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Should I have stopped my medication before SVT ablation?

Posted by brennane01 @brennane01, 2 days ago

I was recently diagnosed with SVT, about a month prior to my ablation surgery. I’m 22 years old I don’t drink, smoke or do drugs. I’m overall a very healthy individual and never had heart problems in the past. Since my diagnosis last month I’ve had five episodes all of which have put me in the Er. I’ve had two cardioversions and three or four shots of adenosine along with many other medications to break my abnormal rhythm. My cardiology team has experimented with a few different beta blockers and calcium blockers which haven’t work. Im having more frequent episodes that are still hard to break, and put me in the ER. I was encouraged to do an EP study with a catheter ablation to hopefully fix my SVT permanently so I can resume working, and normal activities again. I got this surgery done last week and it was unsuccessful. My EP said he was unable to induce the tachycardia therefore unable to ablate anything. I was very disappointed and moving forward my only option is to continue experimenting with medications and potentially try again in a couple months. I’m currently taking diltiazem 240MG and was recently prescribed flecainide 100MG after my surgery. I did a little research and found that others were told to stop medications like diltiazem days prior to surgery to drastically increase their chances of inducing arrhythmias at the time of surgery. I was never told this by my doctors or nurses, in fact they told me to continue taking my medication as normal. I’m curious if this could be part of the reason they couldn’t induce my SVT? Is it common to stop medications like diltiazem 3 to 5 days prior of an ablation surgery? I’m having a hard time understanding how my episodes can be very frequent and yet they couldn’t induce it at the time of surgery, is this a common occurrence? Please share with my your experiences with SVT ablation what instructions were you given prior to surgery

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suerte | @suerte | 1 day ago

Listen to your doctor. I was diagnosed with Afib and went on Eliquis that day. Still taking it today. Started on Diltiazem and then was switched to metoprolol. I was on Eliquis when I had a cardioversion. When I had a Pulse Field Ablation, I was instructed to stop taking it 2 days before the ablation. Back on it the next day. I was taking metoprolol and never stopped taking that drug. Same with cataract surgery. I stopped taking Eliquis 2 days before the surgery and then started taking it again 3 days after. I had stopped taking the metoprolol prior to the cataract surgery.

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marybird | @marybird | 1 day ago

Quite often before a cardiac ablation the patient will be instructed to stop taking the medication used to control the tachycardia/arrythmias, ( beta blockers, diltiazem, or anti-arrythmic medications). The purpose of stopping the medication is for the best chance of the EP being able to induce the arrhythmia/tachycardia during the ablation. Specifically how long prior to stop the medication is specifically directed by the doctor, that time can vary. My daughter had severe sinus/atrial tachycardia from ???? causes in her 20's, medication didn't work all that well to control it, and she had 7-8 ablations over several years to try and bring it under control. I recall there were times she was instructed not to take the beta blocker ( other medication later on) for as long as 5 days before the ablation to ensure the EP was able to induce the arrhythmia to ablate it, other times it was for 3 days. It got to where for her last several ablations, her tachycardia was constant ( base heart rate of 130, would go up to 200 when she got up and walked across the room), and they had her taking her medication up until the day of the ablation.
So it really depends on the doctor's instructions as to if and how long you would withhold your medications before an ablation. If they told you to continue taking your meds that's what you do, I'd guess they were confident enough that they'd be able to induce your arrhythmia during the ablation that they felt you didn't need to stop taking the medication beforehand.
In another "unable to induce" ablation scenario, I was informed by an EP I saw that there is one atrial arrhythmia, atrial tachycardia, that is often notoriously difficult to induce in an electrophysiology study/ablation. I'm not clear as to why that would be except that it can be difficult to find the "earliest activation site" ( where the aberrant signal starts) as atrial tachycardia is of different types and can be multifocal. As the EP told me, atrial tachycardia "doesn't act in the electrophysiology lab like it does in nature", and if it can't be induced, it can't be ablated. I'd had a long history of SVTs, which after this EP reviewed my EKGs and cardiac monitor reports showing this tachycardia, he labeled it as probable atrial tachycardia and he was reluctant to try and ablate it, he wanted to treat it medically instead. By the time I saw him I'd developed sick sinus syndrome, with both bradycardia and the tachycardia, and when the bradycardia failed to resolve after I stopped the metoprolol I was taking, and diltiazem didn't work well for the tachy and I still had bradycardia, he implanted a pacemaker. This allowed me to take as much of the medication as needed to control the tachycardia.

