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Avatar universal

SVT Ablation, should I get it?

I'm a 28y/o female that's pretty active. I've had what I assumed was SVT on and off for the past 9yrs, up until a few months ago it was never caught on a monitor. It mainly came out with exercise, I would feel a PAC then feel my HR increase to very high rate. I finally had a 30 day holter monitor to wear and caught an episode, my HR went up to 260bpm! I got light headed and just sat down and let it ride out, lasted about 5 mins or so. I usually vagal out of the episodes but I let that one go since I had the monitor on. My Dr. referred me to a cardiologist and he wants to do an ablation. I work as a cardiac RN so I've taken care of many patient with this procedure but never thought I would need one. My question is, is it worth it? I get occasional PACs with anxiety or exercise but that's about it. I've read that many ppl suffer PACs and PVCs pretty extensively after the ablation. I understand that these are benign but ppl end up on meds to control them, which I don't want and was the main appeal to getting the ablation. I'm a very active person and love to run so having SVT has definitely stopped me from doing this. Anyone have any advice??
30 Responses
Avatar universal
Hi.  Just wondering what you've decided.  I have a very similar case to yours I think.  unfortunately I haven't caught the rhythm.  My ep cardio suggested ep study as well.  My biggest fear is that they can't make it happen and it's all for naught.  I have exhausted every other test though and done some of them multiple times.  My frequency is about 1-4 a year and it last about 15 minutes.  I really just want to get this monkey off my back.  I'm afraid to go on rafting trips because I'm worried about it happening far from a hospital and what if I can't self convert.  Frustrating.
1423357 tn?1511085442
Is it worth it? ..... for me, it gave me a life free of SVT for the first time in 54 years.  I'm so happy with my decision to have decided to go for it.  As I neared 60, my episodes had increased to 3 to 5 times per month.  Drugs(as they often do) had little effect in preventing,  or controlling them.  At your age, and being active, if you experience these episodes at least once a month, I'd say it's worth it.  As you may already know, the downtime for this procedure is only a few days. I walked with a limp for a couple of weeks.  The key in this procedure is producing an episode on the table.  If yours are once in a while and of short duration, you might want to wait a little.  But if they are consistent and get "locked in" good once they start, I think you should go for it.  I and others are always here if you have any questions regarding the procedure.   You can also read the journal of user Janine 411 for and excellent description of the procedure.  My journal is available as well, but I had general anesthesia for mine and remember nothing after the gurney ride to the cathedral lab.  Good luck!

Avatar universal
Thanks for replying! These episodes have only happened maybe once or twice a year and the longest was around 5-10minutes I think. Seeing as they aren't that severe is why I'm hesitant but the cardio and my dr think that they will start to progress and there might come a time when vagal procedures don't work and being young is the next time to do this. The procedure is somewhat scary but I would prefer that over a lifetime of drugs. I'm just having a hard time deciding on what to do.
1423357 tn?1511085442
Twice a year?... I'd continue with what you're doing presently.  I went my entire life unmedicated relying on Valsalva to convert my episodes.  You will probably notice that as you age, your episodes will increase.  Many of us have experienced that.  Mine had grown to 3 to 5 times per month.  For now though, if you can slow it yourself and stay out of the ER, I'd continue to do what you're doing.  The EP procedure is extremely expensive; perhaps $100,000 US and higher.  Mine was $76,000 nearly 4 years ago.  So you want to be confident they can get your heart to go into SVT so they can find the location and ablate it.

You mention "vagal procedures", what are you doing to convert an episode?.
1807132 tn?1318743597
Odds are as your doctor said, they will likely increase with age.  I had rare symptoms when I was young and it only started to become noticeable once I reached my 30s.  By the time I was in my 40s it started to happen at least twice a month.  I was also starting to have daily ectopic symptoms.  I did not know that is what it was but just because you avoid getting the svt fixed doesn't mean your ectopics won't get worse.  Ectopics arise often from an irritated heart and what better way to irritate it then with an svt episode.  This said, only twice a year it may be difficult for the EP to induce an episode while you are under sedation.  This can be extremely frustrating to know you still have it.  So do consult with the EP on the odd of success with your rarer situation.  

