How successful is Ablation Surgery

[JohnWright]

My research shows in 2-year Catheter Ablation studies, rather than 94% success, 72% were a success, 13% had recurrent of the same SVT, and 15% had SVT in a new area of the heart which needed new Ablations permanently scarring these new areas. Couple this with 1% complications like perforations or AV Node block needing a pacemaker and I am going to try swimming and lifestyle change before considering Ablation Surgery.

[JohnWright]

My SVT started 22 years ago, and every 2 or 3 weeks I had to sit or lie down for 30 seconds to revert. 8 years ago I was getting SVT's once every 3 weeks. Daily lap-swimming for 4 months stopped them and they did not return for 6 years.

After no SVT episodes for years, daily work and stress in a remote camp in 2013 brought them back 10 times in 3 months until December, and then 3 episodes in early February, with Adenosine stopping 2 at the hospital. Now I've been daily swimming for 6 weeks with no episodes.

I think the ectopic extra beat may happen because of a patient's accessory pathway, but that does not necessarily trigger an SVT episode. Mine was triggered by wearing a scarves or heavy sweaters indoors and getting overheated or being stressed. The extra beat may have started it but if I had not been warm or stressed, the SVTs probably would not have started.

In January, 2014, a Cardiologist said 65% chance it was AVNRT, and 35% other Atrial arrythmias. My good physical condition may be why the rate is 160 rather than 200. The accessory pathway may not go away, but my daily lap-swims have to be doing something for me because I have been symptom free for over 6 weeks now.

Due the cool water a swimmer's maximum heart rates is 17 beats lower, and the beats are more uniform, and stronger than a cyclist's max rate on dry land. I swim with a front-mounted snorkel, noseplugs, and goggles so I can relax while at the same time pushing myself to swim at a good speed for 10 lengths before taking my pulse for 2 minutes and then swimming another 10 for a total of 60 lengths, or 1 mile (1.5 Km)

I do not want ablation surgery because perhaps 1 in 10 have to redo within 5 years and about 1 in 4 have new arrythmias or palpitations that bear no resemblance to the original arrythmia, and every time they cauterize your heart muscles there is more potential for other beats to start from the scarring like atrial and ventricular premature beats, atrial flutter, and ectopic atrial T.

I'm not looking for any guarantee that SVT will not return, but it's not returning as long as I lap-swim, and it is correct that swimming will strengthen anyone's heart so their heart will be able to endure longer SVT episodes.

Feeling my pulse there are no extra beats or flutters, only a steady strong beat. I don't know why this regime is preventing my SVT but it is. I'll continue the daily swim regime for another 3 months and post the results.

[tom_h]

Just a couple of reinforcing comments to what Michelle was saying.  My electrophysiologist told me that my events started with one PVC firing at precisely the right moment.  I could get dozens of PVC's per day without incident.  It was only when it occurred at the "correct" moment that it precipitated my SVT.  They know that by duplicating that it the lab.

Regarding the type of SVT.  It is very difficult to determine the type of SVT and even more to determine where it is located.  There's only one form, Wolff-Parkinson-White, a type of AVRT which leave a telltale signature on an EKG, even in normal sinus rhythm.

Any good electrophysiologist worth his salt will tell you there are risks involved.  He should also inform you of his record including the number of procedures performed, and the mortality rate.  Mine lost one patient out of a couple thousand, and that one had complications going in.  He will also inform you that there is indeed a pacemaker ready to be installed should there be complications.

I looked at it accordingly.  I went in there with perhaps 75% of my life behind me.  I was willing to take that slight risk to perhaps live the last 25% free of the SVT millstone.

Is the heart scarred internally? Indeed it is.  That is the barrier to prevent the path from conducting. The "scar" is a very small series of burns which when connected form literally a small line of scar tissue. Can it reform? Yes, it could.  Cells are reproducing constantly.  The barrier can be bridged making conduction possible once again forcing a second procedure.  The one thing I'm interested in reading more on is the issue that some who had ablation therapy had SVT in a new area of the heart.  John, If you could provide me with a path to that report, I'd be much obliged.

