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Debating EP Study
Hello,
I have an EP study scheduled for Friday, but I've been thinking about cancelling quite simply because I'm feeling good.
The reason for the EP study is as follows. My two day holter picked up:
1) 185 bpm SVT while exercising. This happened when I was riding my bike at full speed (equivalent to a full on sprint), so I kind of expected the rate to be this high. I didn't have any symptoms as this was happening. I didn't even realize that anything was wrong because I just kept riding.
2) 7 beat NSVT while sleeping. Heart rate was 65, looked perfectly normal, then bam 7 beats of v-tach at 125 bpm. This was followed by a brief return to normal rhythm, then another 3 beats of v-tach. I was asleep during this so I didn't notice any symptoms.
Now obviously #2 concerns me. I've had low pottasium in the past (2.9) but I have since increased it to the 3.5-3.6 range. Still on the low side, but within range.
My heart is structurally normal according to an echo. My EP said that the v-tach could've been caused by a pottasium deficiency, even though bloodwork around the time said that I was within range (albeit borderline). He also said it was unlikely that he'd be able to reproduce it, but he would at least try.
As for #1, If I really did have SVT during exercise as the holter suggests, then I'm thinking that maybe I had it my whole life and just didn't realize it. Is this really a concern and is this really EP study worthy? I certainly don't want to be afraid to exercise.
I since continued to drink more OJ and eat more bananas, especially before falling asleep at night. I feel like I've been returning to normal, and haven't had any major racing heart episodes for over a month now. It's been a few months since the holter and I've had another one since, which didn't show any v-tach but it did show 120-130 bpm at one point when I was simply walking around a store.
Should I still go through with the EP study? My EP said that it was a "no brainer" and my primary care doctor tends to agree. But then again my EP also said that he would mainly be doing it for the SVT which again was asymptomatic. So should I really care about that? I'm more concerned about the v-tach returning.
What do you guys think? I appreciate any input. Thanks!
I have an EP study scheduled for Friday, but I've been thinking about cancelling quite simply because I'm feeling good.
The reason for the EP study is as follows. My two day holter picked up:
1) 185 bpm SVT while exercising. This happened when I was riding my bike at full speed (equivalent to a full on sprint), so I kind of expected the rate to be this high. I didn't have any symptoms as this was happening. I didn't even realize that anything was wrong because I just kept riding.
2) 7 beat NSVT while sleeping. Heart rate was 65, looked perfectly normal, then bam 7 beats of v-tach at 125 bpm. This was followed by a brief return to normal rhythm, then another 3 beats of v-tach. I was asleep during this so I didn't notice any symptoms.
Now obviously #2 concerns me. I've had low pottasium in the past (2.9) but I have since increased it to the 3.5-3.6 range. Still on the low side, but within range.
My heart is structurally normal according to an echo. My EP said that the v-tach could've been caused by a pottasium deficiency, even though bloodwork around the time said that I was within range (albeit borderline). He also said it was unlikely that he'd be able to reproduce it, but he would at least try.
As for #1, If I really did have SVT during exercise as the holter suggests, then I'm thinking that maybe I had it my whole life and just didn't realize it. Is this really a concern and is this really EP study worthy? I certainly don't want to be afraid to exercise.
I since continued to drink more OJ and eat more bananas, especially before falling asleep at night. I feel like I've been returning to normal, and haven't had any major racing heart episodes for over a month now. It's been a few months since the holter and I've had another one since, which didn't show any v-tach but it did show 120-130 bpm at one point when I was simply walking around a store.
Should I still go through with the EP study? My EP said that it was a "no brainer" and my primary care doctor tends to agree. But then again my EP also said that he would mainly be doing it for the SVT which again was asymptomatic. So should I really care about that? I'm more concerned about the v-tach returning.
What do you guys think? I appreciate any input. Thanks!
