Atenolol vs Ablation

[meandlo]

My daughter is 14 and was recently diagnosed with SVT after a very scary episode in which she was short of air, sweating and having chest pain.  This was not the first time it happened, just the first time we actually got an EKG that showed the problem.  They started her on Atenolol but she is complaining of frequent chest pain and lethargy.  The dr has talked about an ablation.  Anyone have any experience with this that they could share?
Thanks

[bscholar1]

I have SVT and high blood pressure and take Atenolol for it.  But right now, I'm researching what I can do to get OFF atenolol since it is something I have to stay on, and I travel frequently so refilling it is hard.  And its dangerous for me to get off of suddenly.  I had a niece who had WPW (which is similar) and she had an ablation.  Initially she did do well (she was 16), but I understand it often has to be repeated.  That's about all I can tell you, but I do understand the problem and have been there with the symptoms.  In fact, I'm a mature adult and have had 3 scary "heart issues" due to this now.

[tom_h]

I can now tell you that I'm at ablation+2days.  It was a lot of worrying for nothing. I hope it was the total success they told me it was. But if not, I'd do it again ....... in a heartbeat!

[annie1724]

Tom, your post sums up my life with svt exactly. Always wondering if and when it would start, being afraid of being different when I was younger,wondering what people thought of me, being afraid to exert myself too much, the embarassment and disappointment of having to drop out of tryouts as a dancer in the high school musical because I had an episode as we were preparing for tryouts....your post brought it all back to me.  And like you, I went years and years and years without any medicine for it.  The doctors back then told me to lie on my back and breathe deeply to make it stop.  I was always worried that it wouldn't stop, and at the same time worried that everyone would think I was dying!

Meandlo, I couldn't possibly advise your daughter whether or not to have an ablation.  You will have to talk to the specialists and take their advice.  But I can tell you that having had an ablation a few months ago, I only wish they had been available and safe  back when I was 14 and I could have avoided years of messing with the svt and all that went with it.  I don't even know if they do ablations on 14 year olds, but wow....there's nothing like a cure.

I think now, looking back, I realize just how much it really affected my life.  As I got older, I always said oh it's not a big deal...it really doesn't affect my life all that much....but I think I had just gotten used to always having that fear and worry hanging over my head, and always making the necessary modifications to try to keep it from starting up.  As I look back I realize how much it did really affect me and just how much it was always with me.  Just something to think about as you move forward with your research and investigation into options.  

Best of luck to you.  I hope you have a doctor you can really talk to and who really listens to your concerns.  I know as a mom, it's even scarier when it's your daughter and not you!

[meandlo]

Thank you all for your insight and opinions.  We are seeing a specialist and, as you all suggested, I intend to fully investigate all options.  As of now, she seems to be well controlled on the atenolol.  But, as you pointed out tom, she is living with the fear of when and where it may happen again.  As a teenager, having something that makes you different or makes you stand out is such a big deal!  She doesn't want to live with the worry and the fear.  Once the paramedic figured out what was wrong with her they tried to get her to do valsalva maneuvers but she was unable to convert and ended up in the ER for IV adenosine.  I appreciate all of the information and hope that, after talking with the specialist and doing some more research, we can come to a decision that we can all live with.  

[tom_h]

Thanks jyant!  Just two more days.  like everything else I do, I've got get-there-itist.  

To meandlo:
I got SVT when I was 6 years old.  I'm now nearing 60.  So I'm here to tell you that most types of SVT are not life threatening.  But, I know what it's like to be in high school and have to sit out a class of gym because my heart was acting up and have the other kids stare wondering what's going on, having to tap out of a wrestling competition because my heart was acting up, being a nationally ranked speed skater with my sights on the olympic trials and losing it all because I could finish an event when my heart acted up, ditto for cycling, and including sufing of which I was very good at.  Being afraid of going anywhere where I couldn't receive emergency treatment if I had an episode I couldn't convert.  All of these events happened over several decades, and continues today. We just got back from a 250 mile trip, and I kept thinking where would I go if it acted up.  Don't you know it, it took off in the middle of dinner at a restaurant on our way home.  It can happen anywhere, anytime; even in your sleep.  The Metoprolol I am on (or was on until I stopped for my own ablation) helped a little, but I'm still getting 3 to 4 episodes of SVT per month.  The medication only helps to easily convert the SVT.  If I took any more, I'd be walking around like a zombie

