What more can I do???

[Doggiemomma]

I'm having monthly episodes of SVT now, the latest last Mon (12 7 2020) did not resolve at home when I took another Metoprolol Extended Release tablet as my EP suggested, so off I went to the Emergency Room for an intravenous of different meds. Beta blocker intravenously did nothing, but calcium channel blocker IV did bring me into NSR. My EP said sometimes it doesn't make sense, and the 2 different meds might have worked together. It's a mystery to him, too.

I don't drink (no alcohol, no soda, no carbonated water, no flavored water, no tea, no caffeinated or decaffeinated beverages, etc), I've never smoked anything, & while I'm overweight, I eat a healthy diet. I can find no trigger to these episodes.

After this latest visit to the Emergency Room, my EP and I talked about some medication options & changes. I sure don't want to get an SVT ablation during this time of COVID! I'm hoping another medication adjustment will be effective.

I'm VERY concerned about increasing my beta blocker as that already slows my HR into bradycardia, and my EP knows this, but he suggested trying either 50 mg extended release instead of 25 mg extended release, or taking 25 mg faster-acting metoprolol as PIP along with the 25 mg extended release that I already take, or just take a 50 mg extended release tablet, to hopefully avoid another episode of SVT.

I also take 150 mg of Flecainide twice a day, taken on an empty stomach (I don't eat 2 hours before or 2 hours after I take the Flec)--I'm at the max daily dosage, no changes with that.

Does anyone have any suggestions for a BB that wouldn't slooow my HR? or any other input that I could run by my EP? Sorry this is so long, I wanted to give the big picture in the hopes of getting more info, realizing that no one will be giving medical advice, just suggestions of what might work better.

[Hidden]

The simple answer is not a lot. Clearly you are doing all the right things in terms of lifestyle. I’m no expert on yoga etc but there may be areas there which might help to keep you calmer and more relaxed but it looks as though you really need to consider an ablation especially as you are on maximum doses of Flecainide. Here in the UK there are stronger rhythm drugs such as Amiodarone but they are not recommended for longterm use. We can all understand your concerns about Covid, but hospitals here have worked hard to maintain Covid safe units for treatment and hopefully the advent of vaccines will make hospitals even safer. Sorry I cannot be more helpful but ablation would seem to be the best route forward for you. Again here, waiting times are long, but that may not be the case in the States. Best of luck, hope you soon find some solutions......

[Doggiemomma in reply to Hidden]

Thanks, FlapJack... well darn it that there are no stones left unturned, except to try yoga. I have been practicing, not yoga, but deep slow breathing and that doesn't help with the SVT either. Thanks again for your reply!

[mjames1]

In the meantime, have you tried the modified valsalva manuever at the onset of your

SVT attacks. Google it. It is now the first line treatment at many ER's for SVT.

[Doggiemomma in reply to mjames1]

Yes, mjames1, I have indeed tried that, along with a lot of other hopeful interventions, with no success whatsoever. Thanks for your thought in adding this info!