EPS unable to trigger SVT, what next?

[Darola]

I suffer from exercise induced SVT, specifically I'm a runner so during a run, it will usually trigger during a sustained period of hard running (more than 30minutes), or running with or just after a cold/virus. I carry a portable ECG attached to my phone (AliveECG) and have captured it now 4 times, so know it's real.

I had an EPS 3 weeks ago, but they were unable to trigger the SVT, so couldn't find the spot to ablate. I'm interested to know if anybody else has had a failed EPS, what happened next? Did you have another that was successful?

[whizy]

I had an esp in November 2014 but the doctor was not able to ablate on that occasion because of what he found. He needed to order some equipment to be able to treat the condition. I am on the waiting list to have a second esp and hopefully an ablation. Afterwards in recovery my heart went into SVT so I was kept in overnight and was instantly put back on 10mg Bisoporol. I hope the next one is successful. My SVT is not exercise induced though. I am not sure what triggers it but it can be tiredness, bending over, caffeine etc.

[marysteven in reply to whizy]

i have had 3 EPS' so far and none have worked. i have been told that its just something ill have to learn to live with now.

[whizy in reply to marysteven]

Sorry to hear this. Are you now on medication to control your problems?

[Darola]

Personally my resting HR is too low for meds, and as I only get it when exercising/running - and then only occasionally and when I'm pushing it (37 episodes last year off circa 250 runs) meds don't really offer any benefit anyway.

I had a follow up with my cardio consultant a couple of weeks ago and he gave me a 14 day ECG monitor, which I've just completed. We have been discussing doing another EPS in April and I'm meeting with him next month to look at the results of the 14 days ECG and to discuss next steps. Fortunately whilst I was wearing the monitor I did have an SVT episode so he will have some good data to look at.

He said, from the EPS I had last time, that there was a couple of times my heart 'raced' for a few beats, emanating on the left side of my heart and that he would possibly have to pace my heart at a higher rate to induce the SVT. For these reasons he said a 2nd EPS had a slightly higher risk which I should consider.

I'll post again when I've met with him in a few weeks.

[wal4d]

hi

I've had 4 eps but only 2 of them led to attempted abalations as the pe could not replicate my episodes on the table. mine are not stress or exercise related - they are totally random and erratic, they can occur anywhere at any time - even when I am totally relaxed eg reading a book. The last eps/ablation does seem to have improved the condition and made it more manageable. I have tried all sorts of medications which only made me feel worse - usually because they lowered my hr too much and kept it there. I am a relatively fit and healthy 62 yr old male but often suffer from extreme tiredness and presyncope. I get ectopic beats sometimes initiating bursts of high hr (190bpm) but these are rare compared to the more frequent drops in hr (30-37bpm) which last for long periods of time - even weeks in the past but less so since the last ablation. I made the decision not to attempt another eps/ablation as I am able to manage the condition without meds and don't feel that there's any point if there is a low chance of it being successful. After thorough tests and assessments my heart is actually very healthy and strong - just unreliable electrics which are not life threatening but simply a real nuisance.

If you have had only one attempt at ablation it is worth trying again but be aware that it isn't guaranteed to be successful.

All the best.

[Darola]

Successful EPS today, which thanks to the expertise of my cardiac consultant and some whizzy 3d mapping he was able to induce SVT and pin point the spot to ablate. Whilst in there he also identified some arterial flutter, which he also ablated so I got 2 for the price of 1!

Got to rest up for a week now and then can't wait to 'test' it out. Looking forward to a summer with some hard and honest racing, without having the SVT mill stone around my neck. Will take some time for me to get my confidence back, I just pray that this really is it resolved.

[Nickygarbett]

I'm 1 week following eps and an un abilated pathway for wpw. They tried very hard to make my heart use the pathway but it wouldn't so I didn't have it abilated.

They have told me it's non life threatening which is good to know. And I'm now on 2 drugs which I'm still getting used to with only minor side effects

[erica_ in reply to Nickygarbett]

Me too. They told me I needed to do an emergency eps after I was wearing my heart monitor and my heart beat was almost 250 while sleeping. They were sure I had WPW. They went in and couldn't find anything and now I'm on propranolol. What drugs did they put you on? Do they think you should try the eps again or just stay on the medicine? I really don't want to stay on because I think it is causing me to be more tired and gain some weight. Thanks and good luck

[Nickygarbett]

My minor side effects turned into horrendous side effects for me. Flecanide and adizim tremors, anxiety were the worst. Palpations solid for an hour after taking them. Stopped totally and kept a diary. Few moments but nothing like when I was on the drugs, went back on the adizim for 4 weeks but still side effects I didn't want to cope with so no been off them for 3 weeks. I rang the cardiologist as they told me to but they haven't replied

[KRG13]

Hi Darola, I had an EPS last Feb. They could nt induce the SVT and aborted ablation. They did induce A Fib but after too much pacing. So they left it alone. Tried Ivabradine and metroprolol .. Also propranolol.. but nothing helped. Low doses don't keep the tachy at bay and higher ones keep the hr too low for comfort. It's been a year of tachycardia going into 200bpm and brady at 35-45. Anti arrhythmics work, but side effects are crazy. They want to attempt another EP study and maybe sinus node modification. I'm not prepared. The electrophysiologist and cardiologist are both close friends of mine and hence I can and do share ECGs that I take on a home monitor during any episode. Feels safer to know that they are aware on a regular basis..

My EP doc says that sometimes the heart grows out of these episodes.. the sinus node gets modified with age. So fingers crossed.