Your daughter is going to experience similar events in her young life, and I can tell you it's a pain in the neck, to worry about it, and even more painful to feel different than the rest of the kids; to be treated differently when you just want to blend in with the gang.  I would approach each possibility cautiously,  educate yourself, and be proactive.  If your daughter's events are several per year, personally, I wouldn't even give ablation a second though.  If they're several per month, I might begin to seriously look at ablation as a solution to you'r daughter's problems.

Keep in mind that I went for decades with no medication at all.  I learned to convert my SVT's with Valsalva; forcefully holding my breath.  I've been able to convert hundreds of events over my life without ever having hospital intervention.  This technique as well as other should be taught to your daughter so she isn't a bundle of nerves wondering what she's going to do when one goes off.  For me, even today each one is going to be the one I can't convert.  I felt that way tonight when I had one, but I converted it, and we finished our meal and continued on our journey.

FInally, each of us here are just offering our opinions; nothing more.  I don't see any of us here with an MD after our names!  You may see a lot of incidents of less than successful ablations on this forum because this is where people go when they have a problem.  Success stories move on.  Of course, I'm hoping that my scheduled ablation on Tuesday will be a success.  My plan then is to hang aorund though afterwards and help folks like your daughter read and be able to form an opiniopn on what's right for them.

[jyant]

Good luck next week..

BTW when general practitioners start charging $40,000 to burn a wart off, I'm getting my license :)

[tom_h]

Seriously guys.  Referring to cardiac ablation to heart surgery, is like having a wart burned off your toe and calling it foot surgery!  In fact the only surgery involved is the cuts they make in your legs to access the femoral veins. I'm on the road now but more on this when I get home.

[Bromley]

(Oh.  Correction. I am reading this at google books not amazon.)

[Bromley]

Weird.  The link I used is:

http://books.google.com/books?id=q3tnigD1bLAC&pg=PA1023&lpg=PA1023&dq=indications+for+SVT+ablation+%22class+II%22&source=bl&ots=VN6gas-7jA&sig=B7hkw2IJsy_7lXdCWpnNsg60hi8&hl=en&ei=A1LfTJWMJI-lnQeoqpS9Dw&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBMQ6AEwAA

[jyant]

google is only letting me go to pg. 1013 :(

But I've read others and some suggest that the chance of adolescent pacemakers should be taken with great thought and when available, drugs should be your first line of defense. And as we know, some drugs work for some and not others, but there are many out there to try.

[Bromley]

Yes I am inclined to agree with the general gist of what jyant is saying.

To get a feeling for the way this works, check out Hurst's the heart, Book 1  By Valentin Fuster, R. Wayne Alexander, Robert A. O'Rourke, at amazon, which I found after about 5 minutes using google.  You can actually read the book at amazon. On page 1023, you can read about the indications for RF catheter ablation in pediatric patients. Table 39-4 specifies what the thinking was when this book was written. Bare in mind that it is a moving target, and again, talk to your doctor to get the best most recent perspective on this.

[jyant]

No matter how you slice and dice it, it is heart surgery. Unless your daughter was in danger of dying, personally I would leave that decision up to her when she becomes an adult.

[Bromley]

BTW, the success rates and other rf ablation statistics are available to a certain degree. I once read that rate of stroke is reported as being anywhere between 0.5 to 5%. Not sure why we have such a large variation here, but 5% of course equates to one in twenty. At this rate, my understanding is that stroke is one of the most probable, most significant adverse outcomes of ablation.

