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NSVT for 30 seconds after running stairs
Hi there,
I'm a 37 yr old female with history of pvcs and pacs, occasional short runs of nsvt (3-5 beats) the longest recorded was 12 beats during treadmill stress test (thought to originate from lv ot), and a father who has an implanted pacemaker/ icd due to an arrhythmia originating from the center of his heart (he also suffered a heart attack before implant and has heart disease). I've had countless holters, ekgs, thallium stress test and a cardiac cath. My cardiologist and ep doc say I have a structurally normal heart. The cardiologist prescribed beta blockers at first but I experienced a couple of episodes of a racing heart that I'd never had before so he had me stop. Prescribed Verapamil instead and told to take for 6 mos, then as needed when I had days of more pvcs, runs, etc. They seem to correlate with my menstrual cycle (many more during ovulation and just before menstruation) or when I do more intense exercise or activities (which I love!) Things like hiking, biking, running, stair climbing, even sex sometimes.
I've gotten used to the pvcs and pacs and do my best to live a normal life and not worry, although I've gained weight because I cant be as active as I used to be in my life prior to 3 years ago.
It's been 3 years since my 12 beat run of nsvt, which was my longest run, until yesterday. After cleaning the house and running up and down stairs a few times, I experienced what I believe to be nsvt that lasted about 30 seconds - very scary! (heart suddenly racing and beating erratically-somewhat light-headed, no syncope). I took a verapamil and have just had some pvcs today, no more vt.
My questions are: 1) Is this latest episode dangerous, given that it lasted that long and was worse than past episodes?
2) What are the risks of attempting LV OT ablation?
3) Should I be avoiding exercise as it sometimes brings on pvcs and nsvt?
4) Does anyone have any LVOT ablation experiences to share? I've been told by docs it's my decision to make and that there are risks with all choices. Just trying to decide what to do and am scared and unsure how to proceed with all of the info on the internet I've read. Any info is very much appreciated.
Thanks,
Isis
I'm a 37 yr old female with history of pvcs and pacs, occasional short runs of nsvt (3-5 beats) the longest recorded was 12 beats during treadmill stress test (thought to originate from lv ot), and a father who has an implanted pacemaker/ icd due to an arrhythmia originating from the center of his heart (he also suffered a heart attack before implant and has heart disease). I've had countless holters, ekgs, thallium stress test and a cardiac cath. My cardiologist and ep doc say I have a structurally normal heart. The cardiologist prescribed beta blockers at first but I experienced a couple of episodes of a racing heart that I'd never had before so he had me stop. Prescribed Verapamil instead and told to take for 6 mos, then as needed when I had days of more pvcs, runs, etc. They seem to correlate with my menstrual cycle (many more during ovulation and just before menstruation) or when I do more intense exercise or activities (which I love!) Things like hiking, biking, running, stair climbing, even sex sometimes.
I've gotten used to the pvcs and pacs and do my best to live a normal life and not worry, although I've gained weight because I cant be as active as I used to be in my life prior to 3 years ago.
It's been 3 years since my 12 beat run of nsvt, which was my longest run, until yesterday. After cleaning the house and running up and down stairs a few times, I experienced what I believe to be nsvt that lasted about 30 seconds - very scary! (heart suddenly racing and beating erratically-somewhat light-headed, no syncope). I took a verapamil and have just had some pvcs today, no more vt.
My questions are: 1) Is this latest episode dangerous, given that it lasted that long and was worse than past episodes?
2) What are the risks of attempting LV OT ablation?
3) Should I be avoiding exercise as it sometimes brings on pvcs and nsvt?
4) Does anyone have any LVOT ablation experiences to share? I've been told by docs it's my decision to make and that there are risks with all choices. Just trying to decide what to do and am scared and unsure how to proceed with all of the info on the internet I've read. Any info is very much appreciated.
Thanks,
Isis
I can also try to answer:
1) Your episode was not necessarily VT. As you describe "erratic" heart beats, it sounds more likely to be A-fib or maybe a normal rhythm with lots of PVCs and/or PACs mixed in. If you truly had a 30 second run of VT (which is impossible to say), and you didn't faint or have other severe symptoms, and your heart is structurally fine, it's probably not dangerous but a doctor must say for sure.
2) Left-sided ablations carry slightly higher risk because the intraventricular or intra-atrial septum is pierced. As far as I know, the results are about the same as for both sides.
3) You must follow instructions from your doctor. If he sais that exercise is OK, then you should exercise, but if you feel that palpitations are uncomfortable, you may try to avoid pushing yourself so hard that they occur. I have at times benign PACs during exercise and I hate them. If I'm really stressed, I avoid pushing myself.