I had mine done in the Chicago area and it cost a total of $50,000 though my out of pocket was only $4,000. I set it high so I did not have to pay as high premiums monthly since I pay for my insurance on my own. So the fact you paid $2,000 only means that is what you paid not what your insurance paid. it is likely your insurance paid somewhere around the $50,000 at least. Accessory pathway ablations are a little cheaper than afib ablations which run $75,000 - 100,000. Though your area may be a little less expensive than a big city it is very highly likely your actual ablation costs exceeded $2,000. That was likely just your contribution unless they gave you the ablations probono. But out of pocket was established to keep people from going broke from medical care but it does not mean that is all that was paid out for your care during a one year period. The sad part is the rest of the world is probably in line with the $2,000-3,000 mark. We are crazy off course in the states when it comes to medical care.
That is absoultly crazy!!! Where did you go for your EP study? None of mine were that much!! Ha maybe thats why im not fixed yet! I went to the University Of Utah twice and the Utah heart clinic the third time. My last study was in 2011 my total out of my own pocket was around 2,000.00
My ablation was in the $65-85,000 range.
This is part of the rationale behind my previous comments of "it's not a problem, until it's a problem."
If you have standard (USA style) Deductible + 80/20 type in surance, then you will pay the Max OUT OF POCKET for an ablation. If you have HMO and it's $250 Outpatient co-pay, I think you are morally obligated to objective about your spending impact to your peers.
So back to a case of: "I get SVT twice a year for 30 seconds..." Live with it and die of old age.
$1200 for an EKG and blood. Yep. I'd suppose there is a negotiated discount in there too. (my $65k was AFTER discounts - it was ~$100K before).
This is part of the rationale behind my previous comments of "it's not a problem, until it's a problem."
If you have standard (USA style) Deductible + 80/20 type in surance, then you will pay the Max OUT OF POCKET for an ablation. If you have HMO and it's $250 Outpatient co-pay, I think you are morally obligated to objective about your spending impact to your peers.
So back to a case of: "I get SVT twice a year for 30 seconds..." Live with it and die of old age.
$1200 for an EKG and blood. Yep. I'd suppose there is a negotiated discount in there too. (my $65k was AFTER discounts - it was ~$100K before).
Good! Keep an eye on it to gauge if your episodes increase. I hope the supplements work for you.
I'm not having the EP study. The bill is from the pre-testing that they did a few days before the study was scheduled. I then went ahead and cancelled the study after I had already went through pre-testing. Bad timing on my part.
I'm done with my stress echo and cardiac MRI. Stress echo was unremarkable. My doctor mentioned mild MVP but just shrugged it off saying that it's nothing to worry about. Had the cardiac MRI yesterday so I'm still waiting for results on that. Going to call my doc today.
I had another blood test which showed my potassium at 3.7. I was hoping for better than that considering I've been proactive in making sure to eat potassium rich foods. I think I'm going to start the supplements that my doctor prescribed. My Vitamin D was also really low at 16. So I need to start supplementing that. Otherwise everything looks normal.
I'm done with my stress echo and cardiac MRI. Stress echo was unremarkable. My doctor mentioned mild MVP but just shrugged it off saying that it's nothing to worry about. Had the cardiac MRI yesterday so I'm still waiting for results on that. Going to call my doc today.
I had another blood test which showed my potassium at 3.7. I was hoping for better than that considering I've been proactive in making sure to eat potassium rich foods. I think I'm going to start the supplements that my doctor prescribed. My Vitamin D was also really low at 16. So I need to start supplementing that. Otherwise everything looks normal.
Here's a breakdown of my charges; over $76,000 in 2010. I've seen others on here with charges over $100,000. I'm not pulling these figures out of the air! These are documented posts from other members.
http://www.medhelp.org/user_journals/show/257573/Post-Ablation-Observations
http://www.medhelp.org/user_journals/show/257573/Post-Ablation-Observations
I have had three ep studies.. Not one of them cost 75k-100k! The average price was aroundt 20,000.00 then of course my insurance has their allowable price.. I also feel your first doctor was very quick to jump to an ep study. I wore monitor after monitor from 2002-2005 before they ever decided to do the study. I have nsvt, svt, pacs, pvcs. They never were able to induce my nsvt nor my svt. I even had a loop recorder implanted in me for 10 months. Medication made my nsvt worse. Dont be afraid of the ep study there could be complications as with everything but I would do it again if there was a chance I could be fixed.. Good luck keep us posted.
