Tachycardia, missed beats, anti arrhythmics.. and no relief

[KRG13]

Hi everyone,

I've been diagnosed with an arrhythmia that's likely to be IST or SNRT. The EP study was inconclusive. They've put me on propafenone 150 thrice a day.. but it makes me feel awful. I have a recurring throat infection while on the drug. Hypotension too. I stopped the propafenone after asking the cardiologist. Now I have low hr going to 35 and high going to 200 bpm. Today I had an episode which I could catch on a home ECG monitor showing the heart rate at 250. I almost passed out. A carotid massage helped abort the episode.

Has anyone had sinus node modification or ablation? How did it help the low hr? Did it lead to a pacemaker?

Thanks in advance for all the answers..

[2k2d]

First, sorry to hear you are going through that, it sounds miserable. What age are you if you don’t mind me asking? Second, have they tried any other medications? Anti arrhythmics are usually used for life threatening arrhythmias not arrhythmias originating in the sinus node. Before jumping into ablation, I’d exhaust every possible other avenue. From what I’ve researched, ablation is highly ineffective for IST and carries a high risk of pacemaker. It’s a little better if it’s snrt but still a more difficult procedure due to the reentry circuit being inside your sinus node. I’ve read all of these things because I too have been told I may have both of those. For me, a low dose beta blocker did the trick, metoprolol 12.5mg in morning and early afternoon. I was slated to have an ablation because we tried everything. But I really just needed a lower dose, not higher, so I wouldn’t get hypotension and low rates, just like you mentioned. My resting is also quite low unlike typical ist patients. For example, I’m 40 and my resting is about 56 and on my beta blocker I’ve had my heart go as high as 190. But for 95% of the time it does a great job controlling things and I feel way better.

Keep me posted and hopefully you find a solution soon!

[KRG13 in reply to 2k2d]

Hi, thanks so much for your reply. I am 34 years old and fit for my age with a BMI of 21. I've tried the lowest doses of beta blockers but they all make my head swim

[2k2d in reply to KRG13]

Same here...started when I was 38. I’ve always been fit too. I take half of the lowest dose of metoprolol tartrate. Just something to consider. Also, have you tried ivibradine?

[KRG13 in reply to 2k2d]

Yes. Ivabradine and 3 beta blockers. At paediatric doses. The antiarrhythmics at least worked well..

[2k2d in reply to KRG13]

Bummer. Sounds like you’ve been through most everything then. Ablation May be your only option unless you think you can live with it for a few years. I know I couldn’t, I was miserable and willing to do anything to get rid of the problem. It took me two years to find the lifestyle changes and med mix that worked and I just hope it stays ok, I’m 6 months into feeling better. I’m hoping technology/info gets better for this particular condition. They just don’t know enough yet but if you can find experienced physicians and they just burn a little at a time it could work. I hope someone else comments whose had the ablation for ist. But, it’s pretty rare so?? Anyway, please keep in touch and if you end up doing it, post and let me know how it goes. Fingers crossed for you!