I've lived with PSVT for over 40 years, since I was 30. For a while I was keeping track of when I'd have an episode & how long it took me to "reset" the rhythm with various vagus-related maneuvers. During most of those years, I'd have an episode at most two or three times a year; sometimes a couple years would go by with no episodes. In recent years, it seemed my heart could more easily, or more often, start a PSVT episode, then just as easily drop back out. So that was different, but I was still pretty confident of my ability to control it and didn't give it a lot of thought. About a year ago, during an extra-stressful period, I was awakened by my heart pounding double-time. I'd never had PSVT while sleeping before, and I'd never had a "pounding" PSVT before. Anyway, I couldn't slow it down, went to the ER, got some adenosine or cardizem, and that was that. But, I was finally convinced to try some medication and was prescribed metoprolol.

The metoprolol "calmed" my heart, so I didn't get the quick starting & stopping of PSVT episodes, which was nice. The down side though was it seemed like once an episode did start, it was "locked in" and not going to respond to any efforts to reset it. So, over a period of about six months, I made two more trips to the ER for adenosine or cardizem! Easy enough to do, but I didn't want to keep doing it. I read something online about how metoprolol increases the vagal "tone" or activity level (thus that "calming" feeling I had), but in doing so, it raises the threshold of vagal maneuvering required to reset an episode once it starts. Something like that. Anyway, I wondered if there was some other medication that would help in some way other than by increasing the vagal activity level, and asked my cardiologist about that. He suggested continuing with the metoprolol and asked if I would be comfortable with, if an episode started, taking an inderal to help with the vagal maneuvers. I said yes, I would give that a try, and he gave me a prescription for that. (Meanwhile, I also cut out caffeine -- no coffee, no diet coke, no black tea -- and had already cut out alcohol, another sometimes-trigger for me.)

So that's where I am. So far, so good. I've also learned a new approach -- "anticipating" a possible episode, usually based on a quick beat or two that feels like my heart is "thinking" about launching into an episode, and taking an inderal then. No new episodes yet, but it's only been three months. So we'll see!