Yup, that sounds about right. Your EP study with ablation will probably run from $75K to $100K, perhaps more.
Does $1,234 sound right for EP study pre-testing? All they did was an EKG and take some blood. Just got the bill today. My jaw dropped.
"you don't want all that radiation" just wow :(
2nd doc is on the ball. Like I mentioned above, SVT us a very broad term, it can mean all sorts of stuff including exercise, which is a completely normal response.
2nd doc is on the ball. Like I mentioned above, SVT us a very broad term, it can mean all sorts of stuff including exercise, which is a completely normal response.
Just as an update, I went to a new cardiologist, because my current one thinks that MRI's have radiation. After I requested a cardiac MRI, he said "you don't want all that radiation". I wish I was joking.
New cardiologist seems a lot smarter. He immediately ordered me a cardiac MRI and an echo stress test.
I also showed him my holter results and he looked at the 185 bpm that I had during the bike ride. I told him that my other cardiologist (and the EP) said that it was SVT. He looked at me wide eyed and said "you were riding a bike!" as if the holter recording was completely normal. He also mentioned that it was too quick to even tell if it was SVT. And I tend to agree with him because 1) the holter software said no SVT detected 2) I had no symptoms at all and 3) The holter shows my heart slowing down once I slowed down with the pedaling. So that made me very happy.
My second holter did detect some SVT, in which the software clearly labeled it SVT. A very minimal 7 or so seconds of SVT out of 48 hours. And it all occurred as I was sleeping.
I'm glad that I'm getting more tests. I still think that something serious is going on in terms of chest pain at times, like maybe a brief coronary spasm or something. I just hope it's not clogged arteries at age 28. That would suck.
Thanks again for the support. You guys are the best!
New cardiologist seems a lot smarter. He immediately ordered me a cardiac MRI and an echo stress test.
I also showed him my holter results and he looked at the 185 bpm that I had during the bike ride. I told him that my other cardiologist (and the EP) said that it was SVT. He looked at me wide eyed and said "you were riding a bike!" as if the holter recording was completely normal. He also mentioned that it was too quick to even tell if it was SVT. And I tend to agree with him because 1) the holter software said no SVT detected 2) I had no symptoms at all and 3) The holter shows my heart slowing down once I slowed down with the pedaling. So that made me very happy.
My second holter did detect some SVT, in which the software clearly labeled it SVT. A very minimal 7 or so seconds of SVT out of 48 hours. And it all occurred as I was sleeping.
I'm glad that I'm getting more tests. I still think that something serious is going on in terms of chest pain at times, like maybe a brief coronary spasm or something. I just hope it's not clogged arteries at age 28. That would suck.
Thanks again for the support. You guys are the best!
I agree. The rates you note are quite normal for the activities you mention. On a treadmill test just before my ablation, I started throwing salvos of SVT that were almost the same rate as my sinus pulse at the time, 195 bpm.
SVT is a bucket term, what is causing the SVT is what should be discussed. Your 185 was being caused by exercise, so that's normal. The 108-126 while walking around is normal and healthy!
I never actually found out what kind of SVT it was. I'll ask my cardiologist next time I see him.
The interesting thing is that the holter software reported "No SVT detected" and yet my doc says that the 185 bpm while riding my bike was SVT. Could he or the holter be mistaken? I feel that when I go full sprint I can always get myself up to that rate, so does that mean I'm having SVT every time and just don't realize it? I certainly don't become sustained @ 185. Once I stop my heart rate starts slowing as it should.
My second holter report did actually report some SVT, but only 7.2 seconds out of two days, and when I was sleeping no less! There was also a time when I was out shopping and it showed my heart rate between 108 and 126 for the hour - just walking around the store. It didn't say that it was SVT though, just tachy. I wonder again - Can that be SVT and the holter software just isn't catching it? Or do I just have IST at times?
