SVT or VT?

[sheshe00]

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.

[researcher09]

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.

[MichelleP_3811]

All I will say is that SVT doesn't kill.  It is extremely rare for it to cause death and usually only with someone with other underlying issues.  Right ventricle dysfunction is a sign of AVRD so though it has been ruled out it sounds like the issue with the right ventricle may be what is causing you to drop into the tachycardia.  SVT also generally does not cause someone to pass out.  I felt like I would but never did.  I am not sure about POTS because that may involve low blood pressure issues but SVTs caused by extra pathways generally don't cause a person to pass out from what I understand.  The exception may be WPW because that kind of tachycardia involves both the ventricles and atria but usually there is a telltale sign even on a normal ekg that would suggest WPW but that may be what they don't want to rule out at this point.

Honestly if the doctors have that much concern then I would take them seriously and view this as a dangerous rhythm which is usually a VT situation.  And I will also say that if there is heart disease, problems with the right ventricle, then a simple ablation may not correct the issue.  The VT or whatever kind of tachycardia you are having could reoccur because the heart is pumping out of balance and it will throw the heart off and the tachycardia occurs as a consequence so a defibrillator may be necessary.  In general cardiologists do not generally rush to judgment.  They usually err on the side of caution and would not put a shocking device in a person unless they deemed it absolutely necessary.  So if you picked and trust your doctor and have good reviews about the facility I would follow their advice.  

As for having others on the site that have a similar situation I would not worry too much.  Many people come and go.  Stop by when they have an issue and leave once they are fixed so that doesn't mean there hasn't been anyone else in your shoes just that they may not be active at this time.  I wish you the best of luck with your ablation.  Please let us know when it is and I will keep you in my prayers.  Take care.

[sheshe00]

Hi Michelle, I did do a cardiac MRI and it ruled out ARVD and Hypertrophic cardiomyopthy. I have a family history of sudden death and one autopsy of my nephew with Hypertrophic Cardiomyopthy. I did have loss of function on my right side (cardiac MRI).

I had a health heart otherwise no scar tissue. I had a 3 day heart monitor that showed multiple tachycardia event (dozens). It also showed wide complex tachycardia 200bpm and 231bpm originating from the right bundle branch.

My cardiologist says the EKG shows VT but that you cannot diagnosis by the EKG and he will make the final diagnosis during the EP. I am told that because I am now high risk for sudden death I cannot wait to do the EP. I just had not seen anyone else who goes into an EP without knowing if it is SVT or VT. From what I read it seems you can have SVT with aberrancy that will show as wide complex. When any DR or Staff sees my ER EKG seems thing to get serious.

If I wasn't so worried about dropping dead I would go see someone in another practice but at this point I feel like I am risking too much to put it off any longer. I have talked to multiple friends who know people that work at the heart hospital and all of them had said good thing about my current DR.

It bothers me that no one online seems to have the same story as me. I will let you know what happens. He did say if he can cause neither SVT of VT in the EP he will give me a defibrillator because he said the type of tachycardia I had would kill me (as he pointed back to my EKG).

[sheshe00]

Thank you for commenting it really does help to talk with people about this.

[sheshe00]

I did choose my cardiologist. This is my third cardiologist the last two were electrophysiologists.  My 3 day monitor showed several incidents of tachycardia and two incidents of wide complex tachycardia 200bpm and 231bpm. I felt nothing I thought there were no incidents when I wore it. I am being told it is because I had wide complex tachycardia at 260bpm in the ER that did not fix itself on its own that I need to do the EP ASAP. The cardiologist told me his number one priority was to keep me alive his words not mine. I feel I cannot wait for another opinion given that I was told I am currently at risk for sudden death. I was told by both cardiologists and my primary care DR that had I not gotten to the ER when I did I would have died. My primary care also said I cannot wait to go in for the EP that if it were him he would not have waited as long as I did given the risk. I agree a lot sounds like SVT because even SVT may need trips to the ER if it is sustained. Plus I was seen 5 years and 3 years ago for  racing heart and passing out. They found nothing and told me I had POTS. What I do not understand is why does my EKG make everyone freak out and make them think it is VT. I was told my EKG is unusual and they were keeping it for training. My EKGs that have been done post ER visit indicated ARVD which was ruled out in a cardiac MRI. What confuses me the most is that everything I read says SVT is not deadly then why then would I end up in the ER and told if I hadn't come I would be dead? I agree with you nothing adds up that is why I posted to this site. I was told he would have to cause the arrhythmia in the EP to make a definitive diagnosis of SVT or VT. He said he had to assume VT until proven otherwise. He also said my EKG indicated VT. I was hoping someone else had had a similar experience.

[MichelleP_3811]

I am no ekg expert but the strip looks quite like vt to me. VT that sustains is a danger because if it isn't converted it could lead to cardiac arrest and death.  It is generally not a danger if it is short lived and stops on its own.  It doesn't sound like that was the case.  But I agree with Tom that rushing into an ablation or any medical procedure is not a wise thing.  I would get the monitor results to see what they say and consider consulting with an ep outside the practice that you have been seeing for a second opinion.  SVT is generally seen as narrow complex. VT is generally seen as wide complex.  But it can be a bit confusing with the terminology.  VT can be called NSVT while SVT can also be called PSVT.  They all to some degree sound the same so it can be easy to misunderstand a doctor when they talk fast and you are not feeling well.  I'm not saying you did misunderstand but it can be easy to misunderstand.  Usually most misunderstand and think they have VT but really have SVT.  It is possible to have both though.  But if your ekg does not indicate SVT it would likely be AVRD than SVT in my opinion.  Considering your family history and the fact the other doctor considers the possibility of right ventricle function issues it is a possibility that needs to be confirmed in my opinion.  So would ask for further test to determine the health of the heart.  Maybe a cardia mri if you haven't had one.  And I would definitely seek a second opinion before having a defibrillator put in.  I would however, seek treatment at an er if you ever get the tachycardia again.  Your strip leaves too much to question in my mind to wait it out like I could do with my svt.  I personally think an ablation is a wise decision at some point but do agree that further consultation with an impartial party may be in order.   You want to go into an ep study and ablation with confidence in what is going to happen and who is doing the procedure.  Best of luck.  Keep us posted on how you are doing.