So I am a 28 y/o male in pharmacy school, with a 6+ year history of palps. At first, the palps presented lock step with my generalized anxiety (really a health anxiety) but as time goes on the palps seem to have become their own entity, at times unrelated to my anxiety. I had a run of PSVT caught at the ER when I was 22 and it was fully resolved with IV fluids and Ativan. I've relocated a few times and persisted with cardiologists in my new cities, in the past 2 years I have had blood work, echo, MRI, and holters. Holter last year only caught symptomatic PAC's, but I insisted that the PAC's detected weren't the palps that I was concerned about and that I needed a longer monitor period. This May they finally caught a run of NSVT/AIVR - it was a wide complex run with <10 beats, a capture beat, and then another <10 beats, with a rate of 110 bpm during the episode. Since this run was detected my anxiety has, admittedly, ramped up significantly above baseline, and I have had 4 more of these 'episodes'. This is a large increase in frequency, and only adds to my health anxiety.
I have taken my tracings and the holter report to the EP my cardio referred as well as a second EP for a second opinion. Both EPs are of the opinion that the detected 'episode' was an AIVR due to the "warm up and cool down" observed as well as the relatively slower rate of 110 bpm. I was prescribed atenolol and took my first dose yesterday evening - made me feel a little weird but my heart rate and blood pressure were rock solid all night and remain good into today. Having just got married back in Feb, this arrhythmia scares the crap out of me and I am looking to MedHelp for others' experiences or perhaps some context.
All AIVR/NSVT episodes seem to come while I am at rest or only lightly active, in fact the last 4 runs I had while sitting on the couch and playing video games. As soon as the fluttering sensation is over (usually in less than 10 seconds, often 5 seconds or less) my heart starts to race and I either have a panic attack or I just deal with my heart racing until it calms down (5-10 minutes). EP 1 wants an implantable loop recorder to catch more of these episodes, EP 2 wants a stress test to provoke PVC's or another episode to see exactly where they are coming from. I don't know what diagnostic value that the loop recorder has aside from confirming what my cardiologist already knows - that I am having random episodes of symptomatic palps.
Workup so far:
Holter (May) - captured AIVR/NSVT
Echo (March) - normal, but notes indicated LV hypokinesis which no cardio seemed concerned about(?)
Holter (Oct '17) - symptomatic PAC's and/or SVE's
MRI (Jan '16)
1. The EP who went over my holter with me does not think that the AIVR is originating from the RVOT based on how it presents, but it is my understanding that the only way to surely know the arrhythmia's origin is to catch it on a 12 lead. Is this correct?
2. My biggest concern is something like ARVD. Given that my MRI in 2016 was normal, will another MRI be useful? Is it possible for ARVD to come on/progress that rapidly?
3. These palps feel scary, but each cardiologist or EP I've seen says that these look fairly benign. What is keeping these from turning into something more concerning/malignant?
4. Given that these palps are occurring in what the docs are saying (so far) is a "structurally normal" heart, how are channelopathies being excluded? They all say that since my ECG is normal that they don't think channelopathies are a concern, but aren't they classically transient and hard to diagnose?
Thank you for reading through this, I know I have a lot of specific questions, I have made sure to pick my cardio's brains but it is also helpful hearing from other people who are going through the same thing.