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86819 tn?1378947492

When is ablation for VT indicated?

Hi.  I'd appreciate opinions regarding appropriate indications for ablating VT. My VT is paroxysmal, usually short duration, monomorphic in nature, and is occasionally associated with mild vertigo. It tends to arise sporadically when I have been running consistently on  daily basis for several weeks.  And at other times infrequently for no apparent reason at all.
6 Responses
612551 tn?1450022175
I see you've been "around" so I likely know less on this than you do.  Still I'll give you my ideas on ablation, for whatever rhythm problem, mine is AFib.
1) Risk/Benefit, the lower the better
2) Probability of success (doctor's estimate), better than 75%
3) Quality of life - really the benefit issue, if the QoL is low, the possible benefit number is larger than if the QoL is generally good (sounds like that is your case).

I would risk ablation even if I had a 60% estimate of success.  I do not have that good an estimate (see my profile if interested).  I do well with AFib, but, I can no longer run (10 minute miles was running to me when in my 60s) because of the high HR it causes due to the inefficiency of my heart at moving blood.
86819 tn?1378947492
My quality of life is generally good. Running is limited, but I can still run. I need to run less because I am getting older anyway. I generally experience few symptoms, but there is a small but finite risk of having significant problems. I have just been watching it. With my SVT, things just kept getting worse and worse over time. If this were to happen with VT, I would definitely need to do something. I have not passed out from this...yet.

What perplexes me about this whole thing is the probability of failure, in terms of making matters worse.  The original ablation site was on the left free wall, and several burns in that area made from under the mitral annulus eliminated a WPW pathway, but seemed to have created spurts of VT. For this reason, I question whether my VT is coming from the same cross section of sources, which when treated by ablation could result in a better than 75% success rate. And under no circumstances would I want things any worse than they already are as this could imply the need for a pacer, or some rather restrictive life style changes.

Thank you very much for your reply.  I guess I realized that I have some things here that only a doctor can help me with,  but I was really looking for some community opinions and appreciate your view point.
1807132 tn?1318743597
A purely non professional opinion, personally I would go by quality of life as Jerry spoke.  Are your symptoms interrupting with your ability to function? Are you passing out?  Are you in VT longer than 30 seconds?  Do you have heart disease?  Would you need an ICD if you did not do it?  I believe if you can answer yes to the above questions than a possible ablation might be a good consideration.  Otherwise it might be a bit risky in that sometimes ablations for the ventricles cause more issues and I believe I read that they have mixed long term results, meaning the issues come back but it may just be that new issues develop elsewhere in the ventricles.  That said, I would discuss with your doctor what he thinks about your theory that this is a bit related to your WPW condition and find out what he believes are the odds for getting a full cure from another ablation.  Your doctor has your case history and likely has way more knowledge about your particular chances than any of us.  My thoughts are purely hypothetical.  Anyways, I know it is a very tough decision so I wish you peace and health with whatever route you choose to take.
86819 tn?1378947492
Thank you for your comments. My symptoms affect me the following ways. I experience short periods of SVT and short periods of VT. SVT no big deal. VT produces short periods of very slight vertigo. If I am talking to someone at the time, it is quite distracting for me and for them. Mostly, I have few symptoms; however, my symptoms seem to increase in frequency when I run long distances, such as 8  or 9 miles. Which I believe is caused by stress hormones, not heart disease. That's pretty much it. Not good, but not enough in my mind to warrant an ICD. Ablation would carry a fair risk of making these symptoms into something worse. For the time being I have opted out. The diagnosis was paroxysmal VT, not non sustained VT.  This diagnosis may be based on impressions the doctor gained by talking to me about my symptoms, not from a heart recording. Heart recordings show several beats of it, spaced weeks apart, very difficult to capture. It can go on for a while, but it does not last for as long as a minute, and probably lasts for less. It can be slightly unnerving, but for the time being life is normal. Thank you again for your ideas.

Avatar universal
What is the difference between proxysmal VT and non sustained VT?

I think mine also was proxysmal VT and not non sustained VT!

I also have a healthy heart, but I do not like getting any type of skipped beats.  It stills worries me.
1807132 tn?1318743597
From my understanding all proxysmal means is a cardiac rhythm disturbance which occurs briefly and transiently.  I would think that Nonsustained would fall under this.  Sometimes terms are used interchangable.  Nonsustained means that the brief transitional episode does not last longer than 30 seconds. If it lasts longer than 30 seconds then it is classified a bit higher in concern.  So paroxysmal is good in that it doesn't happen all that often and nonsustained is good in that it doesn't last but a brief moment when it does so the threat to a person's health is minimal.  Basically nonsustained may occur everyday but paroxysmal is likely to be very random when it occurs though I would think most paroxysmal episodes are likely nonsustained.  I am pretty sure that is what that all means but I would ask your doctor for clarification in case I am mistaken.  
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