[MichelleP_3811]

What exactly were you diagnosed with, Avnrt or Afib?  Developing avnrt at 68 though not impossible is kind of rare, it usually shows itself before.  A rate of 160 seems a bit low for avnrt as well.  The extra pathway being close to the avnode makes the loop very short thus usually the rate is in the 200s.  This said, if you have a well conditioned heart that could be part of the reason for the lower rate.  However, if you do have an accessory pathway svt it will not go away just by exercising.  The extra muscle fiber is there and will remain there.  It is a physical part of the anatomy of your heart.  The dynamics (shape/size) of your heart may have changed to allow the connection to be made may be one reason why the symptoms are only arising late in life.  I had avnrt and had it ever since I was a child and this is more typical but the episodes are generally rare early on and get worse with age.

Now here is something that isn't mentioned all that often.  It is usually when a person has an ectopic (extra) beat or some sort of variation on a run of them that a person will fall into an svt episode.  The ectopic beat whether it be a pac or pvc disrupts the heart beat cycle giving the signal on the slower path a chance to reach the center of the avnode where it then exists out the fast main pathway and then it circles on itself.  So it may be that you never had enough ectopic activity when you were younger to trigger an episode but now you may be developing ecotopics and thus triggering your svt.  It is possible that the swimming is helping lessen the amount of ectopics for you thus lessening the opportunity for you to fall into svt but the problem is that you can get ectopics at anytime especially once they start to fire off.  When the spot in your heart gets triggered into setting off an extra beat (ectopic) that spot always has a memory to do it again.  So though you may avoid some svt with diet and exercise it isn't a guarantee that you will never have svt again.  But if you are not having episodes often then your heart may recover well once an episode occurs.  In this case you may not need an ablation.  But with your age you will want to get the episodes to stop as soon as you can to minimize the stress on your heart.  If bearing down doesn't work, try drinking a very cold glass of water or even coughing to see if you can break the signal.  Again, as a disruption starts the issue another disruption will also stop it.  

So the ablation really is something that you need to feel good about.  It needs to feel right and if you are not having many episodes it could even be hard to ablate but to be honest I am not sure how an ep can tell where the extra fiber is without mapping first.  I know my doctor had to be forthcoming about the fact I may come out of it needing a pacemaker but that is actually pretty rare.  Especially now they have ways once they are in of telling how close it is to the avnode and then they just choose not to ablate.  But the risks from this procedure are very low with very high success rates compared to other procedures especially avert.  The risks for this are 1% while the risks for an appendicitis are at something like 15% so if you look at it your risks are extremely low.  So if you ever do find your episodes are just getting out of hand and wearing your heart down just try to keep in mind though no medical procedure is without risk as far as one for avnrt goes you have extremely great odds of coming out successful.  

So keep swimming and maintaining a healthy diet and see if you can keep your episodes to a minimum.  And then broach the subject again if things get out of hand for you.  I was having 3 or 4 episodes a month and I let a few of them go too long.  I got lulled into believing they would just stop on their own because mine always did but the couple of times I let them go for a number of hours it did take a toll on my heart so just be mindful to manage them well and your heart should be fine.  Take care and keep us posted on how you are.

[tom_h]

Oh boy, I have to turn off the iPad spell checker. I appologize for the typing mistakes!  "Kapusta", a Polish word should have been "just a ".  Sorry!

[tom_h]

That 312 was measured when I was 6.  I had been in that condition for nearly 24  hours.  I had been ill with a raging fever, and my mother thought I was just "sick".  It wasn't until she saw my bluish lips and nail beds that she called the doctor.  My blood pressure had dropped precipitously low from the reason you mentioned.  My ventricles weren't filling fast enough before the blood was ejected.

I use to sit on the steps as it brought the knees up to,the chest in a crunch position.  I took a shallow breath and bear down keeping my diaphragm and stomach muscles tightened rather than pushing down.  I imagined squeezing my heart with my lungs and diaphragm.  I would hold it for about 3 or 4 seconds.  

A couple other ways you could try.  A woman here use to do a head stand against a wall to slow,hers.m someone else did jumping jacks.  Somebody was taught carotid artery massage.  Apparently an effective method provided you do it correctly.  Then someone else did the old face plant into a panoramic shallow water.  Kapusta a few weeks ago, a woman reported lying in a bath tub while her husband dumped a bucket of ice water on her torso, literally a shocking but effective method for her. I personally have never tried the chest thump method.  Bestof luck to you, andI hope you can keep it under control.

