Ectopics & SVT

[Alldone]

Hi Everyone

Its been a little while.

My history is Ablation June 2021 which was successful. However, I now get ectopics and SVT's. I has a 24 hr hospital monitor which confirmed this via my EP. They are not severe but hugely disruptive and the worry of "will they won't they" is as bad as them actually happening.

3 months ago I had a very short A Fid event of 1 hour self converted but my EP suggested going back on Flec which I have done so. I actually decided to stop alcohol completely - 1 bottle per weekend (over 3 nights) when I also smoked 4 - 6 cigarettes per week. I am not entirely sure that has made any difference as it was the same time as the flec. restarted and it was never brought on by either previously, but I don't miss it anyway.

The problem I have is that I had the ablation to stop the meds. Since being diagnosed I have also had at heart scan which has shown zero calcium so my heart is in good shape outside of this.

I am due to see my EP tomorrow for a follow up and I want to ask about ablation for the ectopics but I am not entirely sure that it is a possibility.

Has anyone had a succesful ablation for ectopis/SVT?

[BobD Volunteer]

Ectopics do not normally respond to ablatiom I'm afraid as they are a normal function of a healthy heart. Even normal healthy people have up to 200 a day.

Try the slow deep breathing trick. Breath from diaphragm not shoulders and slow breathing to less than six breaths per minute for at least five minutes. Works a treat.

[Alldone in reply to BobD]

Hi Bob and thank you . Does that work for SVTs only not finding a good solution for them. Also, do you know if the SVT could be ablated?

My thinking is that having had an a fib event, if they do increase then could a 2nd ablation cover everything? A bit premature I know but it would be good to think it could all be solved. Too optimistic? 🤔

[BobD Volunteer in reply to Alldone]

SVT can be treated with luck. Nothing in this game is certain and we are all different.

[Samazeuilh2 in reply to Alldone]

It's very important to get adequate sleep and avoid sugary foods. Some people find a magnesium supplant is helpful (but discuss with GP first).

[MikeThePike in reply to BobD]

Hi BobD. Can you please explain where you got this information? My understanding is just the opposite. Ablation is the only known way of eliminating ectopic beats originating from a particular group of cells within the heart. It's true that they could start again from a different group of cells but this is not guaranteed to happen. It's also true that success of ectopic ablation strongly depends on if they are coming from a single location in the heart or multiple locations. Also, some parts of the heart are harder to reach with the ablation catheter (wire) or they are more sensitive to damage so cardiologists are reluctant to operate in those regions. People on this forum and others have had successful ablations for ectopic beats and have had total relief for many years. One man said he went for eight years before they recurred. I personally would be happy if I had 8 years relief from my PVCs as I'm sure a lot of other members here.

[BobD Volunteer in reply to MikeThePike]

Very few EPs are interested in ablating for ectopics since they are a natural function of a healthy heart. Since I have been involved with the charity ( when it started in 2007) I have not known of anybody who has had an ablation for such. Yes they can be irritating . I had a very annoying three months when every 2nd, 3rd.4th etc up to 11th beats were ectopic returning to 2nd 3rd etc. continuously following my 3rd AF ablation in 2008 but they did settle helped a lot by the breathing trick.

[Alldone in reply to BobD]

It’s reassuring to know that these events come and go, so I hope mine do the same. I have just seen my EP this evening and we have decided to stop the flec as per my reply to CDreamer. So fingers crossed all stays calm without it .

[MikeThePike in reply to BobD]

BobD thanks for your reply but I think they are interested but reluctant to offer ablation to those who have low ectopic burdens of say a few percent because the procedure is very expensive and they can't guarantee that there will be enough PVCs active long enough time for them to successfully map them and pinpoint their location for ablation. It takes a full team of specialists to perform one ablation. It's a very expensive operation which the NHS (for example) can't afford to do for everyone so they choose patients who have a high ectopic burden (>20% or so) as they are most at risk of developing heart failure and the frequency of the ectopic beats (dozens per minute) makes them very easy to map with their software. I know this from doing lots of research and speaking to the arrhythmia specialist nurse at Royal Papworth. They offer ablation services to cure ectopics but when you ring them up they tell you it's not available to everyone. I bet if you were prepared to pay privately they would do it for you as all of their top EPs do private work. Check their website.:

royalpapworth.nhs.uk/applic...

