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17115252 tn?1456332331

SVT or VT?

Background: During a run on Thanksgiving I ended up in tachycardia. Lucky for me an RN pulled over and took me to the ER. I was put on an EKG and my heart rate was at 260 wide complex tachycardia. The restarted my heart with Adenosine in an IV. I have had a cardiac MRI it has ruled out Hypertrophic Cardiomyopthy (I have a family history) and ARVD(the cardiologist thought I had ARVD based off my EKGs). The MRI showed no scar tissue and everything looks healthy. My cardiologist told me I had SVT and prescribed Flecanide. I have normal/low blood pressure. He told me the only way I would die is if I passed out in front of a bus. I then asked for an ablation. (My primary care DR told me to insist on one).

Turns out the cardiologist I saw was new and did not have operating privileges at the heart hospital. I saw a new cardiologist who said he did not think I had SVT based on my EKG from the emergency room. He said he had to assume VT and thinks I misunderstood my previous cardiologist (same practice). I did not misunderstand. I also found out from the new cardiologist that the cardiac MRI did show minor loss of functionality on my right side. I found out yesterday the halter monitor that I wore for three days prior to my cardiac MRI was never reviewed. I had always assumed it was normal. It had multiple episodes of tachycardia over a dozen. It also had two incidents of wide complex tachycardia at 200bpm and 231 bpm. The nurse said she was contacting her supervisor and my DR. I go in on 4 FEB for a EP. I was told that if it is SVT they will do an ablation, if it is VT they will do an ablation and a defibrillator, and if they cannot determine then I will get a defibrillator.  

I thought I was meeting the new cardiologist for a pre-op for just an ablation for SVT. I was totally thrown off guard. I dont know what to think I am back to having discussions about the priority being to keep me alive. How can I have VT with a healthy heart? How can I have SVT that is sustained at 230-260bpm?  I would like to know others opinions on if this sounds like SVT or VT. Everything I read says that if you have a healthy heart and VT then you do not need a defibrillator so why would my DR say I am getting one?  I have attached my EKG from the emergency room.
25 Responses
12492606 tn?1459874033
That sure looks like VT and not SVT.  Given your family background with SCD, it would be best to follow EP suggestion and get an ICD.  The optimal treatment would be ablation plus ICD and the ablation is complex so hopefully your EP is skilled and experienced with VT ablation.  Once the ICD is in, you will have more choices even if the ablation is not successful.  You will want to have a successful ablation in addition to the ICD.  The closest centers of excellence (the ones that handle the most complex cases at sufficient volume) include -
Medical College of Georgia (Augusta, GA)
University of Oklahoma  (Oklahoma City, OK)
Intermountain Medical Center (Murray, UT)
St. David’s Medical Center (Austin, TX)
The University of Kansas Hospital (Kansas City, KS)
U of Penn (Philadelphia)
Mount Sinai, Columbia U (NYC)

I am glad you caught this in time.
12492606 tn?1459874033
The EKG shows VT.  Given your family history of sudden death, what the EP is suggesting is the standard of care, ablation plus ICD implant.  Because the ablation is not simple and highly dependent on the skill and experience of the EP.  The ICD will protect you from SCD nonetheless so you will have choices later on even if the ablation is unsuccessful.  I am glad you caught this in time and best wishes for a completely successful outcome.  Let us know how things go.
12492606 tn?1459874033
Sorry about the repeat, the first post disappeared and now it is there.
17115252 tn?1456332331
Do you know anything about Sentara Heart Hospital in Norfolk?
12492606 tn?1459874033
Sorry,  Don't know the center or the EPs there at all.  As far as ICD implant, most heart and vascular centers will know how to do that reasonably well.  As for VT ablation, completely different skill set so you will want to know how many the EP does per year and his success and major adverse event rate.  You them to ask them directly.  The EP needs to do a minimum of 50 procedures to be considered a competent expert in VT ablation.  The list I have above are EPs that do over 100 VT ablation procedures/year in addition to their access to robotic magnetic navigation.  The latter tool is way better than hands for complex ablations of which VT ablation is the most complex of all.  I can think of 2 other places that have top hands, Emory and Harvard (Brighams and Women) but they don't have the magnets yet.
12492606 tn?1459874033
I meant minimum 50 VT ablation procedures/year as it relates to expertise.
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