SVT Ablation, should I get it?

[kcolly32]

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??

[MichelleP_3811]

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.  

[tom_h]

"....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......

[MichelleP_3811]

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.  

[tom_h]

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?.

[kcolly32]

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.

[tom_h]

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!