I had an ablation in May 2021 for SVT/Atrial Tachycardia. During the ablation, they fixed the Atrial Tachycardia, and also induced Atrial Fib/Atrial Flutter, which they also ablated. I had symptom free period for a year and a half, and the Atrial Tachycardia (SVT) returned. On the monitor, my burden of SVT/PACs was at 24%. They recommended another ablation. They were unable to induce the rhythm and have been trying different medications. I am so sensitive to most meds and have side effects worse than the SVT. We have tried Beta Blockers (which do not work as mine is vagally mediated), Diltiazem, Flecainide, and now Norpace. The doctor is not opposed to another ablation but wants to try at least a few more meds. Because of my sensitivity to meds, I am hesitant and wondering if the standard of care would point more to trying another ablation? I am 48, not in any other meds, no other significant history related to the heart.
Ablation vs med management? - Atrial Fibrillati...
Ablation vs med management?
Ask about Tikosyn. Worked well for my afib. All procedures carry risks and from my view are best avoided unless absolutely necessary. Best, etheral
Hello Megan, from what we hear here in the UK, treatment plans and options can be different in the US so it’s probably best if you follow the advice offered by your fellow Americans. That said, you are young and the thought of taking and remaining on fairly potent medication for the rest of your life can be quite daunting although in reality, here in the UK it’s not unusual and folk cope well and wouldn’t even consider any form of medical intervention.
However, your post suggests that medication may be an option but finding the right medication that you could take for hopefully, a very long time, could be a challenge. I know that treatment there tends to be insurance driven and depending on the cover provided, there are likely to be more treatment options available such as Mini Maze variants which are almost impossible to get here on the NHS.
From what you are saying, your Doctor seems to be taking a more balanced view about future treatment and personally, I would be comfortable with that although the general view is that the sooner medical interventions are carried out, the more successful they are likely to be. Hopefully you will get some “homegrown” advice soon which will help you to make the right decision, good luck………
Thank you for the advice. It is actually quite helpful to hear a perspective outside the US! I would be okay with a medication if we could find one that works and doesn't cause a lower quality of life than the SVT! I very much appreciate and trust my EP and was frustrated when he couldn't induce the rhythm at the last ablation attempt/EP study. I will keep trying meds for now and do appreciate the perspective!
Hi Megan,
I live in Canada but spend a lot of time in USA and I’m a little bit familiar with the system there. I’m sorry to hear that you have difficulty with meds… I too, was not able to take that any beta blockers, and have difficulty with Meds in general.
also, I have SVT and other types of our arrhythmias like you had and I’ve had one Ablation six weeks ago and was OK without medication for a couple of weeks, and I had to go back on it again because symptoms returned.
Did you try the short acting Diltiazem? 30 mg?
I couldn’t take the 120 slow release, but was able to take the 30 mg that I take three times a day, which is a low-dose, but still manages to control my SVT and other aberrant rhythms. For now at least.
30 mg three times a day is a subclinical dose but it works for me.
if it’s not terrible and you can stick it out for a couple weeks. It does take a bit of time for your body to adjust to the new medication regime.
If I were living in the USA I would certainly look into Wolf Mini Maze (there is a Facebook page)
And that is because I am so symptomatic when I have episodes. Feels like I will die.
I’m only 59 and started this around 56 and young for my age so I can relate in terms of not wanting to take medication long-term. However, I am on a low-dose and many people take it long-term without consequence.
Best of luck to you,
Chrissy
Are you aware of the MiniMaze being an option for other atrial tachyarrythmias, or just Afib? I do not believe we tried the Cardizem short acting, just the long acting. It has been challenging because my rhythm tends to only or primarily occur in the evening and overnight, so he believes it is mediated by my vagus nerve vs sympathetic system, so that leads him to try other meds. I will keep all these notes for my next follow up visit! I, too, am feet symptomatic with the episodes and have a difficult time with them. They begin every night around 6pm and continue until 6am or so. Sometimes during the day, but not as often. I sleep terribly though because I wake with the SVT frequently. Thank you so much for the advice. I will keep trying!
Hi Megan, I'm Ryan. We have had a similar path as I had an ablation attempt in early 2021 but mine couldn't be induced. I'm sensitive to all meds, heck I use baby aspirin as a sleeping pill lol. I didn't want to be on meds for my AVNRT, which is svt incidents triggered by ectopics basically, so was really disappointed my "study" didn't work out. I'm currently on diltiazem and metoprolol and they work well without side effects. Since beta blockers are out for you, my suggestion would be to try magnesium supplements. I take magnesium glycinate every day and I'm convinced it has helped reduce my svt incidents being triggered. Dr Sanjay Gupta is a world renowned cardiologist who very much believes in the power of magnesium and talks about this in several YouTube videos if you'd care to check this out. I know taking meds isn't great, and a permanent solution is preferable, but hopefully you can find something that works without side effects. Hang in there!