The interesting thing is that the holter software reported "No SVT detected" and yet my doc says that the 185 bpm while riding my bike was SVT. Could he or the holter be mistaken? I feel that when I go full sprint I can always get myself up to that rate, so does that mean I'm having SVT every time and just don't realize it? I certainly don't become sustained @ 185. Once I stop my heart rate starts slowing as it should.
My second holter report did actually report some SVT, but only 7.2 seconds out of two days, and when I was sleeping no less! There was also a time when I was out shopping and it showed my heart rate between 108 and 126 for the hour - just walking around the store. It didn't say that it was SVT though, just tachy. I wonder again - Can that be SVT and the holter software just isn't catching it? Or do I just have IST at times?
I didn't read the whole thread so I may have missed it. What type of SVT was it? SVT encompasses many types of tachycardia originating in the top part of the heart including ones that are completely appropriate, like when we exercise. I'd be looking for some type of reentry issue.
On the NSVT, the key is finding out where it originated from (within the ventricles). Certain origins are known to be less benign than others. For instance, NSVT originating in the right ventricular outflow tract (RVOT) is generally considered benign and very ablatable. There's another type of NSVT that originate in the bottom of the left ventricle that can be more troublesome and is usually addressed. NSVT is also evaluated in the context in which it occurs. For instance, exercise NSVT throws a red flag.
So to evaluate the episode of NSVT further consider its origin and context. The EP might be able to tell the general area the NSVT originated from by the holter strip. I get a high load of PVCs sometimes, and they 100% originate in the RVOT for me...
On the NSVT, the key is finding out where it originated from (within the ventricles). Certain origins are known to be less benign than others. For instance, NSVT originating in the right ventricular outflow tract (RVOT) is generally considered benign and very ablatable. There's another type of NSVT that originate in the bottom of the left ventricle that can be more troublesome and is usually addressed. NSVT is also evaluated in the context in which it occurs. For instance, exercise NSVT throws a red flag.
So to evaluate the episode of NSVT further consider its origin and context. The EP might be able to tell the general area the NSVT originated from by the holter strip. I get a high load of PVCs sometimes, and they 100% originate in the RVOT for me...
Don't worry about the EP. It is his job to take care of your mind as well as your body. If you are not mentally ready for this, it is okay to change your mind. Your body, your money, you live with the outcome. Keep us posted.
I cancelled for two reasons.
1) Still have that doubt and will definitely be seeking a second opinion ASAP.
2) I live with my nephew and he brought home a stomach virus from school. He was up all last night throwing up :( I'm not going to take the risk of having to throw up while I'm on the table or during recovery when I have to lay still.
My EP probably hates me at this point. But I need to get more opinions for peace of mind.
You guys are awesome, thanks so much for the input!
1) Still have that doubt and will definitely be seeking a second opinion ASAP.
2) I live with my nephew and he brought home a stomach virus from school. He was up all last night throwing up :( I'm not going to take the risk of having to throw up while I'm on the table or during recovery when I have to lay still.
My EP probably hates me at this point. But I need to get more opinions for peace of mind.
You guys are awesome, thanks so much for the input!
I just recalled when I had a stress test that showed a short, non-sustained run of VT, no one suggested an ablation to me. This was after my first episode of Afib when they were running tests to see if there was an underlying problem. I did, however, end up having a heart cath to rule blockages. This was in 2003. I was told they probably would not do that today. Hoping maybe some of this will be useful to you.
Here's the overall mantra for all things...
It's not a problem, until it's a problem.
If the SVT doesn't bother you... don't get it ablated. 7 beats of SVT == BFD.
If you find yourself having troubles with it... fix it.
It's not a problem, until it's a problem.
If the SVT doesn't bother you... don't get it ablated. 7 beats of SVT == BFD.
If you find yourself having troubles with it... fix it.
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