AF has not returned after all

[Madscientist16]

When seeing my new EP regarding another ablation for the return of AF, I was informed that my episodes in January and March of this year were not AF but SVT. Specifically, they believe I have AVNRT (atrioventricular nodal reentrant tachycardia). So for now, I am back on diltiazem until I can be scheduled for a NEAR AV node ablation (at the triangle of Koch, which is anatomically significant because the atrioventricular node is located at the apex of the triangle) later this year. I am bummed that I have yet another heart arrhythmia issue, but glad that it is treatable.

[mjames1]

they believe I have AVNRT ... for now, I am back on diltiazem until I can be scheduled for an AV node ablation later this year.

That's good news your episodes were not afib. But are you sure they meant an AV node ablation? An AV node ablation means they destroy the AV node, which means you then require a pacemaker for life.

But typically AVNRT can be treated with what they call an SVT ablation, which is near the AV node, but does not destroy it it. This type of ablation has a very high success rate over 90%..

I also had AVNRT sporadically for close to a year and then it resolved by itself which is not uncommon. If not, I would've had an SVT ablation.

Jim

[Madscientist16 in reply to mjames1]

Yes, it would be an SVT ablation near the AV node to stop the reentrant electrical signal. I kept my comment less detailed to keep my post more efficiently worded but it is an AV node ablation at the triangle of Koch, which is anatomically significant because the atrioventricular node is located at the apex of the triangle.

[Ppiman in reply to Madscientist16]

A good friend has this and occasionally has required hospitalisation. I think he has always remains stable, however, so hasn't yet had an ablation. The last the time it happened, he told me that a paramedic abruptly lifted his legs high in the air, and the event stopped instantly.

I wonder whether a quick edit to your original post might be useful since, left as it is, it might worry some who have SVT and read no further. An AV node ablation is a treatment of last resort and post show that it worries many who post here.

Steve

[mjames1 in reply to Ppiman]

The last time (SVT) happened, he told me that a paramedic abruptly lifted his legs high his in the air, and the event stopped instantly.

Yes, it's called the Modified Valsalva Maneuver and in addition to lifting your legs, the protocol is at the same time to blow hard into a blunt syringe.

Some studies have shown it just as effective as the IV anti arrythmic Adenosine which is also used in the emergency room with SVT.

Personally, I found it very effective at home and while ideally you should have a second person assisting with the legs, lying down on the floor and putting your legs up on a couch while blowing through the syringe did work.

Jim

[Ppiman in reply to mjames1]

That’s fascinating. I didn’t even know the friend had this at all. He’s been admitted a few times over the years to emergency.

Arrive

[mjames1 in reply to Ppiman]

If your friend is interested, I used the Terumo Syringe 10ml which was the same used in one of the studies. A really good YouTube video on this from The Lancet. Just google "modified Valsalva maneuver for supraventricular tachycardia"

Jim

[Ppiman in reply to mjames1]

Thanks, Jim. I’m struggling to see him owing to my own AF but I shall tell him the next time he calls.

Steve

[mjames1 in reply to Ppiman]

I found it really effective and again ideally someone would do the leg lifting, but if not, I just improvised. After about a year -- and numerous SVT episodes-- it just stopped. I was told that particular node probably burnt out by itself therefore I did not end up needing an SVT ablation. Fortunately my episodes were usually under 20 minutes even without doing the modified Valsalva, but with SVT your heart rate can get up very high and it can be a bit scary specially when you're out and about.

I remember once getting it in an outside mall and lying down on the ground with my feet up on a planter and blowing into a syringe. People must've thought I was mad and perhaps I was.😄

Jim

[ChadL in reply to mjames1]

An SVT episode is definitely no fun! I think i would get down on the ground too! I had an episode come on while walking, about a mile from home.. I wanted to lie down on the pavement, but kept putting one foot in front the other while doing some breathing techniques ... longest walk of my life!! I stay close to home now 😂

[mjames1 in reply to ChadL]

I had an episode come on while walking, about a mile from home..

I never could've made a mile walking when in SVT! Have you looked into an SVT ablation? Simpler and less invasive than an a fib ablation with a very high success rate.