I will say my EP basically said I had two options, ablate or do nothing.  He did not recommend meds for svt because they do not prevent the episodes, they only slow them down once they start and as you say being on meds for the rest of your life is not something most would enjoy if they could avoid it.  So as Tom said, if you are responsible about stopping it as soon as possible you will cause the least amount of stress on your heart.  It is possible if you are super responsible and heart healthy you may avoid it ever getting to a troublesome point but you will never be free from it without an ablation.  

I find it a little disappointing that yours is only induced during exercise.  I found for me that doing cardio was a tremendous help at my heart handing the svt when I did have episodes.  I stopped when one was triggered during exercise or whenever it hit but the episodes would lay me flat before I started doing cardio and after I could almost be up and walking around with it.  I would ask the EP about whether or not it is still OK to exercise if you are mindful of stopping if an episode starts.  

Anyways, as for doing the ablation, I was absolutely terrified to do it but in the end it was really not bad at all.  I had two full abdominal surgeries that were a nightmare compare to the ablation.  The ablation was basically like getting a couple of IVs put in.  I was awake for mine but could have very easily fallen asleep.  This said, I was pretty active at the time of my ablation so the procedure went pretty smoothly.  I was short of breath for about a day and had an elevated heart rate for a few months but was up and about the next day.  I did have a rise in my ectopics it seemed and it took a good year for them to calm down but after 2 years they were pretty much gone.  I still get them occasionally but I can't really say they were better or worse after the ablation.  I know I was having daily symptoms that I thought were svt related but were not svt so I was likely having daily ectopics I just didn't know any better until after the svt was corrected and I researched ectopic activity.  The point I am trying to make is though it seemed as though they were worse it may only have been an illusion but the bottom line is now that I am a few years past the ablation my heart is truly healthy again, more so than it probably has ever been and I am near 50 now.  

Well it is a big decision and like Tom said if you are in the states expect to pay your full out of pocket for the year, mine was 4 grand.  So just take some time to think this through.  I usually try to base my decisions on my gut going by the option that gives me the most calm.  Even if both make me a bit fearful usually one will give me just a bit more of a sense of peace and I try to follow that path.  Best of luck with whatever you decide and keep us posted on how you are.  
1423357 tn?1511085442
"....I find it a little disappointing that yours is only induced during exercise.  I found for me that doing cardio was a tremendous help at my heart handing the svt when I did have episodes......"

See...when I was 28 like the OP, mine were set off during high physical output.  It was when I got older, in my 50's that I started getting them more at rest and less during physical demands.  I could be eating dinner in a restaurant when... "Oooo,,, my heart just took off..."  That was the keywords I'd say to my wife.  I could be driving home from work, a 50 mile trip on interstates.  Picture trying to Valsalva at 70mph, not a good thing to do. It could be on the sofa watching TV.  It started happening more doing those kids of things than when pushing my aging body to its limit.  Granted as I age, that limit is slowly collapsing.  I can no longer accomplish things in the time I could even 10 years ago.  The beauty of what I do is that I have a distance, and I have a time to do that distance; they're repeatable goals, and I can see them slowly slip.  Perhaps it's because my present (excuse to expression) balls to the wall physical output is somewhat... ok a lot less than what it was 15 or 20 years ago, and perhaps this is the reason I was no longer getting as many SVT events during these activities.  I don't know........ I do know that today I'm feeling great aside for having clusters of PVC every now and then that had disappeared for nearly 2 years.  They're back......
1807132 tn?1318743597
Yeah, from the start I would say most of mine were at rest or doing very little.  Though now that I think about it when I was really young it probably was only when I was active because it always seemed to coincide with running or something and I thought it was natural over heating or hyperventilating.  My young mind just rationalized that it normal and everyone did it.  It stopped on its own so I had no fear of it.  As I got older I would get it occasionally during exercise and so I would stop and it would eventually stop but mostly I remember it just started of its own accord.  I now know that it is ectopics that trigger it, at least it was what triggered mine that they caught but it sure felt like it just started for no reason.