Anyway, it's hard to tell if your tachycardia might have been induceable during your electrophysiology study had you stopped the medication well before the procedure, or your arrhythmia is of a type that's difficult to induce in the electrophysiology lab. Your EP would likely be able to shed some light on this if/when you see this doctor at a subsequent visit.

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gloaming | @gloaming | 1 day ago
In reply to @marybird "Quite often before a cardiac ablation the patient will be instructed to stop taking the medication..." + (show)
Profile picture for marybird @marybird

Quite often before a cardiac ablation the patient will be instructed to stop taking the medication used to control the tachycardia/arrythmias, ( beta blockers, diltiazem, or anti-arrythmic medications). The purpose of stopping the medication is for the best chance of the EP being able to induce the arrhythmia/tachycardia during the ablation. Specifically how long prior to stop the medication is specifically directed by the doctor, that time can vary. My daughter had severe sinus/atrial tachycardia from ???? causes in her 20's, medication didn't work all that well to control it, and she had 7-8 ablations over several years to try and bring it under control. I recall there were times she was instructed not to take the beta blocker ( other medication later on) for as long as 5 days before the ablation to ensure the EP was able to induce the arrhythmia to ablate it, other times it was for 3 days. It got to where for her last several ablations, her tachycardia was constant ( base heart rate of 130, would go up to 200 when she got up and walked across the room), and they had her taking her medication up until the day of the ablation.
So it really depends on the doctor's instructions as to if and how long you would withhold your medications before an ablation. If they told you to continue taking your meds that's what you do, I'd guess they were confident enough that they'd be able to induce your arrhythmia during the ablation that they felt you didn't need to stop taking the medication beforehand.
In another "unable to induce" ablation scenario, I was informed by an EP I saw that there is one atrial arrhythmia, atrial tachycardia, that is often notoriously difficult to induce in an electrophysiology study/ablation. I'm not clear as to why that would be except that it can be difficult to find the "earliest activation site" ( where the aberrant signal starts) as atrial tachycardia is of different types and can be multifocal. As the EP told me, atrial tachycardia "doesn't act in the electrophysiology lab like it does in nature", and if it can't be induced, it can't be ablated. I'd had a long history of SVTs, which after this EP reviewed my EKGs and cardiac monitor reports showing this tachycardia, he labeled it as probable atrial tachycardia and he was reluctant to try and ablate it, he wanted to treat it medically instead. By the time I saw him I'd developed sick sinus syndrome, with both bradycardia and the tachycardia, and when the bradycardia failed to resolve after I stopped the metoprolol I was taking, and diltiazem didn't work well for the tachy and I still had bradycardia, he implanted a pacemaker. This allowed me to take as much of the medication as needed to control the tachycardia.

Anyway, it's hard to tell if your tachycardia might have been induceable during your electrophysiology study had you stopped the medication well before the procedure, or your arrhythmia is of a type that's difficult to induce in the electrophysiology lab. Your EP would likely be able to shed some light on this if/when you see this doctor at a subsequent visit.

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@marybird EP's are trained with several 'tools', one of which is a way to 'challenge' the heart to get it to reproduce the arrhythmia. While you are awake, if you're brave enough, or while you are sedated and about to undergo the ablation procedure, they can inject caffeine, adenosine, or isoproterenol. Or all three. These are goads, or stimulants, that often make the heart go into arrhythmia and with that the places where the rogue electrical signals originate can be easily located by the mapping system they use. From there, it's easy to begin ablating the appropriate tissues.

I don't know if this was done for you, but very unfortunately, you did not get any tissue ablated. In a way, as much of a bummer as it turned out to be, that's not a bad thing. You're still in the earliest stages with infrequent episodes, so that's about the best spot you'll ever be on this long journey with an electrically disordered heart. There's time yet, years perhaps, until it becomes so annoying or intrusive that it will be more easily ferreted out by a skilled and experienced EP.

I had two ablations seven months apart. First had me in hospital for a day on the sixth day. I had to go on amiodarone for seven weeks....thankfully only seven weeks. Today, I am 39 months free of atrial fibrillation (AF), but it took a second kick at the can to get it right.

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