Just a comment: I know I sound a bit mean when writing this, but I think some elements from point 1) in the reply above is a bit "over the top" regarding what we (lay people, we are not doctors) should write. Dave, I know you are trying to help and we really appreciate it, but you are bringing up lots of conditions that are fairly irrelevant here (LQT, R-on-T phenomenon, TdP, CPVT, Brugada, etc.). The coupling interval in VT is really easy to calculate. If the heart rate is, say 180 bpm, the coupling interval is 333 msec. A coupling interval of 400 msec means a heart rate of 150 (and 300 means heart rate 200), and how "dangerous" VT is or isn't is depending on lots more than the coupling interval.
Further, R on T (where a PVC occur so early that the electrical system isn't fully reset) doesn't cause Torsades de Pointes if the QT time is normal. Usually, it's not even dangerous (according to my cardiologist) in healthy hearts. I think, if people suffer from PVCs, that considering "was that beat R on T or not) will cause more stress and anxiety. Polymorphic VT doesn't occur in healthy hearts. Multiple ventricular reentry circuits is similar to cardiac arrest. That doesn't happen in healthy hearts.
Sorry for doing just what I said we shouldn't, but again, we all should try to avoid scaring people unnecessary by bringing up lots of diagnoses that aren't relevant. Cardiology is really scary and the only way I think doctors aren't going crazy is by understanding that most of this don't apply to themselves. We are not trained to do that :/
1) Your episode was not necessarily VT. As you describe "erratic" heart beats, it sounds more likely to be A-fib or maybe a normal rhythm with lots of PVCs and/or PACs mixed in. If you truly had a 30 second run of VT (which is impossible to say), and you didn't faint or have other severe symptoms, and your heart is structurally fine, it's probably not dangerous but a doctor must say for sure.
2) Left-sided ablations carry slightly higher risk because the intraventricular or intra-atrial septum is pierced. As far as I know, the results are about the same as for both sides.
3) You must follow instructions from your doctor. If he sais that exercise is OK, then you should exercise, but if you feel that palpitations are uncomfortable, you may try to avoid pushing yourself so hard that they occur. I have at times benign PACs during exercise and I hate them. If I'm really stressed, I avoid pushing myself.
Just a comment: I know I sound a bit mean when writing this, but I think some elements from point 1) in the reply above is a bit "over the top" regarding what we (lay people, we are not doctors) should write. Dave, I know you are trying to help and we really appreciate it, but you are bringing up lots of conditions that are fairly irrelevant here (LQT, R-on-T phenomenon, TdP, CPVT, Brugada, etc.). The coupling interval in VT is really easy to calculate. If the heart rate is, say 180 bpm, the coupling interval is 333 msec. A coupling interval of 400 msec means a heart rate of 150 (and 300 means heart rate 200), and how "dangerous" VT is or isn't is depending on lots more than the coupling interval.
Further, R on T (where a PVC occur so early that the electrical system isn't fully reset) doesn't cause Torsades de Pointes if the QT time is normal. Usually, it's not even dangerous (according to my cardiologist) in healthy hearts. I think, if people suffer from PVCs, that considering "was that beat R on T or not) will cause more stress and anxiety. Polymorphic VT doesn't occur in healthy hearts. Multiple ventricular reentry circuits is similar to cardiac arrest. That doesn't happen in healthy hearts.
Sorry for doing just what I said we shouldn't, but again, we all should try to avoid scaring people unnecessary by bringing up lots of diagnoses that aren't relevant. Cardiology is really scary and the only way I think doctors aren't going crazy is by understanding that most of this don't apply to themselves. We are not trained to do that :/
1.) Most likely not. If you truly have a structurally normal heart the VT would be termed idiopathic. These forms of VT are generally benign, assuming that other non-structural heart diseases such as Long QT Syndrome, Brugada Syndrome, and CPVT have also been ruled out. Furthermore, you don't really know what kind of arrhythmia you had. A prolonged flutter could have, in reality, been SVT, A-fib, NSVT, VT, or even just a bunch of on and off PVC's or PAC's that felt like they were sustained but they really weren't. If you weren't on a monitor at the time you will never really know.
Generally, idiopathic VT (whether it originates from the RVOT or the LV, which is often termed ILVT or "fascicular VT") is not dangerous in a normal heart, but it is generally provoked by adrenaline (such as from physical or emotional exertion). It's more common in females, and is very commonly triggered by hormonal changes (i.e. menstral cycle).