As you can see though, we here all vary in our views about safety. Whereas, it may be more speculative I think to wonder who is and who is not here to share their experiences, I still think it best to talk to your doctor about the recommended guidelines and the actual statistics that they are based off of.  As tom mentioned, some drug treatments also carry significant risk.

[tom_h]

As others have said, you need to weigh the pros and cons of each possible path.  But I need to point out that the number of successful ablations far outweigh the number of problematic ones.  The thing is, you don't see the success stories here on the forum.  Those prople have moved on never thinking to join a forum to talk about their former arrhytmias.  Remember too that like ablation, drugs come with their own little problems and they must be carefully introduced and monitored.

[Bromley]

Hi. You are very lucky to have a diagnosis. As annie mentioned above, this stuff frequently goes unrecognized for years. At this point you may have a basis for understanding treatment options for taking care of the problem.

I am confused as to why there is chest pain. Be certain to communicate this to your doctors. If there isn't a good explanation for it, I would be inclined to seek an additional opinion about this.

Ablation, if it is even an option for you, is dispensed by a specialist, and as the procedure can have some serious drawbacks, as the subject matter is complex, and as there are numerous opportunities for  pitfalls, my belief is that it should only undertaken by done by the best, most qualified doctors, after you and your daughter have fully understood and have weighed the potential benefits and drawbacks.  

I am also of the opinion that many doctors will make a recommendation either way (to ablate or not to ablate) depending mostly on what you want to do, whereas the "sanctioned guidelines" do in some cases permit the patient to have input on the quality of life assessment portion of the medical evaluation when it makes sense.

I am relieved to see that you were offered the drug treatment option. I believe the standard recommendations are to pursue that line of treatment first. This may be because of the potential drawbacks of ablation, and I would certainly think that because your daughter is only 14, these guidelines should be strongly considered.  

Don't misunderstand me, I am not a doctor and can not make ANY recommendation. From what I have seen here on this forum though, if ablation works its great --- and you can find many people to attest for that. However, I do know from personal experience that problems may arise if it doesn't go well. If you think you are in a jam now, consider what it would be like if your daughter ended up having a stroke, or needed a pacer as a result of having had an RF ablation. Would you think back and wonder then whether drugs would have been a better option to treat occasional paroxysmal attacks of SVT?

This is why I think that if you or your daughter opt for the ablation path at some point, you are absolutely obligated to find the right doctor to do it. I would start your search now and not stop until you have found/done the absolute best for your daughter. Pull no punches here: the repercussions are simply too serious to roll the dice on this.

[annie1724]

There are lots of threads on this board that discuss ablation, pros and cons, what the procedure is like, etc.  Like Jerry said, only a specialist should be the one to recommend whether or not your daughter should have one.  I really don't know the pros and cons of a teenager having an ablation.  I had one for svt about six months ago, and I am glad I did, but I am an adult and I don't know the ramifications (if any) of a teenager having one.

What I can tell you is that I too started with svt when I was 13 years old.  I fully remember the terror of my heart racing, the cold sweat, the weakness, the feeling of being out of control.  Back in those days there was no ablation option, so I lived with the condition for many, many years.  It obviously did not kill me, but it is only since I have had the ablation that I have fully realized how much it affected my life, even though I always said that it didn't.   With that in mind, if your daughter sees a specialist, and if he recommends an ablation, and if it is deemed safe for a teenager (it is considered very low risk for an adult) then I can tell you that I would wish I could have had one back then and eliminated many, many years of tachycardia episodes.

[Jerry_NJ]

You need to have a specialist - and ElectroPhysiologist (EP) who does ablations, examine her to get  good advice.  I'd bet on the ablation as the right way to go, but no one here can substitute for the advice of a specialist who is expert at ablation.

Many who participate in this community, but few if an are teenagers.  Still, there is a lot of adult experience with ablation - hope you get some helpful inputs.