New Ventricular Tachycardia

V-Tach and ICD

by AgentX86 - 2023-08-07 22:30:37

I can imagine you'd be a little "shocked" (very punny).  It sounds like your cardiologist and EP are on the case and you're in good hands. Did he say how long the VT episode was?

200mg of metoprolol (succinate or tartrate?) per day is a fair but.  400mg is the max but 200 is a lot.  I can understand why you're lethargic.  I'm on 3x50mg of the succinate variety (extended release). Metoprolol doesn't bother me much but this isn't uncommon at all.

I'm with you (worried)

by Aintgotrhythm - 2023-08-07 22:57:26

As I've noted elsewhere, I'm 11 days post implant. I had a cardiac MRI the day before and the EP came in to my room (I'm naked in a hospital gown but not yet prepped) saying he wanted to do a PET scan to "rule out the possible V-Tach". He offered two choices:

1. postpone the implant (Boston Scientic L331 dual lead) until I could have the PET

2. proceed with the implant and have the PET 6 weeks - 2 months later 

He said he was "fairly sure" I wouldn't need an ICD pacemaker so I elected to go ahead since I was progressing toward fainting episodes.

I've been mildly stressed about it ever since. I can't say I enjoyed the surgery or recovery enough to want to do it again anytime soon and the prospect of having a device giving me shocks, or even worse, the prospect of V-Tach, is pretty daunting.

So I totally understand the anxiety you're feeling.

I'm hoping for the best for me and for you!

Metropolol

by angkbee58 - 2023-08-07 23:22:05

It's metropolol succinate 100 mg. Twice a day. 

Also the transmission I sent from my bedside Merlin indicated the v- tach but the event didn't show the length of the episode because the tech said my settings didn't allow them to see how long it lasted. 

They did set some new settings to  help that in case I have another episode. So for now they only know it was v- tach. 

Hopefully the ventricular tachycardia was non sustained (lasting less than 30 seconds)?

by Gemita - 2023-08-08 03:27:20

Angkbee58, I know it is worrying, especially if you had difficult symptoms at the time of your recent VT episode, but if it was non sustained VT, it may not require an ICD.  A sustained episode of VT would be another matter.  I think it would be reasonable to wait to see what is found on your pacemaker records, or to have longer term additional external monitoring first to see what is going on.  I believe after an ablation, the heart needs time to heal and since you have only just had an ablation for atrial arrhythmias, I am not surprised that your heart is throwing a tantrum.

Your EP is taking precautions by saying no driving, no hiking until they figure out what to do next.  This is clearly to protect you and others until they have a better picture of what your heart is doing.  It doesn’t mean the worst for you.  After the ablation, you are still in the healing period which can last anything up to 6 months I believe.  And just when you were beginning to feel so well.  Let us hope it was just a one off non sustained VT episode.   I wish you lots of luck and hope your heart will calm on Metoprolol.  It may be all that is required.

Update:  I was concerned to see your comments:-

"Also the transmission I sent from my bedside Merlin indicated the v- tach but the event didn't show the length of the episode because the tech said my settings didn't allow them to see how long it lasted". 

That statement "my settings didn't allow them to see how long it lasted" would concern me.  In view of your earlier VT episode, I wonder why they didn't set your pacemaker appropriately to confirm/record VT events.  I find that hard to believe?  

Hi Gemita- I found this

by angkbee58 - 2023-08-08 09:06:01

I was re-reading the notes from my last office visit.

EGM suggests VT of unknown duration since rate dropped below detection. Therefore the recording ended before episode self terminated.

This occured in the setting of an EF of 60-65% per echo performed on 12/27/22.

They readjusted the pacemaker  settings so that wouldn't happen again.

Also, my previous cardiologist did not send my records to my new EP. They have been requested multiple times. I have it documented that I had previous episodes of v-tach and it was documented. 

It's a frustrating situation.

Understood, thank you Angkbee58

by Gemita - 2023-08-08 09:20:40

It seems that although the ventricular rate was intially high enough to set off the VT event trigger for its recording and storage, the rate then dropped below the detection rate, so the duration of VT could not be assessed. Not good enough and I can understand your frustration.  I hope now they are listening and watching carefully.  They have clearly stated that the recording ended BEFORE episode self termintated.  Your EF is good