walk on the treadmill, not run and do weights). Perhaps a slower warm up, a longer cool down would work for you when running. I notice a difference if I go too fast, too quickly. Or you can continue to run and just stop and pause when the tachy acts up. I do that at the gym. And on days where my heart just wants to be a brat, I keep it light and simple in terms of activity.

Ask your EP about running with tachy. See what he suggests. I know plenty of people that run with arrhythmias. Not sure how they do it but I'm not that brave.

[stutterheart]

Agreed. I don't think it's worth puting a pacemaker in. And yes, the bursts are for about 30 seconds and happen about 3 times per episode, meaning at T+0 I get a 10-30 second string, then a few thumps, then sinus for a few minutes, then rate rises to maybe 110-120 as a trigger to the next jump to 170ish for 10-30 seconds. Also periods of stops and starts in the middle. They were able to at least replicate this with pacing and it seems to me like there is either another focal point that they were not able to stimulate or else I have a bit of SA malfunction. Good thing was the sustained 350 bpm for 3 minutes seems to be gone because they ablated the slow pathway last year.
They reassured me that it won't kill me and I buy it this time because they spent the time to tell me how a svt can kill you and why it won't kill me (because I don't have a rentry pathway).
I can tolerate this every once in a while. But if it happens every time i run like it does now, I'd like to find it and modify the sa node or burn off the other focus if we can find it. I guess it's just a long process, huh?
Just curious, were you really scared at first and then learned to tolerate it? I used to be mortified at every pvc and rush to the hospital but now I get them and shrug it off. Hoping I can progress with this too.
Best.
-A

[ireneo]

LIke you, I've had ablations done and still have my atrial tachy bursts. Even in my ablation notes it mentioned tachy but not sustained. I would like to know how long it has to go on before it's considered "sustained." Just a funny thought.

If your tachy times are short (less than a minute like mine are now) I'm not sure I'd go for a pacemaker or any other kind of interference. If you realize the heart's going to race along for a few seconds and then straighten out, that's tolerable.

You didn't specifically say how long your bursts last or the rate. You mentioned 150 and 30 seconds. Is that what typically happens?

Just ask your EP about this, whether your episodes now are worth intervention.