Cardiac Ablation

[k&ajsmom]

I have a question i hope one of u smart cookies can answer for me..=) i am being driven to my breaking point with pvcs, pacs, afib, and now possibly v tach arthymias....sigh...i can deal with the tachy (sometimes) and the low bp (sometimes lol) and all the other endless symptoms but these arythmias are making me lose my grip. I know generally ablation is frowned upon for us causing a worsening in symptoms, but i was wondering if anyone knows why? What mechanics cause this? Im starting to consider ablation to lessen some of these events but i cant risk an even lower bp(im rarely over 90/70 even with florinef and compression or laying down im even lower 70/40) so im just wondering what exactly the negative effects are with these procedures...im constitantly in fear of these events and worry about vfib ....ugh so over this mess....thx guys =)

[Racer]

During one of my EP visits, he warned me of the possibility of needing a ablation or pacemaker. I don't think I will need either, I came to the conclusion I would skip having the ablation and only consider it or a pacemaker if it was absolutely needed to save my life.

I dont have a answer, just want to say I can relate. I have been trying to get back to exercising, and I have been experiencing a bunch of arrhythmia as a result. I only get tachy when standing (during a bp drop), and normally have a low bp (100/70 with midodrine) and low resting hr. I tend to experience arrhythmia at rest when my hr goes into the 40s.

I am really interested to know the answer to your question!

[bustersacc11]

I am not the sharpest pencil in the pencil box but I would like to try to help you in this case. I have a pacemaker for a slow heart rate and we thought it may help my dysautonomia but it really didn't. Have had multiple holters, event monitors, etc. Also, I experience those annoying PVCs, and bursts of PVC's. For me, they are like hard thuds in my chest. Take my breath away. Unfortunately, I just deal with them.

Further, I do not have POTS. Learning from this site, and other references there seems to be that debate whether or not the tachycardia is a compensatory response and responding to our bodies needs (i.e marked venous pooling). The high heart rates cardiac in origin doesn't seem to be the case; rather, an altered autonomic nervous system. I may be wrong. However, It makes sense that patients should be reluctant when considering cardiac ablation for inappropriate sinus tachycardia, or sinus tachycardia, or SVT with dysautonomia. It appears not to be the source of where symptoms are coming from. If you start knocking out electrical pathways, or altering the SA or AV node than you are messing with things that didn't need to be messed with. Left where you started. But if the origin of the rhythm comes from the SA node, AV node, or ventricles and it causes a person severe symptoms than I think ablation makes sense. Even then comes risk if they don't do it right. For example, if they knock a patients SA node for IST. Now, the patient becomes pacemaker dependent and with a whole different set of issues.

You mentioned PVC's - while annoying they are benign arrhythmia. EP research has shown that it would take 20% of your rhythm or 20,000 PVCs per day to develop cardiac myopathy (over a period of time). That is a whole lot of PVCs! If you are having what you feel like are runs of V-tach often (greater than 5 PVCs in a row) than I would consider discussing this my cardio and either get some reasssurance that everything is OK or revisit tx. options. I just wonder if you are feeling runs of PACs that are similar to what you are feeling when experiencing PVCs. Ultimately, you know best.

PACs and SVT are not life threatening. Just really annoying. Those fast rates arising from the AV node do not all pass through to the ventricles so your pumping action in the ventricles is protected when having those burst of SVT. This is a good thing! Which is helpful is differentiating btw v-tach and svt. I know you feel lousy. Just trying to offer some kind words of reassurance that PACs, PVC, and SVT stink but not life threatening.

I see you are in a bit of a quandary. You have low blood pressure so treating these annoying rhythms with medications would be challenging and bit risky. I understand why you are inquiring about ablations.

Lastly, I will relate it back to my case is the rhythm causing your symptoms cardiac in origin? Than it makes sense to reconsider an ablation. However, like my case putting in a pacemaker to speed up my rate did not help improve my quality of life. Now, I know the slow heart rate is not from sick sinus syndrome rather an altered autonomic nervous system that generates slow rates for me. If I had true symptomatic sinus bradycardia, got the pacemaker, I should be on my way. That wasn't the case.

