Ablation for ventricular tachycardia

[ruffity]

When I've posted here before over the last 8 years it has been about my own fairly benign AF, which needed a second cardioversion a few months ago.

This time, I'd welcome your advice for my wife, who has patiently put up with my moans and groans, and herself went into ventricular tachycardia a couple of weeks or so ago with a HR of 198 bpm.

She was admitted via A&E to the Resuss unit of the local satellite hospital for a week, where they struggled to get her HR down.

Eventually got it down to 80ish but not stable, discharged her immediately with 3.75 Bisoprolol and Edoxaban, then readmitted her two days later when it surged again. After another infusion of Amiodarone, she was discharged with Amiodarone 200mg x3 tablets and Digoxin which gave her terrible side effects.

She then saw an electrophysiologist, there for the day from a leading London hospital, who simply said: "We can fix it" and arranged for an urgent ablation by himself. (Yet to get the appointment.)

Her HR continued to fall down to just 44 bpm and her extremely helpful GP phoned and arranged her immediate return to the hospital. Apart from the EP, now back in London, she has never seen anyone but very newly qualified junior doctors and nurses. Very different to my experience 8 yeas ago.

Initially, she was to be readmitted yet again so that the dosing could be reduced while being monitored, then changed their mind and announced that she could stop both the Amio and Digoxin completely and go home. Then said they would write to the EP to say she now doesn't need an ablation.

She's 76 and not aware of having VT before. Your thoughts please.

[Rainfern]

I wonder if you have phone access to the cardio department? Im sure you’re doing all you can, but I’d really push to find out what’s going on and if necessary get a second opinion with an EP privately. If an EP has said it can be fixed then the decision should be with them, not junior staff.

[ruffity in reply to Rainfern]

Thanks Rainfern. We don't have any way of contacting any cardiologists there directly, not least, because my wife has never seen or spoken to one throughout. I assume the junior staff, this time all in the Same Day Emergency Care Dept, not cardio specialists, are getting instructions from a cardiologist somewhere, but we don't know who. Same as when in the Resuss Unit which is staffed by specialist nurses.

I'd also question the wisdom of sending a 76 year old home who might have no ability to monitor her own HR. It was only because I've had AF myself that I checked her, knew 198 bpm wasn't good, and phoned 111. They were great, with a doctor calling back fast to say get her to A&E ASAP.

But I don't know anything about VT, the pros and cons of an ablation, and whether or not she should press for the one that had been arranged. Up until now that is, until some unknown with questionable decision-making skills decided to cancel it.

A new partner at our GP practice who sent us into hospital yesterday was excellent and she will be phoning on Friday, so we emailed her an update ahead of that. Was also impressed by the EP. So we'd rather depend on their opinions than anyone else who has been involved so far.

Our hospitals seem to be a mess and her experience worryingly different from mine 8 years ago.

[Rainfern in reply to ruffity]

I just have the usual AF and my GP told me it was age related and they’d deal with it all at the practice - ie medication only. Meanwhile PAF turned rapidly to persistent. I insisted on a specialist appointment but due to all the delay paid for a private consultation with an EP who works both for NHS and private. So I’m still under him while awaiting ablation on the NHS and am about to have a second cardioversion. It went against purse and principles to do this but it seemed the only way to ensure I had a good half hour appointment with an EP to explain everything and who also communicates with the NHS team.

It must be very alarming for you both, having to face a new condition and I hope that you get all the help and info you need and find a way forward soon.

[wilsond]

All I can say is that my goddaughter had an VT ablation at age 12 last year,completely fixed.I am of the opinion that you should consider a private EP appointment, cost approx 175 to 200,usually seen within days or weeks to get to the bottom of this confusing situation.

Best wishes

[rosyG]

agree with the others that you need a cardiologst to review theECGs that would have been taken -may have been SVTs which are easy to ablate ( Right side of the heart) Unlikely to be ventricular as these are usually fatal unless someone had a defibrillator handy??

[Deejay62]

Hi I’m sorry your wife is going through this. I have a lot of VTs going off in my heart at the moment, but I have underlying conditions. I have an appointment for November to see an EP cardiologist who I saw years ago for other arrhythmias. I have a pacemaker defibrillator fitted and I was told if they go on for long I would get a shock. So far they don’t last long. I hope your wife’s VTs get sorted out. I live in London.

[Dippy22]

WHAT!!! Digoxin is contraindicated with Amiodarone!!

[BlueMonday67]

Hi, u asked for my experience on amiodarone - not sure that it will help you very much!. Had it first as a PIP alongside verapamil which worked until I had my first covid booster. Was then prescribed 200mg initially then 400mg a day after a failed cardioversion for atrial tachycardia which flared up 12 hours after that booster. Took it for 11 months until a CT scanned revealed ground glass nodules in my lungs caused by the amiodarone. Cardiologist had sent me for the CT scan as was so breathless and fatigued. It did cause a lot of problems for a few months exacerbating my asthma, very breathless, difficulty breathing once or twice and bad cough Prescribed antibiotics and steroids which made little difference but luckily given the all clear 5 months after stopping it. Had ablation c 6 weeks after stopping it which has improved arrhythmia. I hope all goes well with your wife