Increase in VT & pacing

[kim62]

I had an attempted ablation for VT about 7 weeks ago as well as an ICD. All was fine for the first few weeks, then the PVCs started back up and now over  the last week or so, the antitachycardia pacing on mu ICD has occurred many times a day. I currently take 120 mg of Sotalol twice a day. I know when the onset of VT takes place as I get a real quick dizziness, get a really warm feeling and a little pressure in my chest,(this even happened before the ICD & ablation) then the pacing kicks in.  I have noticed as each day goes by, they become more frequent. My antiarrythmic pacing on my ICD is set at 5 attempts to pace me out, before the first shock occurs(5 jules). In the last 7 weeks, I "think" it had shocked me about 6 or more times. My question is, how much pacing is too much? This is starting to make me uncomfortable. I am not scheduled  for my device check until May 2nd and the last time I called the office/EP, I was told by the nurses not to worry about the PVCs I was having. I have tried to explain that per my past history of the PVCs & VT... the more PVCs I have... the more the  VT episodes will arise. Thus, I have proven my point. Is this something that I need to worry about? Or should I call my EP?  I have a structurally healthy heart... MRI showe no scarring or anything abnormal. Have any idea who is considered the best of the best where VT /arrythmias are concerned?

[kim62]

I live in Toledo, Ohio,  I did speak with the device clinic and they are seting me up on their remote monitoring. As for the controling it with medications, I have tried what seems like all of them. They work for a few months then it all goes down hill from there.  I had an ablation )in which they stated they chased it for about 8 hours. As soon as they would get it slowed or stopped another would pop up. According to the study I have what appears to be 6 different VTs. It is all confusing to me... and I definitely feel sorry for the doctors that are treating me.  

[kim62]

Thank you for the advise. I have since had my device interrogated (after I received my very first shock over a week ago) and found that what I thought were "shocks" actually was the anti-tachycardia pacing. I have a new issue that I would like some diection on before speaking to my EP about.
1) How much play in the heart rhythm does the sympathetic and parasympathetic nerves play?
2) Have you ever had a patient tell you that he/she has used chiropractic manipulations of the T1 and T2 vertebrae to help control  PVCs? The reason I ask is because I document all my activity(PVCs, BP readings, pacing, etc) on a calendar and found that when being treated by my chiropractor, I had no pacing and very little PVCs. I had stopped the treatment and the PVCs came back after 10 days in full force and it threw me into VT, thus causing the ICD to fire. I resumed treatment last Wednesday and by Saturday, only have a few PVCs. I know I still have a VT problem, but just wanted to know if there is any connection. The chirpractor told me he feels I definitely have a medical issue going...but when the T1 & T2 vertebrae are out of whack, it makes it worse. What are your feelings on it?
3) Have you had a patient that has multiple morphologies of VT and you can't find where they are coming from? Where anti-arrythmic drugs only work for a short time? I am scheduled for a CT scan next week andam scared to death because they are looking for "something" that is causing the VT. I have explained that the PVCs when they come often and close together.... is what causes the VT...but I don't think they hear me.

[Michael J. McWilliams, M.D.]

You should definitely talk to your EP -- they know your case the best. If you have an ICD, interrogation of the ICD will show if these events are just PVCs or if pacing is involved.  If you have a structurally normal heart and VT that cannot be suppressed with medications, ablations are often very helpful.  There are many very good doctors out there, it just depends on where you live.  Where do you live?