Has anyone had ablation for Sinus Node reentrant Tachycardia? Or for IST?

[KRG13]

Hi everyone, I met my electrophysiologist last week and he spent a generous hour pouring over all my ECGs from the last 12 months. He had been avoiding ablation so far but now is convinced that I should opt for it. Being the sinus node, the risk of damage during the procedure is high and if something were to permanently damage the sinus node during the ablation, a pacemaker would be my only option. Has anyone had their sinus node ablation? For IST or for SNRT? I'd love to know what your experiences were. Thanks in advance

[Longqt]

I haven't had an ablation, but hope someone can respond to this. Best wishes

[2k2d]

I haven't had an ablation either but will be following this thread...

My EP came to the same conclusion about me after 2 years of fighting IST and SNRT. I couldn't bring myself to do the ablation based on the statistics and found a medication and dose that helps enough I can tolerate as long as it keep working. I want to get older 50+ if I take that chance in case I end up with a pacer (right now i'm 41). But I can't speak for your decision as it's a big one. I'd say just read as much as you can on the internet about the pros and cons. If you type in google scholar, you can read medical journals about the results, etc. I'd say from my very limited research it looked like about 30% of patients ended up with a pacemaker. I'm really hoping technology gets better in next 5+ years and they can better treat or ablate this condition.

[KRG13 in reply to 2k2d]

Hi 2k2d, Thanks for your reply. I am 35 and also wanted to wait a few years. My cardiologist is wary about the effects of the frequent tachy episodes on the heart. No tachy induced cardiomyopathy yet, but hes not happy about waiting too long. And like you said, I hope technology races ahead like the heart does and we find a safer solution!

[2k2d in reply to KRG13]

I totally understand! Good luck with the decision.

I was more worried than my doctor about my ongoing health from the tachycardia. I noticed my entire health declining, higher blood pressure, sleep issues, memory/concentration issues, etc.

I totally would have gone for the ablation if I hadn’t gotten 80% relief from meds.

Fingers crossed for better solutions in the very near future!

[KRG13 in reply to 2k2d]

What meds did you take, if I may ask?

[2k2d in reply to KRG13]

Tried 25mg metoprolol tartrate - too strong

Tried some other beta blocker nadalol? - didn’t work

Then tried calcium channel blocker, can’t recall name

Then Ivabradine 5mg 2x- worked ok but caused other palps and felt like my heart was constricted

Then a few weeks before ablation consult I decided to self dose with metoprolol tartrate but at just 1/2 a pill (12.5 mg), worked the best. I take every six hours or so and if major event or major exercise I take more.

My heart still shoots up some but I don’t feel it as much and it doesn’t get stuck for hours at those higher rates anymore.

[CharlieK01]

I just discussed ablation for IST last week with my EP. In his clinical experience, ablations for IST are not always successful - and in the event that they are, symptoms tend to come right back after months or years (which I would be OVERJOYED to have even a few months of relief). He also mentioned the need for additional ablations which would likely lead to a pacemaker. I am also 35....he feels strongly against someone our age getting a traditional pacemaker. However, he did talk about new technology within the pacemaker space (that should be available within the next 2 years) which would totally make me feel better about having a pacemaker down the road if I do choose ablation. Right now I can’t find a medication combo to give me adequate relief - beta blockers, calcium channel blockers and ivabradine all cause me to have prolonged sinus pauses (3-6 seconds). I am currently off of all medications and am worried about the effects of constant tachy. Please keep us updated on what you decide to do. Rooting for you to get relief!

[FoggyBrainJ in reply to CharlieK01]

hello Did you ever find any meds to work for you? I also have Ist for about a year now. I went on metoprolol 25 but caused me insomnia and liver issues and too much for me. so I am not on any medications for it as well. My heart stays at the 125 around house and 100 resting so it’s not so bad but with being underweight has been a challenge to gain weight with elevated heart rate. I know they say it doesn’t harm the heart if it’s just true ist but does get draining sometimes.

[CharlieK01 in reply to FoggyBrainJ]

I am now 20 weeks pregnant, not on any medications at all. The pregnancy has definitely exacerbated my IST 😩. The extra blood volume makes the palpitations much more symptomatic too. My EP wants me to try labetalol if things get unbearable, but like you I was very intolerant of beta blockers (definitely identify with the insomnia - and they also cause me to have 5-6 second heart pauses). So I’m kind of in a lose lose situation for now, but it gives me more confidence if I can handle pregnancy with IST then I can probably handle IST medication free after delivery. Just hoping there is some non medication option for us in the future.

[FoggyBrainJ in reply to CharlieK01]

Congratulations on the baby. I wish you all well. I know that would be great.

[KRG13]

Hi all! So here's where it stands now. I met the EP again and told him I was scared of getting a pacer if something went wrong. He said we can try 2 more drugs .. right now I have been started on Sotalol BD .. if it doesn't help then we will try flecanide. If that doesn't help or causes too many side effects, we will revisit the possibility of ablation in 6 months. Sounds very reasonable to me.. and I hope the drugs work

[2k2d]

Good luck!! Thanks for keeping us posted :). And let us know how it turns out.