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]

The 77% success rate for RVOT ablation quoted to you is about right for tertiary referral centers.   The top centers are getting around 90% and you can skip the ICD implant if you get a successful procedure.  They can tell whether it worked or not by trying to induce a VT after the ablation while you are still in the EP lab.  Non-inducibility would be the end of the procedure.   Was he giving you the success and complication rate for the Sentara EP clinic?  

[sheshe00]

I thought he was giving the success rate for VT in general at least that is how he said it. He would do the ablation if I had VT and he would ensure he could not induce another episode of VT. He would put in a defibrillator anyways as backup to the ablation because the ablation had a 77% chance of not being successful in the long run. He did not specify to me which type of VT he thought I had. I am assuming it is RVOT given I was able to treat it with adenosine and I had indicators of ARVD.

[MichelleP_3811]

I tend to low bp myself and find it best to have eaten before getting on the elliptical.  SVT can make it feel like you will pass out but you generally don't.  I always had to lay down with mine until I started to exercise regularly then I was able to sit up and even move around a bit though that was a bit taxing on my heart so I would not suggest it.  Holding your breath and bearing down like straining to go to the bathroom, coughing or drinking a cold glass of water may help.  I would also suggest getting more sodium in your diet if you tend to low bp and drink plenty of water to help your heart function better in general.  Well best of luck Thursday.  I will keep you in my prayers and do hope that it turns out to be an easy to fix svt.  Please let us know how it goes when you feel up to it.  Hugs.  

[is_something_wrong]

Sustained VT at 260 bpm would more likely cause more severe symptoms than SVT. Typically, VT does not respond to adenosine as it doen't involve the AV node. RVOT VT can sometimes respond to adenosine.

Luckily, you have an EKG from during the arrhythmia, and a skilled EP doctor cound fairly easy determine if it shows SVT or VT. Regardless, unless you had symptoms like fainting during the event, the heart was able to maintain your blood pressure, which means that sudden death is less likely. An arrhythmia is rarely dangerous if you remain hemodynamically stable during the event.

[sheshe00]

I wish this was more clear cut before I go in on Thursday for the EP. During the episode I could not walk or sit up,  because I was starting to blackout. The strange thing I had was my neck hurt and I couldnt hold up my own head.  My EKG shows both SVT and VT. I spoke again to my cardiologist on Friday and he said he was convinced it was VT even with the indicators of SVT. My previous cardiologist was convinced it was SVT. I have had two other cardiologists review the EKG and they both think it is VT. I have had episodes before where I got very light headed and it dropped me to my knees but it always fixed itself. I also passed out once a few years ago while on an elliptical. I had just started and I say my heart rate go up to 200 and I woke up on the floor. At the time I did many tests and they found nothing. I failed a tilt test and was told I had POTS. I had all of this while being seen at the same practice. I also tend to have normal to low blood pressure especially when I was pregnant. 90/70

Like what you said I feel like it was fixed with adenosine so probably not VT (I'm hoping). Also I have had episodes for 5 years just not like this last one. Everything I read is at odds with what the last three cardiologists are telling me. I guess I need to stop trying to control everything and wait till Thursday for the EP and then I will know.  

[sheshe00]

the other issue that confuses me is that I had signs of ARVD on my follow up EKGs which was then ruled out by a cardiac MRI so it very well could be RVOT. Except what I read about RVOT does not involve a defibrillator just and ablation. My cardiologist told me that ablation alone was only 77% effective for VT. He didnt specify what kind of VT. I should have asked.

[researcher09]

Questions to ask -
How many VT ablations has he done in total?
How many of those required epicardial ablations? (20% chance needed in your case)
How many does he do per year now?
What is his success rate, acute and chronic?
What is his major complication rate?

[sheshe00]

Thank you this is good to know. My Dr is a EP cardiologist for the procedure but I did not ask how many VT procedures he has done a year. I will ask today. Thank you,

[researcher09]

I am referring to the electrophysiologist who is going to do your ICD implant and ablation if they are one and the same.  Many general cardiologist do ICD implants.  Ablations are strictly performed by electrophysiologists which takes a lot of additional training beyond general and interventional cardiology.  50/year just refers to VT ablations.  If a specialist does 50 VT ablations, he would also do many more less demanding ablation procedures such as SVT and AF.  The are experts that just focus on VT/PVC ablations that do 150 per year and they will not have time left over for simpler procedures and the simpler ones will be handled by somebody else in the practice group.