Jim

[ChadL in reply to mjames1]

it took me forever to make it back home. I was so afraid... but trying to remain calm.. two steps then rested..Thankfully, I've been SVT free for several months. My Vitamin D and Iron was very low and they believe that MAY/MAYBE have been the cause.. still on anti arrhythmia meds, very low dose just in case. Hopefully it stays that way!

[mjames1 in reply to ChadL]

FWIW I once stayed SVT free for 100 days when I switched to the FODMAP diet. But unfortunately returned before it miraculously disappeared and then seem to morph into atrial flutter at a lower rate as well as more episodes of atrial fibrillation.

I did try a daily rate drug -- diltiazem-- for a few weeks, but the SVT always broke through so I stopped it. I suppose it would've made my episodes more manageable, but since they were relatively short and self terminating. I decided not to stay on a daily rate drug.

Jim

[Teresa156 in reply to mjames1]

I used to stop my afib 9/10 (though it may have been afl or tachycardia too, that I may have been in at the time, it’s hard to tell) with the same manouvre - and using a syringe to blow in beforehand. I used to worry too that I’d have to try it in public 😊

They did tell me it shouldn’t work for Afib….but I was always irregular at the time….

[mjames1 in reply to Teresa156]

I tried the modified Valsalva numerous times while in afib, but it never worked, which is consistent with what the study found.

That doesn't mean it couldn't work for some people, or like you say, maybe you had a different type of tachycardia when it worked.

Jim

[Teresa156 in reply to mjames1]

Yes, I always wondered that too. My EP knew I could stop most of them this way and said to carry on doing it, if it worked, though I did always wonder if it was actually Afib ( watch and Kardia always said it was, though of course, it might be wrong) The trick was always to get it early, I found. I was onto it within minutes 😊

[Madscientist16 in reply to mjames1]

They did try adenosine TWICE when in the ER, but it did not stop the SVT. According to my EP, they should have onboarded diltiazem or metropolol prior to trying adenosine. However, the diltiazem had me back in NSR within 2 hours.

[mjames1 in reply to Madscientist16]

If they didn't try, you should ask for the modified Valsalva maneuver next time. You can even do it at home. I've mentioned it in more detail elsewhere in this thread. No medications are needed with it.

Jim

[Madscientist16 in reply to mjames1]

Thanks Jim. I have never responded to any vagel maneuvers before, so my medical team did not think to try. Besides since I was so dizzy all I could only do was just lay there.

[Madscientist16 in reply to Ppiman]

Thanks Steve, but it appears I cannot edit my initial post, unless you know how.

[Thomas45 in reply to Madscientist16]

At the bottom of your post are four sections starting with Reply, then a heart for liking a post, then Report, then More with a downward arrow looking like a v. Press or click on More and it gives the option of editing a post. Press or click on that, edit your post and then press or click on the Edit response "button" at the end of your post to enter the edited / amended post.

I put press or click depending on whether you are using a mobile phone or a computer with a mouse attached.

[Madscientist16 in reply to Thomas45]

Thanks, Thomas! Post edited.

[Ppiman in reply to Madscientist16]

Thomas has explained. Also, it's good to know your age and any previous conditions. And most sign off with their first name as the monicker allowed by the forum is hardly the friendliest one (mine is Ppiman - but my first name is Steve).

Steve

[Madscientist16 in reply to Ppiman]

I have posted my journey since 2019. Just click on my name/profile. First time I have been told about signing off by using my first name. Not being unfriendly, just cautious. I have seen how hostile some posters can be/become on this forum sometimes.

[Ppiman in reply to Madscientist16]

Yes, it has happened occasionally, sadly, but a first name creates no loss of privacy. I had two awful PMs just because I dared to use the phrases "blood thinner" and "small op"!

Finding posts is much harder than finding the bio, the was all.

Steve

[Buzby62]

I suspect it’s not a full AV Node ablation as mjames1 says.

Here is an info sheet for when AV Node Ablation is used.

api.heartrhythmalliance.org...

Best wishes

[Madscientist16 in reply to Buzby62]

Thank you. Yes, it would be an SVT ablation near the AV node to stop the reentrant electrical signal. I kept my comment less detailed to keep my post more efficiently worded but it is an AV node ablation at the triangle of Koch, which is anatomically significant because the atrioventricular node is located at the apex of the triangle.