Check page 9. What I'm saying is true.

I agree that many people don't have ablation for ectopics. I think this may be because they have not been offered the procedure, don't understand the procedure, are scared of the procedure or can't afford the procedure. Private ablations cost thousands of pounds in the UK.

[Ppiman]

It's good that your scan showed such clear heart, although I don't know your age. I was told the same after an MRI (but with LBBB and a "wide QRS"). I gather that ectopic beats and tachycardia can arise in two ways "focal" (i.e. a single point) or "multifocal" (i.e. multiple areas). The first, if the area can be found, can be ablated successfully; the latter, not. Ectopics need to be very bad for them to ablate them, I gather,

I get ectopics most days, some worse than others. They feel as bad as AF to me, which I get very irregularly. I also get mild tachycardia, which of late has been infrequent (it is usually 85-130bpm). I don't know whether this is SVT or not as the Kardia doesn't differentiate it and my doctor failed to tell me.

Steve

[CDreamer]

Hi - firstly WELL DONE kicking the wine and the cigarettes! That will do a lot more good than taking Flec or considering another ablation but you need to give it time.

Secondly - I would go the lifestyle route way before taking Flec and use the breathing techniques Bob suggested. Stress and anticipating what might happen are the perfect combination for triggering SVT’s. Relaxation techniques really do work.

Many people find they have SVT’s and ectopics following ablation and most people find they eventually disappear with calm and breath work.

Best wishes.

[Alldone in reply to CDreamer]

Hi CDreamer

I value your input as along with Bob I see you offering great advise often!

I would like to come off the flec and am going to ask if that’s a good idea so that I can see what’s currently happening.

I am trying so hard to push it back in my mind and it’s getting easier but so very slowly.

On the plus side I restarted running at a sensible rate, along with Pilates and weights. Previously I felt that I needed to get back to where I was pre AFib but I am coming round to being more reasonable with my expectations.

Thanks for the praise by the way, really appreciate that.

EP appt this evening so see what he says🤔😀

[CDreamer in reply to Alldone]

That’s obviously up to you and your doctor to decide. In these situations I think one needs to consider - Am I better with or without overall and long term. To get you through a particular short term problem it may help but I would also consider what may happen longer term as well as how may I be without. Good luck with the appointment.

[Alldone in reply to CDreamer]

Hi

We have decided on stopping the flec immediately and he is going to order a 7 day monitor to just check on what my heart is doing over an extended period. He said with the lifestyle change it should help enormously and he referred to a recent study undertaken in Australia with drinkers vs non drinkers and AFIB. Results showed overwhelming reduction in “events” for non drinkers, way better than they expected. But the main thing is that the drinkers had no more than 14 units a week so really not as much as you would have expected for such positive result. I am assuming that will refer to SVTs as well?

If I do need to go back onto meds he will change the flec to another med which he says does not give the blurry vision which is my side effect. Not sure what is was but began with P and they don’t prescribe it very often - I assume it must be an expensive drug!

Seems like a good plan to me.

[needlestone]

yes. I had a successful ablation for SVT. Some alcohol still sets off ectopics but I just deal with it and not afraid of them as my heart is in pretty good condition overall. I had terrible SVT in my mid forties where my heart rate would shoot up to 250 bpms almost daily. After ablation, I continued to havecectopics until a naturopath suggested I try going gluten free. So I tried it and everything calmed down. I also must avoid artificial sweeteners like aspartame and sucralose as they both will instantly set off my heart. I also notice caramel and hard liquor can trigger my ectopics. I don’t have problems with gluten free beer or the alcoholic seltzers as long as I don’t overdo them. I have not taken meds since my ablation in 2016. Meds made me feel like a zombie so I do what I can to avoid my known triggers.

[Alldone in reply to needlestone]

Thank you for your reply.

It’s so hard to know what starts and stops all of this. Alcohol for me wasn’t a problem but I am glad I stopped it anyway so that’s a bonus.

I am not too sure which was to go at the moment but I will see my EP later and see what he suggests. I see him privately and that makes it easy to have 3 monthly follow ups which makes me feel secure.