An ablation for PACs, PVCs, and SVT. Thats a tough call but I get it. Unless the numbers were out of sight. Maybe. Risk of knocking out an electrical pathway that didn't need to be or damaging my SA or AV node not to have symptom relief and possibly continue to have the same annoying rhythms would be weighing heavily on my mind. On the other hand, for AFIB and runs of PVCs or bouts of VTACH...yes, I would explore that option if meds were not an option due to the long term risks associated with untreated AFIB and VTACH.

I am a member of the pacemakerclub.com. I was surprised but there are a lot of people with NCS, dysautonomia, etc that have pacemakers. Doing a search on ablations and you will find tons of info. There is one guy, name is Electric Frank, who is our "yoda" on the forum that is awesome for answering questions. He has an engineering background and thinks totally like an engineer. There are a lot of very nice people on that site that might be able to speak from their experience with having an ablation that may be of some benefit. Keep in my mind, it is a pacemaker site and these people have all ended up with PM. Keep things into perspective that you are dealing with some unfortunate cases. Sorry for the long winded response. Your topic was a good one! Just got caught up in it.

[Mydoggielovesme2]

When I first became symptomatic, before POTS diagnosis, I was told I needed ablation. I was in the Az Heart hosp. During EP study it was found that I had sinus tachycardia. The Drs there said they do not do ablation when the problem is in the sinus node as is creates more problems, can even cause fatal event. Same with pace maker, they said 50/50 as to makeing it thru surgery. Not odds any of us willing to take.

Sorry you are going through so much.

[Aimes]

My experience with an ablation was not a fun one at all! Looking back, I wonder if some of my misery was caused by what I'm now suspecting is MCAS. The procedure was miserable! Six hours, flat on my back, and even after they gave me the anesthesia I didn't fall asleep. I couldn't feel anything but I was awake, talking, and remember the entire thing. I also had one of my violent tremor episodes shortly after they gave me the anesthesia (possible MCAS?).

I stayed the night and went home the next day. The recovery was easy enough, not too painful. However, a few days after the procedure I developed constant tachycardia. My heart rate rarely went below 120, even at night. Beta blockers did nothing to help. Luckily, it corrected itself after about three months.

It's been about eight years now and my POTS is still as bad as ever and I still experience PVCs. Not fun! I think for us POTSies, ablations aren't successful because our hearts are just a terrible symptom, not the problem. Ablations are intended for people with wacky electrical pathways. Our hearts act crazy in response to a bigger issue. Not saying that an ablation won't help some of us. If you have extra electrical pathways, it may be beneficial to have the procedure.

I'm sorry if my story is scary! I realize I'm a minority and most people don't have the problems that I had. I was pretty devastated and traumatized at the time though. Especially when I later went to Mayo and they said I should not have had an ablation at all! I don't mean to be a Debbie Downer but I think it's important to be aware of the good and bad things that can happen with these procedures. I always just wish I had gotten more opinions before having an invasive procedure done.

[Krissy21]

I had an ablation done in December 2011 for SVT. I had POTS symptoms then but was not yet diagnosed. It did not make my dysautonomia better or worse but it completely cured the SVT. I was in SVT almost everyday that lasted anywhere from a few minutes to over an hour. Between that, POTS, and also IST, I was miserable and really couldn't function. So for me, the ablation was worth it just to get rid of the SVT. I was told by my doctor that ablation of the sinus node is what can cause the dysautonomia to get worse but ablating an accessory pathway that causes SVT is relatively safe. He said he was very careful to stay away from my sinus node during the ablation for this reason. I'm not sure what needs to be ablated to get rid of PVC's or a fib so I would talk to your doctor about that. Of course there is risk for a pacemaker and other things during any ablation but I was told that as long as they don't mess with the sinus node, that risk is less than 5%. I hope this helps answer your question.

[Sushi]

I have a question about people's experience with ablation for Afib. I have NMH and have a Pacemaker for sick sinus syndrome. (It does help me with OI--it is set for 70). I've been taking the antiarrhymia drug flecainide to prevent Afib but after 2 1/2 years it is starting to fail and my EP just doubled the dose. From everything I've read antiarrhymia drugs will all fail after some years and they do have side effects.  I see my EP tomorrow and want to consider an ablation as I am getting older and don't want to be left with a history of failed drugs when the risk of ablation has gone up due to age.

I remember that Dr. Grubb used to say that there were only a few scenarios where he would recommend an ablation and I wonder if Afib is one of them? I'd assume that with dysautonomia the recovery would be more difficult. Does anyone have experience with this? 

Thanks!