Recurrent VT in HOCM.

[Andrea703]

I am a 34-year-old female with hypertrophic obstructive cardiomyopathy and congestive heart failure.  I have a biventricular pacer/defib implanted and since the surgery my EF is up to 50%.  I have had approx. 10-15 ablations (I have lost count) for fib, svt, pvc's in the last five years.  I have also had a concentric myomectomy at Mayo. I had my last ablation about four months ago and have done well until about three weeks ago when I began experiencing more frequent episodes of nonsustained VT.  My rate, according to my pacer recording, is up around 200 or so with the episodes.  I am wondering why I would suddenly be experiencing more frequent VT, and by frequent I mean a few times per day at most. I am also have more runs of PVC's. Prior to this I very rarely had VT.  No med changes.  Can anyone advise?  

[831jen]

Hi Andrea
It is possible that your EF is lower now if you are having more VT? If you have a medtronic BIV they can interrogate it to see if your "Optivol" is up, which shows heart failure before you feel it. When the heart failure improves, so does the VT. Also if you are on amio you are getting TSH tested and cxr every 6 months?
Take care
J

[Andrea703]

I realize it is difficult to understand that my heart could be so rapidly, but my EP says that during one of my many ablations my heart rate was over 250 and he had to cardiovert emergently during the procedure.  I have been cardioverted in the ER and by my defibrillator over 20 times in the last four years.  My pacemaker is now set to record events only over 185 beats per minute because I have too many episodes every day to record everything under that. Part of my problem is that my heart rate is too high and because of the hypertrophy and the inability of my heart to relax, I am extremely symptomatic.  My resting pulse is never less than 85 and walking just a few steps I am in the low 100's.  For the most part, I have learned to deal with this aspect of my disease, though I am struggling to do any strenuous physical activity. My EP and cardiologist are both U of M physicians who specialize in HOCM and I am very happy with the care they have given me.  I was to be transplanted initially, but at my request my cardiologist sought out the surgeon at Mayo who was doing experiemental concentric myomectomies and I had my first open heart surgery in 2002 which did relieve most of the obstruction.  It is my understanding that at this point, most of my problem is from the diastolic dysfunction. I have been on Amiodarone and Rhythmol without success.  I wish the best to your daughter, and thanks for the advice.

[grendslori]

Have you been to the University of Michigan? My daughter had HCM with non-sustained V-Tach and they put her immediately on Amiodarone. It's very difficult believing you are having V-Tach at rates of 200 BPM because a hypertrophied heart can't relax and keep up with rates like that. My daughter also has had more ablations than I care to count, a pacemaker implanted due to Sick Sinus Syndrome and an open heart surgery in Houston when she was only 7 to ablate W-P-W so that she wouldn't have a future problem with SVT. She eventually developed A-Fib which was horrible because it caused such severe chest pains due to the hypertophied heart which couldn't keep up with those high rates. She has had to cardioverted several times and it wasn't long after that that she recieved a new heart. Obviously, you need to see your cardiologist as soon as possible, consider the idea of Amiodarone. The side affects are terrible, but it really works well to get any kind of V-Tach under control.  After an ablation, the heart muscle is irritated and that may be the reason that you are having an increase in arrhythmia problems. It takes up to several months for the heart cells to settle down again. Talk to your doctor. HCM isn't an easy disease to treat, as you probably aready know. take care.

[Andrea703]

Thanks so much for the response.  I am not taking any meds that would cause the VT.  I have been on antiarrhythmic drugs in the past, but unfortunately they caused VT and long QT, so they had to be stopped. I do have an appt. scheduled for next week after calling them today.  Problem is, I really feel like the docs have done the best they can, but they don't really know what is happening.  I am hopeful that someone out there with similar rhythm problems might have some insight.  Also, anyone with recommendations for another clinic to try?  Have been to three Michigan hospitals, Cleveland Clinic, and two different Mayo Clinics.

[azrael13]

By chance are you taking any meds that could be adrenalina based?   If you are you need to see about getting off of them.
Second you need to contact your doctor to let him know what is going on.  And check to maker sure that your pacer/defib inplant isn't acting up.
I do hope this helps.