SVT and medication

I've had a long history with SVT, going back to those very occasional episodes when I was much younger, to episodes that could last from a couple minute to several hours 2-3 times a year as I got older. I was started on medication for SVT after I presented to the ER with a heart rate of 225 after several hours of this at home. They slowed down the SVT with an IV drip of adenosine- it went down to around 120, then gradually reduced to normal overnight with a digoxin drip. They started me on 100 mg/day of metoprolol succinate ( long acting formulation), and that seemed to keep my heart rate in the normal range for a number of years. They wanted me to have an ablation at the time, but my SVTs were infrequent, so I refused. The cardiologist told me I'd likely have to be on the metoprolol for the rest of my life unless I agreed to the ablation, I told him I was happy to take the medication as it seemed to help.

I had a few side effects when I first started taking the metoprolol, kind of a light-headed, floaty sort of feeling and another side effect I actually liked, which was a calm, calm feeling and nothing bothered me. The light-headedness and floatiness disappeared a couple weeks after I started taking the metoprolol. I still take metoprolol about 25 years later, though now it's 150 mg/day of metoprolol tartrate ( shorter acting, twice a day formulation) and believe it or not, it still seems to have a calming effect on me. I still take it for SVT, but now also for A-fib and flutter.

One of the side effects of metoprolol, along with other beta blockers can be lowering the blood pressure too much in people who have normal blood pressure. These folks could have additional side effects that come with low blood pressure and may be advised not to take beta blockers. But I've had high blood pressure since I was a spring chicken ( genetic) so I have never had those side effect with this drug. In fact, the metoprolol seems to work with the other drugs I take for blood pressure to keep my blood pressure within a fairly normal range.

I can’t answer your question but relative to my experience with NSVT, I am shocked to learn that one can survive VT at that heart rate for 12 hours! When I experienced NSVT at 180 beats per minute for 7 seconds, I was advised in the strongest terms to get a defibrillator asap to avoid the potential for sudden death.
I wonder if my renowned EP prefers being aggressive in this regard, having learned from experience. Could I have avoided the defibrillator?

You may have read this already on another thread, but there is a recently approved nasal spray for aborting an episode of PSVT. It is a drug called Etripamil. ( Cardamyst) It may now be available in pharmacies, I don’t know. I’m also not sure about insurance coverage, and last I checked it is very expensive. This is something I am considering inquiring about as I have a long flight coming up this summer. Good luck.

@marybird
Great information. I have heart failure and one of the prescriptions I take is carvedilol which conflicts with Metoprolol so cannot take both. I am on Mexiletine but not working at all. I am scheduled for ablation June 4th for LV.

I read on poster only having tachycardias 1-2 time a year. I have those almost every day even though am on Amiodarone.

I am interested in the one post about Valsalva or raise your legs and if thy work and how to d l them.

I have a similar situation to yours. I've been on metoprolol succinate for about 2 years now. I had a difficult time adjusting to it for about the first 6 months , with dizziness, fatigue and feeling 'tamped down'. I discovered that I have to eat when taking it twice a day and that helps tremendously. Although the tamped down feeling persists, and I have to take a nap now and then. I have a breakthrough episode about once or twice a year. Most recently during an episode I took 1/2 a metoprolol and coughed hard and the episode abated. I also carry an EpiPen for bee stings and asked my doctor about the effects on my heart if I had to use it. She said there is really no choice but to use it if needed but to get to ER immediately if I did. Not comforting.

@wcuro The answer to that question really depends on your cardiac health in general, and likely the best answers would come from the doctors who know you and your history. Non-sustained ventricular tachycardia (NSVT) is defined as 3 or more rapid beats originating from the ventricles, is self-limiting and lasting less than 30 seconds. It can be considered as a benign condition if the NSVT occurs infrequently in a healthy heart, or as a potential indication for other problems if it occurs, especially frequently in people with cardiac conditions ( such as cardiomyopathies, coronary artery disease).

Generally, ventricular tachycardia (VT) is considered significant if it lasts longer than 30 seconds, and from what I've read, seen when patients experience these longer VTs is when there's talk of implanting defibrillators to shock them out of future events of VT and hopefully prevent them going into ventricular fibrillation, which is often fatal if it's not stopped. Here are a couple of links to excellent articles about NSVT:

https://www.cardiovasculardiseasehub.com/archives/25243 ( This looks to be an excellent site for discussions, and information about cardiac issues, including arrhythmias.
https://my.clevelandclinic.org/health/diseases/nsvt

My husband has had perisodic atrial fib once or twice a year for 40 yrs
His Dr prescribes Inderal to slow the rate down and that helps with symptoms. He also takes Multaq to help convert him back to normal rhythm.
The Multaq does take a few hrs to work. He has sometimes needed a second dose but he has always converted within 24 hrs. In the meantime the Inderal continues to lessen symptoms.

There are definite differences in treatment for SVT and VT. In my previous comment, I was referring to SVT (atria are involved, not ventricles).
Different comments have referred to one or the other.
VT usually required a Pacemaker/Defibrillator.

@kaka50
Yes, letters can be confusing…VT vs. SVT etc.

You can’t feel the difference. One is life-threatening (VT can progress into ventricular fibrillation), while SVT won’t.

I have SVT. Events have been 4-5 a year now for several years. I take atenonol immediately to bring down heart rate. Takes about 15-20 minutes. But over weekend I blacked out almost immediately. I only remember getting the pill swallowed. Woke up on tiled floor with large bump on back of head and horrible back pain still. My Dr had wanted to do a loop procedure which hadn’t been done yet. Should I just ask for the Ablation. I’m really scared that could happen again