Non sustained ventricular tachycardia in cabin crew

[Flyhigh2204]

Guys I am keen to know..... I have non sustained vt and a structurly normal heart.  I cannot fly as cabin crew whilst taking regular beta blockers, so am I right in thinking I will need to have a cathetar ablation in order to continue flying? And if this does not work, will I be able to use beta blockers just if and when needed or is that it for my flying career? Many thanks

[littlegreenman1]

I have a Third Class Medical and from my understanding it's only because I was sucessfully ablated. The AME required very detailed reports on the procedure.

I *severely doubt* you will keep a First Class Medical and your ATP with SVT or while on meds for such. Go seek an opinion on ablation.

[Bromley]

Hi. This basic article might interest you.

Journal of Cardiovascular Electrophysiology
Catheter Mapping and Ablation of Right Ventricular Outflow Tract Ventricular Tachycardia

You can find this at Medscape.com

[Flyhigh2204]

Thank you for those answers. Ah ok, so the cardiologist should say that due to the fact that it is fairly benign, I should be able to carry on with flying and just take beta blockers if i was to get an attack of vt. itdood what are pvcs? And would the cardiologist be trying to trigger the arrhythmia in a different area to that of when he thought it was svt? Many thanks. Sorry for all the questions

[itdood]

RVOT is a common source for ventricular ectopics and is in a location that can be easily reached with a cath.  RVOT stands for Right Ventricular Outflow Tract.  Not sure what the success would be.  From what I've read in the past, benign VEs in general are tough to completely eliminate or reduce with ablation.

I get a lot of PVCs and runs from the RVOT and considered ablation at one point but decided to try lifestyle changes instead.  Everyone is different here and you should keep searching for the right answer.  You'll be OK.

[MichelleP_3811]

Unfortunately no one can guarantee they will be able to correct the issue.  They could have trouble initiating the arrhythmia which they need to do to know where to ablate or the spot could be in a location that makes it too risky to ablate but considering your career is on the line it might be worth a shot to try.  Best of luck whatever you decide to do.

[Flyhigh2204]

Many thanks for all your replies, that has been most helpful. I know the cardiologist said i had that rovt type of NSVT and therefore said it was the safe kind? 3 years ago i was initially told i had svt and the cardiologist did an ep study and tried to ablate but couldn't trigger it so therefore told me i was fine. Now that it has been diagnosed as nsvt would it be more likely that it can be fixed by ablation? I just want to know that i can still be cabin crew. Many thanks

[Bromley]

Regarding itdood comment on ablation: yes exactly. However one point of clarification.

The paper by Marchlinski and associates describes a method for ablating idiopathic left fascicular VT without having the VT present at cath time.  There are also some stats given for the idiopathic subtypes in terms of success rate and so on. The paper does mention that the strategy is different if you can find the VT.  In that case, it is preferrable I think for them to just ablate the source of it. If not present, they can put a short line of lesions on the mid inferior septum (at the exit point of the tachycardia), or at least this is the main proposition of the paper.  Not sure how many people have  done this or what the statistics are on it at this point.  This small study had some limited, but very reasonable success with this. I would need to ask an ep whether this is an widely accepted protocol, or effectively too developmental in nature to put into practice. But several papers seem to make mention of this technique. These papers are really very interesting to read. I recommend. I have not read about the outflow tract type ablations (my ecg is not consistent with outflow tract type), but understand that that the more common type (right outflow tract I think) is quite common and has high success rate. I'd be willing to bet there is some info out there on left outflow tract too....

[itdood]

BBs don't treat the NSVT directly.  The only way BBs might be therapeutic is if your NSVT is brought on by elevated heart rate.  The BBs will suppress heart rate.

For the ablation, this depends on where the NSVT is coming from.  Certain parts of the heart have higher success rates for NSVT ablation than others.  If you find out this info you would get a better answer.  Finding this out would require them to cath you and observe the NSVT.

[Bromley]

The reason I made the bit about small study vs international was not to confuscate things by muddying the statistics across technical centers, but because it seems like if a study is too small there could be more margin for error. I am neither a doctor nor a statistician mind you, but these small studies concerning the ablation techniques (in the papers I mentioned above) give me reason to pause a bit before I feel like I am ready to jump in.

Nevertheless, I especially appreciated the fact that these papers at least tell  you that "VT", if in a structurally normal heart, generally has several common forms that (according to the papers) are treatable. Just knowing these common forms is helpful as far as I am concerned. For instance, since the outflow tract type is apparently distiguishable from the fascicular type by looking at any number of ecg leads, I can at least confine my worries to the one subtype that is consistent with what is on my ecg (in my case left posterior fascicular, if VT at all).

I can also go look for more information or opinions about the specific technology being used  if ablation is considered. Hopefully putting myself in a better position to understand the problems and risks.



 

[MichelleP_3811]

I can understand being restricted from flying for VT as it can cause one to pass out if it lasts too long but I am sorry to hear that simply using beta blockers keeps you from flying.  So that means no one with high blood pressure can fly either.  Well I am sorry to hear of your predicament.  I send good thoughts your way that you get a cure so you can continue on your career.  I send the very best of luck your way.  Please keep us posted.

[Bromley]

OK, one other thing.  I am not a doctor or medical professional, and I am in no way endorsing having a procedure done at a teaching hospital, although that is one way to get the job done, if this is what you decide to do.  For that matter though, you can also visit very good, experienced ep's in your local area.

Best of luck.
Bromley

[Bromley]

Two ideas for you.

1. You can read the paper written by dr william Stevenson et al, entitled "Catheter ablation for ventricular tachycardia." You can find this online in pdf format. You can also read a paper by Francis Marchlinski and Friends at the University of PA, entitled "Idiopathic fascicular left ventricular tachycardia: Linear ablation lesion strategy for..." these papers give you some ideas and point you to additional references.

2. You can think about the difference between a small study involving only a few people, and a very large study performed at multiple technical centers internationally.

These are just a couple of ideas.  There needs to be an appreciation for risk too. For this, I suggest Two you tube videos.  Both are from a 5 part series designed to prepare ep's for their board exams' you can find them on you tube by searching for Thomas Dressing (Cleveland clinic doc)  and for Thomas Munger (Mayo clinic doc)

This is a start; you can also visit these people.

[tom_h]

Cardiac ablation COULD cure you of NSVT. There is no guarantee.  As far as using occasional BB's afterwards, they are meant to be taken continuously to establish a therapeutic level in your body.