When should you get a SVT Ablation?

Heart health and blood vessels
1

Hi All,

I am hoping to get some reassurance and advice here if possible.

I am 23 years old and booked in to have a catheter ablation at the BMI London Independent Hospital to cure my SVT in 2 weeks time. 

I am feeling extremely anxious about the operation and worrying that I am going to feel worse after it then I do now...

I had my first SVT attack in October 2016 where my heart rate hit 200bpm and I was taken to hospital and administered Adenosine three times before my heart rate returned to normal. I then had another SVT attack in April which led to me in hospital again and needing Adenosine. 

My question is, after having an SVT twice in six months should I be getting the ablation or would you advise waiting for it to become a weekly/daily occurrence? 

I do experience palpitations daily and an increased heart rate after eating often but i have not suffered from SVTs on a daily basis as of yet. 

As we all know, SVTs won't go themselves so am I right in getting the ablation done now before it gets worse? 

Any advice or guidance would be greatly appreciated. I cannot stop worrying about whether I am doing the right thing and if the risks of the operation are worth it  

Thanks in advance!

2

Hi.

in general, SVT is not life threatening and there are four options. Option 1 is to do nothing. Option two is a pill in pocket approach where you take a pill only during an attack. Option three is to take daily medications. Option 4 is ablation. Going back to option 1, "doing nothing" means medically doing nothing. If relevant, this is a good opportunity to modify your lifestyle which may include losing weight, cutting down on stimulants (coffee,drugs, alcohol), managing your blood pressure and going on a regular exercise program. I assume they took a thyroid panel to rule out overactive thyroid? Sleep apnea is often linked to arrhythmias, so a sleep study would not be out of the question.

I also have been having SVT epiodes for the past six weeks at the rate of 3 per week. Fortunately, they last under 10 minutes and they convert back by themselves without drugs in under ten minutes so I have not had to go to the ER. I am still with Option 1 (doing nothing) but am experimenting with diet and exercise. If things don't get better soon I will speak to my EP about meds and/or ablation.

In your case, you've only had two attacks in seven months, so doing nothing is a very reasonable option. Have they taught you how to do the valsalva maneuver or the modified valsalva maneuver at home? This or other techniques could conceivably save you a trip to the ER. Or maybe they tried these manuevers at the hospital before adminstering Adosonine? If not, they should have. Did they have you blow hard into something and then possibly elevate your feet?

In the end, it's a very individual decision regarding ablation. The good news is that SVT ablation is a shorter and safer procedure than afib ablation and the success rates are very high around 90% I believe. But it's still an ablation with general anathesia and all which is my understanding.

The other thing is that my understanding is that SVT, while it can happen at any age, is more common with young women and that they can outgrow this condition when they get older. Has your doctor brought this up?

No easy answers, but a second (or third) opinion from both an EP (and cardiologist) might be reasonable. Just be aware that EPs tend to favor ablation because that is what they do. Doesn't make it the wrong choice, but doesn't make it the right one either.

I asked my cardiologist when does he recommend ablation and his answer was when the patient asks for it. What he meant was that ablation in most cases is more of a lifestyle decision than a medical one because the other options are all valid. 

The phrase "breaking point" is sometimes used with SVT and ablation. And that's when you just get so fed up with the episodes and/or medical treatment, that you say, "enough' and do an ablation. With my frequent episodes, I'm getting near that breaking point but it doesn't seem you are.

No right or wrong decision but if unsure, take your time to think this through and get more opinions and don't feel don't be pressured by your two week deadline. You can always reschedule if need be.

Jim

 

3

The daily symptoms you are getting won't go away with the ablation, in fact for some they get worse.

I think the right time to have an ablation is when the SVT is having a considerable impact on your quality of life  (in its episodes, not anxiety) and you've done all the research you can do, have asked all the questions  you need to ask, know all the risks and potential outcomes and feel that the impact of it on your life outweighs the risks.

Back when I was your age you would not have been offered an ablation after two episodes but things have changed and it's now commonplace.  I was diagnosed at 24 but had symptoms from the time I was a kid and now 45 and have chosen to manage it and consider an ablation later.  I've had adenosine many times but I've also learned to convert it myself and that's worked many times too (have a look at u tube modified valsalva trial). It's a very individual choice.

4

Just want to add that some here have had success with the FODMAP diet. You can look it up online and there is a good phone app from Monash Unversity in Australia. Like yourself, I have daily PACs and after eating is often the tipping point where they convert into SVT. Right now I'm experimenting with FODMAP and smaller meals.

Jim

5

Thanks for your response. I don't smoke, drink or have caffeine, I also exercise reguarlly and have a healthy diet so I have no concerns that is related to my health...I don't think there is much more I can improve on there! 

They have tried  valsalva maneu both times and I have also tried techniques such as blowing into a syringe but unfortunately neither of these helped and I had to have adenosine both times.

I have never heard about women growing out of it, I was told it became more of a problem during pregnancy which also worried me as I would be looking to start a family soon./ 

6

Thanks for your response. 

I have read they get worse for some people and that is what scares me as currently it does not affect me in my daily life much...I don't want to do something which will make it worse. 

As the ablation has a high success rate, I am hopeful that the risks are not too much of a problem....

7

Good afternoon , Jim . Where did you get the information that young women can outgrow svt?

