Failed Ablations

[Verethyl]

Hello ALL, My brother has had a total of 3 ablations. We live in Victoria,Texas, he is 47 works for the county and really has crappy insurance compared to the city employees. Anyway the first 2 ablations were done in Houston and the last was done in Austin. His ekg's have showed him with psvt up to 236bpm. the first ablation in Houston was done in under 3 1/2 hrs. the 2nd in Houston by the same md he couldn't find the area causing the problem so just cauterized the same area. His cardio here in Victoria stopped using the Houston md and sent him to a different EP in Austin, he looked and couldn't find anything  so burned an area he didn't like and that was in under 2 hrs also.
Once while going to the ER the drs. were unsure if he was having svt or vt which has really started to worry us. my brother is going tomorrow to wear an event monitor for 30 days, he is on metoprolol 200mg / day. He has been given amniodorone ( sp ) ?? in ER. An Austin nurse suggested a pacemaker, and when I asked his cardio about it he said NO. I've heard about the Cleveland clinic how good they are and was wondering if they would just look at his tests results and suggest anything ??? He is really getting tired of practically living in the ER.

[MichelleP_3811]

Actually it is not weird it is very typical of and accessory pathway svt.  Essentially your brother has an extra piece of muscle that conducts electricity.  When there is a disruption to the normal beat cycle typically by an ectopic beat, a pac from the atria or a pvcc from the ventricles then the heart pauses and during that pause the extra muscle fiber has time to complete a loop of the electrical signal thus causing it to run in a circle.  The most common kind is the type I had called avrnt but there are others and it is possible his is on the left side of the heart which is a bit more complicated to ablate.  This said, he does not have them often enough to make trying an ablation a sure fire success.  I think eps know enough now where to look but obviously they are having difficultly locating the spot.  Being heavily sedated for as rare his episodes are is probably not the best approach but I am sure the ep was confident he could find it.  This all said, if he only has them once a year there is no guarantee the 30 day he is wear will be captured which could find him more frustrated though it is worth a shot.  But as well if he is only having them once a year he heart really is not in a lot of danger.  If it progresses as he gets older and becomes more frequent he may be a better candidate for ablation but try to implore him to figure out how to get the episodes to stop for him and he may never need an ablation.  As well when I started to do cardio it helped tremendously to tolerate the episodes.  It didn't stop them or slow them down but I was able to function a lot better while in an episode so if he doesn't work out have him consider it. I had a lot of episodes in my lifetime and they became more frequent and long in duration the older I got.  I only had chest pain near the end after letting an episode go on for 3 hours while also trying to function, I should have sat down, so I would say if he feels chest pain it is best he get himself to the er.  Strangely for me driving in the car and getting bumped around was a good way to stop it.  But again not so strange because as much as an ectopic beat starts it the same principle stops it, doing something to disrupt the looping signal. That is basically what one of the meds they sometimes give them do.  It stops the heart for a split second to get the rhythm back to normal.    Take care and I do hope he is able to eventually get a handle on it all.  

[Verethyl]

Well after his 2nd ablation in March of 2013 he didn't have an episode until July of this year, and he's tried  bearing down, and the carotid massage, nothing seems to work. The first 2 ablations he was awake and the last one he was sedated so maybe he shouldn't have been. I've read that placing your head in ice water will sometimes help and I told him this last week , will suggest the ice water thx. His episodes are weird, the majority of the time he's doing practically nothing, sitting down, last Thanksgiving he was cooking the turkey on the grill and had an episode, several times he's not gone to the ER, just waited it out, the only times he's gone is when he's actually had chest pain with the event or it won't stop, the longest he was in an event was 40 mins.

[MichelleP_3811]

This said, if it does turn out that your brother is having vt then sometimes an ICD is placed to knock the person out of the rhythm since vt is dangerous where svt technically isn't considered a danger so that may be what the nurse was considering if vt was being suggested at the time.

[MichelleP_3811]

A pacemaker is generally not prescribed for svt unless the svt is being triggered by the SA node which is subsequently ablated and a pacemaker is put in its place.  SVTs can be hard to catch. Was your brother put under for the ablations?  I was awake for mine and I hear sometime having too much sedation can be an issue.  How often does he get the svt?  I was having it basically weekly so when I went in they found the spot right away.  It is helpful to be pretty active because svts do have a mind of their own.  Ectopic beats usually trigger but not every ectopic beat will trigger an episode so I don't think it is an exact science.  To be honest I am not sure how one can mistake svt for vt but I am not a doctor but for my understanding the ekg strip would look completely different but I am not a doctor so I am not educated enough to make that ruling.  That said, it sounds like the svt isn't in the typical place so finding it may be a little tricky.  As far as I know the Cleveland Clinic is very reputable but I don't have any personal experience with them so I can't say for sure.  I would suggest that your brother try to work on vagal maneuvers to see if he can control the svt on his own without the need to go to the er.  Have him bear down and strain like going to the bathroom and hold his breath.  Or having him drink a really cold class of water.  Try coughing or even jumping up and down and see if that will break the connection.  If your brother can control the svt then he may not feel so displaced by it.  I wish him the best of luck getting a handle on it and finding a cure.