Vtach Sustained with VFIB

[CT_GUY]

I am a 38 year old healthy male that loves exercise and working out.  have had Wolfe Parkinson's White Syndrome that has caused SVT runs since birth. I also have had an Aortic Valve Replacement in  June 1992. I had multiple WPW sites ablated and in 1992 it was discover that I had another pathway. My echocardiograms every time for the past 23 years have been the same-EF over 55% and everything else normal. I have low cholesterol, and the cardiologist said I had beautiful fat coronarys during a heart cath. LOL  Fast forward to 2006, I met a local Electrophysiologist and he said he knew where the pathway was just from looking at the EKG and would be an easy fix. He went in and took care of it with no problem. He also "opened up another can of worms" so to speak. When he conducted pacing exams to elicit the SVT he actually induced VTACH!! The Vtach also deteriorated to Vfib and I was defribrillated. Then, during relatively unaggressive burst pacing to elicit the VTACH again,  I went straight into VFIB!! What the hell???!!! He said this is definitely abnormal for my age regardless of my past surgical. history. He cannont tell my why it happened and he noted he could find no scar on the heart during the procedure. I had an ICD inplanted in 2006 and I have gotten shocked a total of 3 times all while working out. I get my heart rate into the 140 range and bam!!! It just takes off. The whole time before it takes off I feel great!  The rate of the VTACH during this time is 240. I do not feel faint or anything when it happens. I thought this fast of VTACH would cause your blood pressure to drop like a rock. The ICD probably shocks me about 12 seconds later. The EP wants to do another ablation and I am afraid that he puts me into VFIB and cant get me out! I am a father of 4 beautiful children and a loving wife of 14years and I am really scared of another ablation.
     Can anyone offer any insight on the risks of not converting VFIB when put into it and how dangerous are VTACH ablations?
     How likely is it that my heart is weak? He mentioned that "maybe your heart just doesn't like high heart rates" That sounded like a bizarre statement to me. Thoughts?

[kcolly32]

Do you have a pacemaker (ICD) or a pacemaker/defibrillator (AICD)? My guess is the AICD since it is shocking you when you go into vtach/vfib. An AICD should only shock when it detects an abnormal rhythm, and it seems when you get your HR elevated you are going into vtach. Why, I don't konw. Vtach is usually common in people with low EF's so that's why it's strange that you have it with a 55% EF and otherwise good heart muscle. However, I thought WPW did pose a disposition to VTACH/Vfib and that's why It's encouraged to get it ablated, but I'm not 100% sure on that. What you have is definitely a wiring issue, I had SVT via an accessory pathway that had to ablated but after my ablation haven't had any episodes. I've had patients in the past get ablations for VTACH and from my understanding it's more complicated than a SVT/WPW ablation because the mapping is alot harder for the cardiologist and you're scarring the ventricle instead of the atrium. As far as how easy is it to come out of vtach/vfib? That's not something I think anyone can answer really, I've seen getting shocked work and people come right out of it and I've seen people get shocked and not so Idk if anyone can really tell you the risks of not coming out of it. However, your heart muscle is good, which helps, most of the people deal with have weak hearts so that makes it harder to get them out of vtach/vfib. I can't give you any opinions on whether or not you should get another ablation. If you think getting shocked every once and a while is something you can live with then maybe wait but that's something you and your cardiologist need to have a good discussion about. Goodluck!!

[itdood]

I'm not an expert on ICDs but I'm pretty sure they don't measure VT directly.  In other words, it's not looking at a running EKG and checking for VTach waves.  It's purely based on rate alone.  If yours is set to 180, and you take it up to 181+ during exercise for a set amount of time it will shock.  The ICD can't distinguid between a 181+ NSR or a 181+ VT.

So maybe I'm wrong, but you might be able to tune it better for what is actually going on?

[CT_GUY]

My EF on ECHOs always have been over 55% so its not that. I had a million EKGs so probably not that. Must just be #3. Thanks

[CT_GUY]

I asked what he meant by that and he never really gave an answer. I don't have  long QT. Before the EP study I never had a documented sustained VTACH run. I have only had VTACH runs after my ICD was implanted so who knows if they would be of the sustained variety or not. I only stay in the rythum for what I approximate to be about 12 seconds. I dont have a chance to convert on my own before the ICD delivers therapy (defibrillates me) which is always fun. NOT!!! lol.

[itdood]

When it comes to heart muscle, I put conditions into three buckets.  

1.  Ischemic, meaning blood flow issue (can cause ectopics)
2.  Issues with the muscle cells themselves  (can cause ectopics)
3.  Electrical pathway issues, or bad wiring (can cause ectopics)

So as you can see, the complexity in figuring out a root cause is very high and very difficult.

I would think that if your muscle had signs of issue 2 (making it weak) it would be seen and measured in various ways.  It would be seen in electrical patterns on the EKG and on echos (if you had that done).

[Bec2610]

Hi, have you has your cardiologist checked for long QT? The exact same thing happens to me while exercising I'm only 21 so I know how you feel, it's pretty scary,  I only went in to non sustained V-tach. I do have a prolonged QT interval so that is probably the reason why, I don't see how your heart can not handle high rates, there must be some cause, maybe next time you could ask him? Good luck.