As for the pvcs I have heard that we never really totally get rid of them.  I now have long periods were I will feel very few of them if any and then they flare up for a day or so.  But overall even when I get them they are not much of a bother at this point.  I don't think anyone with heart rhythm issues can expect a flawless heart but I think our hearts are much happier without the svt. Well hope yours go away quickly.  
Avatar universal
Thanks for your input guys, as far as cost, I was told my insurance is covering the procedure, thank goodness! When I was saying i vagal, I just bare down like I'm trying to have a bowel movement. That usually kicks my SVT back into normal rhythm. I have PACs while working out and that is what usually kicks my SVT in, I'll start feeling them then one hits just right and my HR takes off. I've never had this happen at rest though. Like I said my Dr is concerned it will progress and become unmanageable. I just read how most ppl don't feel normal for about yr which is really discouraging. My main concern is starting a family, I'm sure pregnancy will cause my SVT to become worse. But I being able to workout with out the fear of SVT would be nice to have...
1423357 tn?1511085442
Michelle and I had it most of our lives.  For me, it was always manageable.  That technique you are using is called a Valsalva.  It was what I used for 54 years until I got it fixed.

Again, speaking from my experience I was back to normal within a month.  My heart was not immediately still.  But it was a lot less than what I was experiencing prior.  Over the next year, the short runs of SVT I was experiencing after the procedure began to diminish.

An electrophysiology procedure while safe does carry some risk.  Again, it is my opinion that 2 episodes per year does not warrant this procedure, especially since you can control it with what you're doing.  Regardless of your decision, best of luck to you!
Avatar universal
That is also another concern for me, what if they can't make SVT happen and fix it the day of?! Mine seems trigger by stress and high HR so I'm hoping the adrenaline they give will set it off. While I'm worried about the procedure, I'm also nervous to do any exercise that requires my HR to get too high. I used to run a lot and haven't been able to this year. I know someone that had that the procedure done but they couldn't get it to go in SVT so they stopped it. Can't do anything if they can't find the area. She was disappointed so she's back on metoprolol at this time. I've read how a lot of ppl feel so much knowing their SVT is fixed afterwards so I understand having to worry about going on trips. Like tom_h said he has a much better life without it. Our situation isn't as severe most so in that case we are lucky. I'm leaning towards getting it done just so I won't have to worry about it getting worse... Still gonna read more about it tho before I make my final decision.
1423357 tn?1511085442
Your comment could have been written by me prior to my EP procedure.  I too would never do anything that put me out of reach of a hospital, even while knowing that in the 54 years that I had it, I never set foot in one as I was able to slow it with Valsalva maneuvers.  Still it was always back in my mind, and I took up sports that kept me closely to where I started,  Yes, something like rafting in the Colorado would be out.  That would put me in a remote area.  Instead I took up speed skating, and track cycling.  I was never far from where I started.  My family had a big sailboat, and I'd often sailed with them offshore or in the Chesapeake Bay.  But when they sailed to Bermuda, I declined to go much to the disappointment of my late dad,  That was out of the question for me. This was long before they had the technology that they do today. So while I definitely challenged my SVT, daring it to happen participating in sports that required every ounce of whatever I had in me, there was this particular limit that I had that I wouldn't cross.

We've had a few people here in the 4 years that I've been associated with the forum that had failed procedures due to the inability to get their heart to go into SVT.  That is key to finding it.  Unfortunately, the hospital bill is nearly the same as a successful procedure.  So unless you have a very low co-pay, or have money to burn, it['s good to make your procedure count.  Being somewhat of a cynic, I would imagine that an electrophysiologist doesn't think about that when he's encouraging a prospective patient to commit to the procedure.  It's another payday for him regardless of success or failure.
1807132 tn?1318743597
If your svt has a history of stopping on its own within a certain amount of time you can feel pretty comfortable doing just about anything or going just about anywhere.  Atrial issues are rarely life threatening.  I understand a certain amount of caution being out in the wilderness but in general svt is not rated by the medical community as a health threat and as such ablations are considered optional.  I rather wish this wasn't the case but the point is svts are rarely if ever the cause of sudden death.  I respect the idea of not straying out to where help cannot be found but I would not stop living your life because of your svt.  It isn't anything to fear but rather just to be managed.  If your body is stopping it on its own odds are it will continue to do that.  There is usually a progression to the syndrome as opposed to a sudden change.  I would highly suggest consulting on this with the EP finding out if there is any activity you should restrict yourself from but I suspect they would tell you to continue to live your life.  As well learn vasovagal maneuvers to help you manage your svt on your own.  If you can take control of your svt instead of it controlling you then there isn't a thing you can't do.   Stay strong and fear not.  
Avatar universal
You mention the key is finding it.  I assume you are talking about the particular area of defective tissue?