The only time this would really be dangerous would be if you had a short coupling interval. The coupling interval is the amount of time between the last "normal" beat and the first PVC, and then if they string together to form NSVT or VT, the time between each of those beats. Anything under 400ms is usually safe. The reason it can't be much lower is that if a PVC falls on the T wave from the previous beat it creates an "R on T" phenomenon which can lead to torsades de pointes (a particularily lethal form of polymorphic VT), which is normally associated with Long QT Syndrome. In LQT Syndrome TDP comes about because the QT interval is longer than normal (>460ms) so the T wave occurs much later an a PVC has a greater chance of falling on the T wave even without a short coupling interval. But in people without LQT PVC's and VT are fine so long as it does not have a short coupling interval. 99% of the time in a normal heart you won't have a short coupling interval, which is why it is benign 99% of the time in a normal heart. Since your 12 beat run of NSVT was recorded I would ask a doctor what the coupling intervals on those beats were, and if they are well over 400ms you really have nothing to worry about. Usually it's not really dangerous until we are talking below 300ms.
One other situation I could think of where idiopathic VT could be dangerous in a normal heart (also rare) is if it has a polymorphic origin. If multiple spots are creating VT, most likely due to a re-entrant mechanism, then the VT could cause cardiac arrest, but if you are truly having a 30 beat run of VT and not passing out it most definetely has to be a monomorphic VT, because the body couldn't survive a polymorphic VT that long, so it doesn't appear you have to worry about this one either.
2.) The risks of an ablation for the LV are greater than for the RV, but in the larger picture they are miniscule. Complications of any kind range 3-4% (like minor bruising, bleeding at the insertion point in the groin), and major complications (like death or heart puncture) are well less than 1%. The success rate, if they can map exactly where the arrhythmia originates from is usually about 80-90% for the first attempt. It's a cost-benefit analysis. Most likely nothing bad will happen, and most likely they can fix it, but is it worth the small risk, or can you deal with it emotionally? It's a personal call.
3.) If they bother you from an emotional perspective. However, it sounds like your doctors say your heart is structurally fine, and if that is true then it would be safe to exercise. Again, it's your call.
4.) I do not have personal experience with an ablation, although I do suffer from benign arrhythmias much like yours.
Any further questions feel free to ask. I can try to help, as can others.
Generally, idiopathic VT (whether it originates from the RVOT or the LV, which is often termed ILVT or "fascicular VT") is not dangerous in a normal heart, but it is generally provoked by adrenaline (such as from physical or emotional exertion). It's more common in females, and is very commonly triggered by hormonal changes (i.e. menstral cycle).
The only time this would really be dangerous would be if you had a short coupling interval. The coupling interval is the amount of time between the last "normal" beat and the first PVC, and then if they string together to form NSVT or VT, the time between each of those beats. Anything under 400ms is usually safe. The reason it can't be much lower is that if a PVC falls on the T wave from the previous beat it creates an "R on T" phenomenon which can lead to torsades de pointes (a particularily lethal form of polymorphic VT), which is normally associated with Long QT Syndrome. In LQT Syndrome TDP comes about because the QT interval is longer than normal (>460ms) so the T wave occurs much later an a PVC has a greater chance of falling on the T wave even without a short coupling interval. But in people without LQT PVC's and VT are fine so long as it does not have a short coupling interval. 99% of the time in a normal heart you won't have a short coupling interval, which is why it is benign 99% of the time in a normal heart. Since your 12 beat run of NSVT was recorded I would ask a doctor what the coupling intervals on those beats were, and if they are well over 400ms you really have nothing to worry about. Usually it's not really dangerous until we are talking below 300ms.
One other situation I could think of where idiopathic VT could be dangerous in a normal heart (also rare) is if it has a polymorphic origin. If multiple spots are creating VT, most likely due to a re-entrant mechanism, then the VT could cause cardiac arrest, but if you are truly having a 30 beat run of VT and not passing out it most definetely has to be a monomorphic VT, because the body couldn't survive a polymorphic VT that long, so it doesn't appear you have to worry about this one either.
2.) The risks of an ablation for the LV are greater than for the RV, but in the larger picture they are miniscule. Complications of any kind range 3-4% (like minor bruising, bleeding at the insertion point in the groin), and major complications (like death or heart puncture) are well less than 1%. The success rate, if they can map exactly where the arrhythmia originates from is usually about 80-90% for the first attempt. It's a cost-benefit analysis. Most likely nothing bad will happen, and most likely they can fix it, but is it worth the small risk, or can you deal with it emotionally? It's a personal call.
3.) If they bother you from an emotional perspective. However, it sounds like your doctors say your heart is structurally fine, and if that is true then it would be safe to exercise. Again, it's your call.
4.) I do not have personal experience with an ablation, although I do suffer from benign arrhythmias much like yours.
Any further questions feel free to ask. I can try to help, as can others.
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