Hi Ryan…
You sound a lot like me as well. I am very sensitive to medication… Also, I had an ablation study done in 2022 in April and they could not induce my arrhythmia.
however, they put me on the list so I had to wait another year to have PVI alblation… that seems to have fixed SOMETHING because I’m not getting a spikes that I used to in my heart rate….on my apple watch… and even though I started taking medication again (I went about four weeks without it after the Ablation) but started having symptoms around 6 pm daily… not as bad before, but enough to make me feel tired,) I do feel better than before ablation. I’m not getting all the symptoms and extreme tiredness and am able to exert without my heart spiking…
So its positive…
Did they ever suggest PVI Ablation for you?
they have to go into the left side of the heart, and up into the pulmonary veins… they don’t do that during a Ablation study they only go into the right side.
maybe you know all of this already…..my apologies if so…
hi Meghan sorry for the delay.
No I am not aware if the mini maze works for other tachyarrhythmias, but that is what I have and the Doctor Who does the mini maze in Canada told me he would operate on me if I had two failed ablations that is the rule here in order to get on the list for the mini Maze…You have to have to failed ablations first.
to be honest as long as I’m doing well on medication I don’t feel that I will go for the mini maze since it is quite invasive and all procedures carry risk.
you sound exactly like me I can feel it in my vagal nerve when I have an episode at almost jumps just under my left rib cage and even get sore sometimes.
doctors here are not that detailed.. when describing the condition…in fact, they barely tell you what you have to start with…. They treat us kind of like idiots sometimes.
I’m still waiting to see my GP to see if he knows anything about whether or not my ablation was a success… apparently it’s supposed to be three months before it’s healed. But still meed meds…but I feel better than I did before the alblation.
sorry I can’t be of more help but as I said, we are given very little information hereabout our condition. We are told we have AF no matter what rhythms we have… and we have to investigate to find anything out further.
It’s frustrating….the lack of information.
in fact, when I was getting ablation the head nurse told me They would be treating my AF, and I said to her, but I have atrial tachycardia I was told? And she didn’t even pay attention to what I said…..so hard to deal with it that attitude. They keep us in the dark…
From my experience you can have an ablation but it doesn't always mean you can come off drugs. Good luck whatever your decision.
Please can I ask how long you tried beta blockers for/which ones? They do work for vagal ( I know there’s a lot of stuff on the internet that says they don’t, but I would argue that) mine is definitely vagal, episodes only ever happened in the evening, or during the night only and are connected to vagus nerve. I never had an episode start during the day. Since being on Bisoprolol 1.25mg, my last episode was Sep 22 - before that Nov 21. I apparently have Afib/AFlutter and SVT/atrial tachycardia during my episodes. My last episode I managed to stop with a valsalva manoeuvre, (to my surprise).
I’m not saying medication is the right way to go though, ideally I’d love to not take anything as I’m sensitive to medication as well, but I just wanted to point out that beta blockers can work for vagal and shouldn’t be ruled out for anyone reading this.
Have you tried valsalva manoeuvres? You need to check this with your medical professional first of course.
Thank you for the reply! My doctor definitely tried the Beta Blockers first. Unfortunately, over time, they just do not seem to work and the Atrial Tach. Breaks through. He decided to switch to channel blockers or others because the beta blockers we tried just simply were not working anymore. My experience is a bit odd.. I have paroxysmal atrial tachycardia so the episodes last 12 hours or more but it isn't constant. I have runs of SVT that last seconds, minutes, and sometimes hours, but then just over and over and over. I have not had any luck with vagal maneuvers or other methods. I also have a fairly low blood pressure normally, so my treatment options are limited with beta blockers due to that. We struggled to find a beta blocker that stopped the rhythm at a dose that wouldn't drop my pressure too much or lower my heart rate too much during the day. A balancing act. I am currently waiting for the Norpace to arrive to try. It is an older med. Not sure what to expect. It isn't used much anymore.
It’s a shame they still break through for you. Yes, It is a real balancing act getting meds right unfortunately. I too had similar type episodes to you, with all three tachycardia, A flutter and Afib, but ( touchwood) bisoprolol has calmed all of it down. I was getting them every 3 weeks for a few months in 2021. During 10-12 hour episodes, I’d get runs of tachycardia and flutter then back to Afib. I see from your posts you tried propanolol and Metaprolol. We aren’t usually given those for Afib in the first instance in the UK. They dish out Bisoprolol, usually, first.
Unfortunately I also had normal/lowish blood pressure and my HR was always normal 60/70 resting before bisop. My HR often goes to 54/55 during the day, but I seem to have got used to that. It’s not ideal though, but mostly it’s in the 60s. My BP has fortunately stayed around the same level.
A lot of changes I’ve made in my life also have helped, as those do need to be changed, if you can. Also being aware of possible triggers along with taking magnesium, which I noticed another review also said. I was also deficient in vitamin D, which is also worth you getting checked, if you haven’t.
I hope the Norpace works better for you 🤞
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