My mom used to say “never worry worry until worry worries you” So I do try to push it back as much as I can and I am getting better, albeit very slowly, at doing that.

[CDreamer in reply to Alldone]

Love that saying of your Mom’s - so true but so difficult to achieve.

Everyone’s triggers vary and I remember Bob saying at the beginning of my AF journey that chasing them is the road to madness and I sort of learned what he meant. You think you have nailed one trigger and another pops up, rather like the Bat the Rat game.

Having said that there are various substances that most agree will cause arrythmias and aspartame and sugar and NSAIDs are top of that list, alongside cigarettes and alcohol so best avoided or at limited to small amounts on rare occasions.

Any stress - physical such as biological pathogens such as infections, excess physical activity, certain food/drinks, psychological such as worry thoughts causes an inflammatory response. Inflammation = biological response such as arrythmias, high BP, fatigue and many other symptoms.

[Alldone in reply to needlestone]

Hi and thank you for taking the time to reply.

The overall theme seems to be that these things seem to come and go, sometimes without rhyme or reason? A colleague of mine recalled a day about 6 years ago when I was in work and telling him that my heart rate was all over the place for the whole morning and he suggested a trip to A& E. I was very matter of fact about it and I now know that was AFIB but somehow I just managed to brush it off. We are told it won’t, or at least shouldn’t kill us and again my EP stressed my own extremely low risks of stroke and heart attack, but somehow once your focus becomes 100% heart based we don’t truly believe it. I do know I am extremely lucky at the moment with good health and mobility around this. So for now going to refocus on the positives and see how that goes.

😊

[theohappy]

Hi, I had an ablation this past May. I am just now starting to settle into NSR without any drugs. I still get AF for brief periods of time. I've only been on Diltiazem and though not a rhythm drug it kept me in NSR. Slowly weaning off of it. Have you considered something less strong than the Flecanide as you try to move off drugs? Also, I get quite a few ectopics throughout the day. My EP tells me no big deal. Though I prefer to see the words Normal Sinus Rhythm on my kardia versus Sinus Rhythm with supraventricular ectopics. I have a history of Tachycardia so I get that as well, usually after exercising. I am working on breathing and relaxation exercises, along with building up my heart and lung strength. I had a pericardial effusion after my ablation. So still working through that, along with the surgery that went with it.

[MikeThePike in reply to theohappy]

Thanks for sharing your experience. I really wish someone would explain why AF ablation always seem to result in ectopics. What I find interesting is that some people still experience fast arrhythmias after AF ablation and need meds while others don't. Could this have something to do with the mapping stage of the procedure? Perhaps all the necessary ablation sites are not accurately located so they are missed or maybe the heat energy damages good heart heart cells along with the bad so they they start acting up. Who knows? I wish someone could explain it! Mind you I notice that you had your ablation only a few months ago so it's likely your heart is still healing and the brief periods of AF may eventually stop. Would you mind telling me a bit more about the pericardial effusion? I have heard this is an ablation risk. When did this occur and how is it being treated? How has it affected you?

[theohappy in reply to MikeThePike]

Hi Mike, So did not mean to be misleading, but should have stated my PE was not due to my ablation. I had and ablation and a Watchman device placed at the same time. It was the Watchman that caused the PE. It poked a small hole in the outside of my LAA (left atrium appendage). Unbeknown to me for 7 weeks!! Because I had both surgeries at the same time I kept being told, it takes a longer time to heal when both procedures are done at the same time. I thought I was just being inpatient. Unfortunately, I got to feeling SO bad and in pain I finally went to the ER, where after a brief time and testing I was told the bad news. I had a really bad PE, along with a pleural effusion in my left lung. The heart normally has 40 cc's of fluid in the pericardium, mine had 600 cc's! Because the fluid was a mixture of clear fluid and old blood the only way to resolve the PE was through what they call a pericardial window to my pericardium. So they cut a 3 inch hole in me between my breasts to perform the surgery. They also did a puncture hole beneath that where they placed a drain for the pericardium to continue to drain for about a week. It was and has been just a horrible surgery to have and recover from. My heart with the ablation, Watchman, and then emergency surgery has been through quite the trauma. It will be months still before I regain my endurance back in my heart and my lung. I was on an antibiotic for possible infection for a brief time, but mostly in addition to the surgery, I was put on a diuretic for about 5 weeks. Diuretic common for PE treatment.