I have never heard about it before.

 

8

yes I definitely get more episodes now than I did when I was young.  At age 40 I went through a very stressful time and at that point started to have them more frequently.  I was offered an ablation then but was told there was no harm in not having one but that I'd get sick of increasingly having to go to the ED.  I go through stages of them happening more often and then not having one for months and it doesn't increase exponentially. The last two years have been less than the year before that.  Diet makes a difference and knowing the triggers (Sleep deprivation, PMT, stress, stimulants etc).

9

I can,t advise you I,m sorry but I have the same problem, a couple of attacks in a year requiring hospital help and always after I,ve eaten i feel pounding pulse and discomfort, ii,m on the list for ablation but like you I,m not sure whether I want to go through with it.  Normally my attacks were short and went back on their own.  I,m 71

10

Glad to see that you are making good lifestyle choices but you still might want to look into the FODMAP diet if so motivated. Next time, and hopefully there won't be one, ether try or have the hospital try the "modified valsalva manuever" which came out of the REVERT trial. You can look it up online with videos on how to do it.

As to "outgrowing it" let me try and separate fact from speculation. The fact is that many types of SVTs are more common with younger women then in the general population. There is also some thought of a relationship/morphing between SVT and panic attacks, so treating any anxiety is reasonable. I have read on at least one website (BUPA) that SVT can get better when you get older but I have also read the opposite. I have also read several anecdotal observations on women outgrowing SVT with age. At least one that supports it, and several that don't. So in conclusion, as a young woman, you may outgrow SVT but then you may not. I would still ask your doctor about this. I have also read that pregnancy can be a SVT triggger. It's not an easy decision because medically you don't need an ablation but on the other hand it can be a reasonable decision. How and when you make that decision is very individual.

Jim

Jim

11

Ann, Food is a big trigger for me. Seems to happen not during the meal but within 10 minutes of getting up and walking around. Lately trying smaller and more easily digestible meals and instead of getting up right after I finish, sitting around for at least 30 minutes to give the digestive process a head start. 

Jim

12

Ann, forgot to ask at one age did the attacks start, what is the frequency of attacks and about how long do they last.

Jim

13

Hi Caitlin. I had numerous episodes of SVT, hospitalisation and one incident when I blacked out with a change of SVT medication. Can I suggest you have the ablation and kick SVT into touch. After the black out I was forbidden to drive but could after the ablation.  There is nothing to fear with the ablation. 

14

Yes, I get about an hour of palpitations after I,ve eaten my main meal, I graze throughout the day on small amounts until my evening meal at 6pm, I never eat large amounts but get the discomfort anyway.  I do not eat then until 7 am because going to bed with food in my stomach causes me problems and results in me getting short episodes of Svt.

15

i started having palpitations when I was 28 and had small attacks of svt in my 50s which have got worse in the last 2 years resulting in the dreaded adenisone to put it back.  I did not know what they were until last year, I had gone to accident and emergency a few times and my heart had gradually slowed down by itself by the time I was seen, the big one was last year at 196 beats which had to be put back, since then I,ve had 3 more attacks which is one every 6 months, I,ve been put on the list for ablation but am unsure whether I will go through with it, I,m quite active for my age and live alone, I wouldn,t want to be a problem to my family who all go to work.

16

Ann, I"m sort of doing that now, grazing through the day but it's difficult because I'm used to larger meals and while my BMI is good, I probably need 2,500 or more calories a day to maintain weight. No idea how much I'm going to lose on my current grazing diet! Did I mention I'm also doing the FODMAP diet but a lower protein and fat version. Curious how much exercise are you doing and does it seem to help?

Jim

17

So far no dreaded adenisone as my episodes are under 15 minutes and convert at home with either valsalva or just waiting it out, although my last two episodes were out on the street which was very stressful. 160-190 bpm is typical of my episodes. Just ordered some Terumo 10ml syringes which are supposed to duplicate the pressure used in the REVERT study for the modfied valsalva manuever. I have also read, I believe here, that putting ice bags over your eyes is another way of converting. I think I will try that next time and if so, maybe carry some some with me when I go out in an insulated bag. Probably cause less attention than sticking a syringe in my mouth!

Jim

18

 Hi, I am 13 dats out from my ablation and I can say the procedure is not a fun day but it is not something to be as scared as I was leading up to it. It is pretty routine. The recovery has not been bad, I am trying to hold myself back but I am back at the gym lifting about 90 percent of what I was and doing 30 min of Cardio. The groin area is back to the same as it was before. I was nervous but was able to do some leg exercises yesterday. I would say give it a try. The one thing I can't tell you yet is it worked. I won't know that until I have a few drinks or push myself and don't have any episodes.

19

My apartment looks out onto a field, I live outside London, I walk in the afternoon and in the morning I always go out to the town, I,ve always been active, worked until I was 60 and brought up 3 children, never have done serious exercising because I never had the time just ate healthy.    I,ve never been overweight and exercise became more important to people later on in my life,I was born in 1947 in Wales uk we did a lot of exercise walking 3 mile and back to the nearest village to catch the bus. Lol

20

Thanks so much for your reply. I have decided to go ahead with it, so this is reassuring to here. How long did you have off from work? Glad to hear you are recovering so well!