EP Study... really necessary...?

[babi64]

Hi!

Last year after a panick attack episode I have been diagnosed as suffering from a AV Block II... I am a fitness instructor and apparently this is due to my low HR (about 58-60).

A couple of days ago I have had another "episode" when I felt dizzy and had heart palpitations... went to the Emergency Room and ECG was fine... Met cardio yesterday and he is going to put me on a holter fro 24 hrs (same test done last year) and mentioned the possibility of doing an EP Study... which to me sounds too invasive and "radical" for having just a couple of episodes in one year... (also considering that there are also other factors to be taken into consideration, emotional and early menopause).

I am very puzzled and need to try to understand if this is absolutely necessary at this stage...?

Thanks...

[Michael J. McWilliams, M.D.]

Hello,

I am very puzzled and need to try to understand if this is absolutely necessary at this stage...?

I am going to assume that type II AV block is what we call Mobitz I or second degree AV block type I.  The reason I clarify is because some forms of second degree AV block (type II) often require a pace makers and an EP study would not be necessary.

If the events are infrequent, there are several options.
1. EP study
2. 30 day monitor that can be worn any where including outside the doctors office and your home (home telemetry).  This will pick up things that you might have in your sleep or do not notice.
3. implantable monitor that will record rhythm events for up to 14 months -- this is triggered by you.  This options requires a small incision and a small, removeable device implant.
4. Event monitor.  Worn for 30 days and you press a record button to record times when you have symptoms.  If there are heart rhythm issues associated with your symptoms, this will record them.

EP studies are very low risk but are invasive. (meaning we put catheters in your body that we remove when the procedure is done).  There are cases when EP studies should be done, unfortuately I cannon comment on the appropriateness of your study without seeing all the data.  At least you have several options.  Be direct with your questions when you talk to your doctor -- ask questions like why do I need an EP study now and would a monitor help non invasively answer the question.  Remember that there are risks to waiting too -- if you doctor feels  you are higher risk to fall down with one of these episode but you want to wait, you have to accept the risk of potentially falling.  Life is never easy, is it?  These are tough questions and it is all about weighing the risks and benefits.

I hope this helps.  Thanks for posting and let us know what you decide.

[SillyHeart]

I wouldn't want an EP study this soon, personally.  I'd try to get an episode caught on an event monitor first.  Ask for a 30 day event monitor, because my guess is that the 24 hour holter won't catch it.

[ireneo]

That's a good question to ask your doctor. I don't think he can force you into the cath lab for an EP study but you can tell him that you're not ready for such a test since the episodes are so infrequent. See what he says. The monitor might show what's going on in your heart. Has he mentioned any meds to you? Pacemaker? I think you have options but you'll have to push him for more information to make a good decision.

BTW - stress and hormones can trigger some arrythmias as many on the board will tell you. I'm more concerned with the heart block.