But you are right about PE's being somewhat common for ablations. With an RF ablation it can result from small microperforations since they crossover into the right atrium. But, I read a study where it stated Cyro ablations equally as common for a PE. Also there is a higher incidence of PE's that occur in coronary artery diseased patients. Just what was stated in the study. Usually, however, the PE's are mild and easily treatable. They typically occur right away and can be dealt with. In my case someone should have checked me out sooner. Because I felt so bad, I had bloodwork done that indicated I was anemic. And I was having bad reflux at the time. Those two things combined made me excuse my own symptoms, until I simply was convinced something was really wrong with me.

It is actually pretty amazing that my heart is now about 95% of the time in NSR. I was told it would be quite some time before that happened. I have high hopes that the ablation was successful, but needless to say the process will be longer for me. On the bright side my Watchman is completely sealed and I am no longer on a blood thinner. Axiaban/Eliquis caused my acid reflux and I am much improved since being off it.

Hope this wasn't too long a reply. But, don't fear a PE with an ablation. It is normally easily treatable.

[MikeThePike in reply to theohappy]

OK, many thanks for the clarification. Personally I think ablations are like a miracle procedure. To be able to home in on the tiny electronic pulses generated by rogue cells inside the heart and blow them up like a heat seeking missile is just amazing. I only wish they could make the procedure a little less risky with fewer side effects. I'm sure the technology will get even better but how long will we have to wait for it do so?

[theohappy in reply to MikeThePike]

They are always improving the procedure. And the new pulse field ablations should be through trials and FDA approved in about two years. The PFA does not burn or freeze the heart. It will be quite the game changer. Google it if you have not heard about this.

[MikeThePike in reply to theohappy]

Hi thanks for the info. I heard about PFA before but never really looked into it. I read up on it again and it does indeed sound interesting. My only question is whether this technology could be applied to ablation in general or if it only applies to AF ablation. Could it be used to ablate PVCs?

[theohappy in reply to MikeThePike]

That's a good question, don't know. I think I also read somewhere that it would replace cryo but not rf ablation, since it can't cross over to the right atrium. So if someone had aflutter, like I had, they would combine both procedures doing the PFA in the left atrium and then rf for the flutter. But, don't quote me on that. I will ask my EP sometime though.

[MikeThePike in reply to theohappy]

Hi theohappy and all! I just done some Googling and found the answer. Check out this interesting article abstract:

academic.oup.com/europace/a...

You might also find this article interesting. It suggests that ectopic ablations are more likely to be successful when they originate from the Right Ventricles Outflow Tract:

academic.oup.com/europace/a...

Of course, this does not mean that the ectopics will never recur but it does prove that ectopics can be eliminated with this new, safer ablation technology which is very good news.

[Alldone in reply to MikeThePike]

Hi

It’s certainly interesting.

In the meantime, I have stopped my flec (day 9 ) and so far so good. My resting heart rate seems to be back to my pre ablation rate of around 60 ish, it’s been more 75 on the flec. So that is taking a bit of getting used to in itself. Maybe the alcohol free for me really will make a difference, never would have thought with only 10 units a week!

[theohappy in reply to MikeThePike]

Both of these articles I found of interest. I'm in an interesting time right now of waiting to see if my ablation will be successful or not. I also struggle with tachycardia and low blood pressure. I am still on a low dose of Dilitiazem to keep me in NSR, which puts my BP low. When the tachycardia strikes, it lowers my BP even further. And based upon the second article you posted, I have reason to believe that it may be hindering the final outcome of my ablation. I will definitely be discussing this with my EP. I doubt if I will do another ablation until the PFA is approved. I certainly know who will do the PFA if I need one. I almost participated in a PFA trial prior to moving ahead with my ablation 4 months ago. The EP assigned to the trial is world renowned. He's my guy for future ablations, PFA or otherwise.

Thank you very much, Mike, for researching these articles! Helpful and appreciated!