I'm 52 and have been experiencing palpitations for years.  I'm fairly active for my age and do a few half-marathons or marathons each year.  This summer I had a big episode while finishing a run.  Got to the ER and they ended up doing a heart cath but found no blockages.  Everything checked out great.  30-days on an event monitor lead to a finding of SVT.  I've been on a beta-blocker for about a month. I resumed running shortly after that. I believe the palpitations abated for about a week and have steadily resumed.  I currently experience approx 20-30 "episodes" of fluttering per day.  Can't seem to pinpoint a food/supplement/medicinal cause. However, I haven't had another situation similar to that which sent me to the ER.  My EP has suggested an ablation and we are considering it simply in hopes that my heart will go back to feeling normal and I can quit thinking about it all the time.

Does this sound familiar to anyone?
1807132 tn?1318743597
There is a type of svt that happens in older folks and really active folks called afib.  I would try and find out if this is the type of svt you have.  It is a bit trickier to fix so you will want to read up on it to know what you are dealing with.  But first question your ep on whether or not they suspect afib.  If so then the flutters may actually just be some ectopic activity.  I had svt my whole life but it didn't get active until my late 30s.  By my early 40s I was starting to get a lot of the flutters every day from my heart being irritated by the svt.  They are a separate issue from the svt.  I got the svt cleared up and the flutters have just about gone way.  When you were in the ER were you there for a super fast beat or these flutters you mention.  Meaning do you feel different symptoms or is this all just a flutter feeling for you?  It is important to know what you are dealing with so you can make the best most informed decision on whether to try ablation or not.  Take care and keep us posted on how you are doing.
Avatar universal
I've decided to go on with the ablation next week just because it will never go away otherwise. As much as I am terrified of the procedure, if I want a chance at being able to run again and start a family SVT needs to be taken care of. I'm hoping everything works out ok and will keep everyone updated. Thanks for all the replies!
1423357 tn?1511085442
Well I wish you the best!  I think we all go in the lab with some degree of fear and dread.  If you haven't done so already, speak to the electrophysiologist and ask if he can give you something to make you comfortable.  The day of your procedure IS NOT the time to ask for this.  They have everything "mapped out" by that time.  Inquirer now!  Let us know how you do, and we're always here for any last minute questions.  BTW, forum user "Jannie411" has an excellent journal on her procedure.  She was completely awake for the entire process (I don't know how she did it!)  Good luck!
Avatar universal
Hi there,

Good luck with the procedure.  It was a piece of cake for me.  I sent you a message, hope to hear from you.
Avatar universal
Had the ablation today and I can honestly say I worried way too much about this procedure. I went in at 9am and now home by 5pm! Other than a sore groin and some lightheadedness I feel way better than I ever expected! My Dr was able to induce my SVT with adrenaline and brun the spot that caused it and couldn't get it to go back into SVT so he feels like it was successful. My procedure took only 2hrs, and the staff was wonderful! I encourage anuone living with SVT to get the ablation done. I know it'll be a while before I'll know if it was a 100% successful but the procedure itself was totally worth it. Get
It, you'll be glad you did!
Avatar universal
Congratulations!  Glad it was easy peasy for you!
1423357 tn?1511085442
Great!  I knew you could do it!  Now take it easy for a couple of days, then slowly pour it on.  Enjoy you life and don't look back!
1423357 tn?1511085442
Sorry, I directed my comment to you!
Avatar universal
Thanks, its such a relief to have it done and over with!
1807132 tn?1318743597
I am so glad to hear it went well.  your odds of a cure are super high so you are likely free from this for good.  I had the same response realizing I got myself all worked up over nothing but until you do it you just can't know.  I was in and out in a couple of hours as well which I am sure helped our experience.  Well rest up.  Your heart may run a bit fast and be jumpy for a time but it will get slowly better and soon be a distant memory.  Congratulations.
1423357 tn?1511085442
You're going to be a little limpy for a week or two perhaps.  I found that a stroll around a mall after a day of resting helped a lot.  Yes, I had jumpiness too!  Expect that for up to a year or longer.  You're young, and still have a full life ahead of you now free of SVT.  Live it!
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