[JohnWright]

Wow, 312 is dangerous (same as a rat!). How long did they last? Did your blood pressure drop or was your left ventricle able to fill with enough blood to keep your blood moving?

So once a week you were 220 or 4 beats/second (same as a monkey), whereas I'm sporatic 160 bpm or 2.7 bp second. Your accessory pathway in the left Atria was not close to AV node where my Cardiologist thinks mine is, which is often damaged with AVNRT surgery resulting in AV Block needing a pacemaker. That's the overriding principle reason I'll only have Cath. Ab. when all else fails.

Valsalva has not worked for me. I find a toilet or chair, sit, breathe deeply, hold my breath, and bear down for 6 seconds or more. Is this correct, or should it be 10 seconds?

Did you ever try the Chest-thump which is thumping the chest 10 times directly in front of the heart quite hard with your closed fist?  

I'm 68, 6 ft 180 pounds. My resting pulse is 58 bpm, left ventricle ejection fraction 63%, and blood pressure 124/78.

I'm praying the SVT does not return but know I'm most likely deceiving myself.

I'll keep swimmin' and keep prayin'.

[tom_h]

AFNRT?....AVNRT perhaps.  If that's what you meant, No. Mine was accessory path in the left atria.  However, most people here have AVNRT, as it's the most common variety.  As I mentioned in my post, my rates were around 240 bpm, 3 to 5 times per month.  They weren't short lived either.  Mine were the self sustaining meaning once they started they would run on until intervention.  Fortunately, they responded well to Valsalva and I never once had to go the the ER.  I learned Valsalva at 6 years old after I was admitted to the hospital with a heart rate of 312 bpm.

Cycling often antagonized my SVT.  I attributed that to a combination of two things, the crunch position I maintained (see my photos), and the fact I did a lot of inadvertent Valsalvas while sprinting.   They worked against me as  well.  

[JohnWright]

Did the doctor say you had anything else besides AVRT, like AFNRT? What was your resting rate (taken 10 minutes after waking up)? What rate were your episodes, 160 or over 200 bpm? Did they stop with Valsalva or cold water on fac, or did you need Adenosine at hospital? How many months were the episodes 2 times/week? When you were doing daily cycling did the episodes stop, because for 2 months with daily swimming I have no SVT? Interesting that users leave site after Ablation, for this most likely mean success.

After initial Ablations, 13% have recurrent SVT and 15% generate new arrythmias in other areas of the heart, so you could have been in these groups, but you fall into the 72% successful group for now.

Also your ablated heart miocardium muscles can heal which can produce a new electrical pathway which may mean more surgery.  

[tom_h]

Well, certainly everone is entitled to their opinion. But in the near 4 years that I've been a member I've personally seen many, many forum members pass through here before and after the ablation procedure, never to be seen again.  I'm 3+ years following my ablation for AVRT, and doing fine as well.  Towards the end of my 54 years of SVT, I was was getting it once a week; 3 to 5 times per month.  My cardiologist took a look at the rates I was producing (240 "resting") and advised me that an "old guy's" heart really didn't like being run at rates like that.  He was definitely concerned about my safety now, and especially as I advanced in age.  He was also well aware of my athletic pastimes and the rather excellent shape I was in for my advancing age.   So after dealing with SVT for nearly all of my life and delaying for reasons similar to yours,  I decided to try it.  The results literally returned a normal life to me, one that I hadn't had since I was 6.  As a youth and young adult,  my SVT occured mostly during high physicsl output.  My passions were sprint cycling and short track speed skating.  I gravitated to both sports mainly because they challenged my SVT, but because both sports were held on a track, so consequently I was never far from where I started if an episode occured.  

If you look at ablation therapy for PVC's and atrial fibrillation,  those conditions have a wide range of results.  But from what I've seen here in the 3+ years that I've hung out here.  SVTers appear, get the procedure done, and are gone.  Some like me hang around to inform others.  In summation, I've had 3 years without that mill stone around my neck.  If it comes back tomorrow, I will be eternally grateful to my cardiologist for having convinced me to have the procedure performed.  Oh.. and I make an appointment immediately to have it done again...