Supra Ventricular Tachycardia

Hi. I too have had SVT. I had a stroke (mild thank God) last year and then heart issues beginning the following year. My first episode, I did not go to the ER as I just didn't know to, and was able to get my HR under control. It took about 45 minutes in total and had jumped to 220. It stayed elevated all night, but was "better." The next time I had an episode, I had to be taken to the ER and was in the hospital for a couple of days. I had worn a holter monitor previously for a couple of weeks, and the ER cardiac docs were able to read it to see all of the arrythmia issues I was having, with bi/tri and even quad geminis. I was high dosed with a beta blocker which kicked my butt. When I finally got an appointment with an electrocardiologist he took me off the metoprolol and put me on an anti-arrythmia med: Flecanide. I also had a stress test, CAT scan, and EKGs, and found that the structures of my heart are good, it's the electrical impulses that are out of whack. Ablation came up during my hospital stay, but my Cardiologist said the Flecanide would be what would work (and it has) and also making sure I'm hydrated, watching alcohol intake, exercise, and trying to manage anxiety and stress.

Hello, and welcome. The rate control medicines, those such as metoprolol, act in two ways, and because they act in concert they tend to be aggressive in some patients to the point where they are officially in bradycardia (heart rate below 50 BPM). The beta blockers act by reducing the strength of contractions and by lengthening the interval between contractions. The net effect, ideally, is that the blood pressure gets reduced for those in incipient hypertension (those with more serious hypertension will need other medication or treatment), and for those experiencing tachy-arrhythmias, the rate will ideally come down to 100 or lower. The heart is amazingly robust and durable, and it can go a long time in higher rates, just not for days or weeks. It will tire, just like any muscle doing hard work. So, even if the arrhythmia persists, if you can control the rate with BBs, great. The only arrythmia that is exceedingly dangerous and that needs critical and urgent care is ventricular tachycardia. The others you can put up with, leaving some awful symptoms aside, for a long time.

To get to the point, beta blockers do a good job, but some individuals don't respond well, or they respond overly and enter bradycardia. Often the dosage needs to be reduced, but then the rate control may go wanting, which is counterproductive.

Second point. Arrhythmias tend to get worse over time, even when treated fairly well by medication. They'll begin to come on more frequently, and they'll tend to last many hours. This is a sign that the heart has remodeled itself. It means the heart is finding durable pathways for spurious signal and the extra signals make extra beats, or the chemistry is wrong in the sino-atrial node where the signal is mean to be issued sequentially and in a frequency that sustains the body...only. On higher demand, the SA node raises the rate. For some reason, tachycardias seem to be runaway at times and there's no relief unless you take higher doses or have a pacemaker installed. I don't know that an ablation will work, but it might, especially if the SVT we're talking about is flutter or atrial fibrillation (AF). If either the SA node or the Atrio-Ventricular Node further down the septum from it (AV Node) is defective and can't be treated, then a pacemaker must be installed, and one or both of the nodes must be ablated to 'kill' them. You become reliant on the pacemaker solely.

This may all sound draconian, but it IS the protocol, with some variation between patients AND their attending physician/experts (who are individuals after all as well). The various diagnostics are contrast dye treadmill stress tests with CT scan (called a MIBI test), angiogram and MRI to determine is there is substantial atherosclerosis that might be impacting the heart's ability to feed itself, and of course Doppler/Echo ultrasounds and cardiograms to do much the same, all of it meant to determine if ischemia is the cause of your heart's stress and arrythmia, or if it's apparently just an electrical disorder. If you are electrically disordered, you see a cardiac electrician, an 'electrophysiologist', and you'll want to do some work to find the best available. You want an EP who is busy, highly sought, highly regarded (especially by the OR staff who work with her/him), and whose record of success with index ablations (first ablations) is a minimum of 75%, but better than that is what you'll find claimed for the very best EPs in the land. Two crackerjacks are Dr. Andrea Natale at the Austin Cardiac Arrhythmia Institute (he has privileges in several hospitals in several states and travels to them to perform ablations), and Dr. Pasquale Santangeli at Cleveland Clinic. There are certainly others, but I have not heard of them or have not remarked on their names when seeing them offered by other posters here.

I have said a ton. The EPs really know their stuff, and most of them are good at stemming arrythmias. It isn't always the case, though, that a tachyarrhythmia will respond well to an ablation unless the cause is firmly established that way. It may be that the nodes themselves are problematic and you'll need a pacemaker.

I also have experienced SVTs and the "no energy" side effect of beta blockers. I moved my beta blocker schedule to take it right before bedtime. Now, most days, I don't need a 3 hour afternoon nap.