EP study no ablation

Thank you for the update Savannah

by Gemita - 2021-03-17 10:55:17

and thank you for sharing those Settings adjustments.  Always useful to know. Your EP (electrophysiology) Study was clearly helpful even though your tachycardia could not be triggered while you were being tested.

Being a palpitation/arrhythmia sufferer I can understand your frustration with palpitations when in Sinus rhythm.  I have just had three weeks of relative bliss in NSR (and no ectopic beats) and suddenly last night my heart started for no apparent reason to throw palpitations and then the tachycardia (Flutter/AF) started from these relatively benign arrhythmias and it caught me by surprise.  I started imagining, well was it that fresh pineapple I ate?!  But no, sometimes there is no explanation.

The only thing I can usefully add to your EP Study (from my own experience) is that extra palpitations following the Study can be fairly normal for a week or two while your heart is getting over the shock of being manipulated with burst pacing.  Maybe if you give it a bit more time to settle and as your pacing adjustments start to make a difference, you might see a reduction in your palpitations/ectopics?  

That is all I can suggest other than raising base rate to help outpace any ectopics.  This works fairly well for me, since palpitations before pacing were truly horrific and affecting my daily life and disrupting sleep. The other thing I noticed was that some meds made palpitations more likely, especially those that reduced heart rate like beta blockers.  It was suggested that for bradycardia induced ectopics I might do better on lower doses of beta blockers and maybe even consider switching to a calcium channel blocker like Diltiazem.  I stuck with low dose Bisoprolol because I know the med and am now doing much much better on the lowest dose possible.  Don't forget to have your electrolytes and thyroid checked and avoid dehydration.

Perhaps others can suggest something else?

Thanks Gemita

by Savannah55 - 2021-03-17 16:51:19

I think that you are right in that my heart has just been tampered with again so likely to feel some palpitations. Providing they do not last I am ok with it for now.

Prior to my pacemaker I suffered with palpitations. For as long as I can remember I have fallen asleep to the sound of my heart thumping away- even when it was at 45bpm!

I had no luck with Bisoprolol unfortunately. Just suffered the unpleasant side effects. I may approach my GP and see if they have any recommendations for a different type of beta blocker.

Once my week of no strenuous activity has passed I will get back on the treadmill and see if these new settings work!

Atrial Tachycardia

by Marybird - 2021-03-17 18:58:16

Hi Savannah,

I know it has to be frustrating to go through an EP study with an intended ablation only to find that pesky tachycardia that's made your life miserable beforehand is nowhere to be found when they try and induce it in the EP lab.

I've had issues for quite a while with what the EP I was referred to identified as atrial tachycardia. This EP also discouraged ablation for me as he explained that atrial tachycardias can be notoriously difficult to induce in the EP lab, and can't be ablated if they can't find a source ( site of first activation). He also mentioned that sometimes it's difficult to pinpoint a single source even when it can be induced, or ablating the sources can irritate other areas near that site ( I think this happened with my daughter). Though he also said later, with improvements in the mapping equipment this may not be as much of a problem- IF the tachycardia can be induced.

I've been able to control my atrial tachycardia fairly well ( though there is still breakthrough) with medication, ie, beta blockers and calcium channel blockers. It's taken an increasing dose over time, but the metoprolol ( currently 150mg/day) and diltiazem ( 360 mg/day- partly for blood pressure) seem to keep the tachys to short runs. Problem is, I've been informed that there are some short runs of afib creeping into my remote pacemaker reports as well- they're more concerned with those than the atrial tachy, as I understand it.

In any case, are you taking any medication to control your atrial tachycardia? As you mentioned, and Gemita agreed, your heart may be adjusting to pacemaker adjustments, and still getting over the EP study, so perhaps your tachys are at least partly a reaction to that? In any case, your doctors ought to know you're still having issues with the tachycardia ( I doubt they'd be surprised to know this), and perhaps an adjustment with your medications might help. Everyone's different, but I think for me the metoprolol has worked the best to control my tachys. I take diltiazem as well, and that works well for other people though it's not all that great by itself for me, I hope it works with the metoprolol and isn't just along for the ride.

It may be that your EP could suggest another go at ablating the AT if they think they might have a better chance at inducing it with another ablation, but that'd be down the road a bit, I'd think, and if medication isn't doing well at controlling it. The EPs might suggest an antiarrhythmia drug or two if the rate control drugs in fairly high doses don't help. I have a friend with AT ( he doesn't have a pacemaker) who seems to have it fairly well controlled with a dofetilide ( Tikosyn), though this requires a 3 day hospital stay on initiation of the drug to ensure it doesn't cause other dysrhythmias.

Or maybe it'll settle down. We can hope for that.

Similar experience - different ending

by Pinkit94 - 2021-03-18 13:38:41

I had the same thing happen to me, I went in for an EP study for atrial arrhythmia and they were unable to induce it. Several years later, I had another EP study, this time I went in without sedation, and they were able to find all of my atrial arrhythmias(I had three; Atrial flutter, atrial tachycardia, AVNRT). I was awake the entire time they did the ablation, the pain was unbearable, the worst part was staying as still as possible & the smell of burning meat, I had tears running down my face. But the reward of having a "normal" rhythm, was worth all the pain. Stay strong, hope your palpitations get better!

Not sure if I actually have AT

by Savannah55 - 2021-03-22 09:41:38

but who knows. The EP thinks the main issues were the fact that my pacemaker was tracking incorrectly, even though they said AT episodes were noted on the ETT and in my pacemaker log??? I have a pacing check in May so will see if that shows any episodes.

I do not take any medication regularly... I have 1.25mg Bisoprolol which I can take when I experience palpitations for a long period. I try and avoid them as they make me feel unwell.

I am now 1 week post op and my palpitations have calmed down a lot. I am also not getting as out of breath doing simple tasks, which is great! 

My next appointment is in 2 weeks in the inherited cardiac conditions clinic. I was supposed to see them last April but it was cancelled because of covid. My MRI scan last year states potential early dilated cardiomyopathy, which is not welcome news especially as consultants have never mentioned it to me. I only found it out from obtaining my hospital notes. 

I will post an update after the appointment.