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Well, my cardiologist seems to not know what to do anymore. He is referring me to an arhythmia specialist and told me to increase my meds once again. This is all getting so frustrating. He also mentioned abalation surgery... I remember reading a post from someone saying that was a bad route to take. Can anybody elaborate on this?

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If you are able, seeing a specialist is sooo worth it. Otherwise you probably will feel frustrated. :(

Here is an article from mayo that talks about POTS/ablations:

Pacing Clin Electrophysiol. 2001 Feb;24(2):217-30. Related Articles, Links

Is sinus node modification appropriate for inappropriate sinus tachycardia with features of postural orthostatic tachycardia syndrome?

Shen WK, Low PA, Jahangir A, Munger TM, Friedman PA, Osborn MJ, Stanton MS, Packer DL, Rea RF, Hammill SC.

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.

Inappropriate sinus tachycardia and postural orthostatic tachycardia are ill-defined syndromes with overlapping features. Although sinus node modification has been reported to effectively slow the sinus rate, long-term clinical response has not been adequately assessed. Furthermore, whether patients with postural orthostatic tachycardia would benefit from sinus node modification is unknown. The study prospectively assessed the short- and long-term clinical outcomes of seven consecutive female patients with postural orthostatic tachycardia syndrome and inappropriate sinus tachycardia who were treated with sinus node modification. The study was conducted in a tertiary care center. The electrophysiological and clinical responses were prospectively assessed as defined by autonomic function testing, including Valsalva maneuver, deep breathing, tilt table testing, and quantitative sudomotor axonal reflex testing. Among the study population (mean age was 41+/-6 years), 5 (71%) patients had successful sinus node modification. At baseline, heart rates were 101+/-12 beats/min before modification and 77+/-9 beats/min after modification (P = 0.001). With isoproterenol, heart rates were 136+/-9 and 105+/-12 beats/min (P = 0.002) before and after modification, respectively. The mean heart rate during 24-hour Holter monitoring was also significantly reduced: 96+/-9 and 72+/-6 beats/min (P = 0.005) before and after modification, respectively. Despite the significant reduction in heart rate, autonomic symptom score index (based on ten categories of clinical symptoms) was unchanged before (15.6+/-4.1) and after (14.6+/-3.6) sinus node modification (P = 0.38). Sinus rate can be effectively slowed by sinus node modification. Clinical symptoms are not significantly improved after sinus node modification in patients with inappropriate sinus tachycardia and postural orthostatic tachycardia. A primary subtle autonomic disregulation is frequently present in this population. Sinus node modification is not recommended in this patient population.

PMID: 11270703 [PubMed - indexed for MEDLINE]

I hope this helps!


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The basic overview of the article Michelle posted is this:

Ablation can make things worse in some patients--much worse. For most people with POTS, treating the symptom of high heart rate is like only treating the last step in a very long string of steps the body goes through before getting to the high hr. For most of us, a better route is to work on building total blood volume by increasing salt intake and fluid intake, by tricking the kidneys into keeping more fluid (florinef), by assisting venous return via compression stockings, by increasing baseline blood pressure via meds (promatine, dexadrine, ritalin, caffeine)...etc. Also, long term use of some antidepressants seem to help stablize the ANS. There's probably more that I'm missing, but my brain is fried tonight...

If you've not been tried on all of above or combinations of the above, then ablation is probably not something to think about yet.

For most of us, the high heart rate is FUNCTIONAL--it's the protective mechanism the body uses to keep the major organs and brains protected with blood flow when ones blood pressure falls. By ablating the nerve(s) in the heart that tell it to pick up the pace, some people with POTS end up having more fainting episodes or near-faints because the heart can no longer shoot up the rate to compensate for unstable bp.

Hope that make some sense. Keeping all that in mind, if all you've got going on is a high heart rate and no other problems (no falling bp, for example), ablation might be a decent option.

At this point, I'd suggest finding a doc who knows ANS stuff, not just an arrythmia specialist. Ablation is not reversible and not a choice to take lightly.

Nina :(

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