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SVT ablation in relation to Afib ablation

Posted by SteveW 
SVT ablation in relation to Afib ablation
January 02, 2018 07:21PM
I've been living with Afib for a little over three years, described in a previous post. The most uncomfortable part of it has been something I've understood to be RVR, as that is what I was told when I landed in the ER with it two years ago with a sustained rate over 200 and peaking at 226 followed by 24 hours of Afib. I've had several of those very high rate episodes and always thought it was part of the Afib (and I suppose in a way it is). Yesterday I clicked in to a rate of 205 and it stayed there for about half an hour, dipping to 180 and cycling back up. I had gotten the Kardia watch band for Christmas (I'll post separately about that as I don't want lose sight of my main question here). This allowed me to take several EKG's during the episode (like a dozen thirty second strips). I was surprised to see it was a regular beat. Went to the ER, as I wasn't sure if I should do anything more with an anticoagulant after that episode (I typically just take aspirin 1x day) and I was on the way there already when the episode broke. The ER doc was Very thrilled to see the recordings I took with my Kardia band and confirmed that this was SVT.  This seems like good news, as the worst symptoms I've had all felt the same and I now believe they were SVT. So the question I have is what do I do about it? I've heard that the SVT ablation is much simpler and with a high permanent success rate. Does this mean I could do this with my local EP in Fargo? I completely buy the idea that if I were to do an afib ablation I would seek out the best and most likely that would mean Natale. I have an appt. coming up with my EP  in Fargo, and I know he will suggest the SVT ablation and I need to form an opinion. Can this procedure stand alone from an afib ablation and can it be done reliably by a run of the mill small town EP? Or does it need to be done with the idea that the afib could be hit at the same time. I'm very reluctant to do that afib ablation at the moment as I don't want to open pandora's box. BTW, I've never been able to record an afib episode myself, using the old Kardia device or my watch and so I believe that I am rarely ever in afib these days. Though it was clearly recorded for 24 hours in the hospital two years ago, following the crazy high rate that started the episode that I feel was maybe SVT even back then. Thank you for your responses, I look forward to sorting this out. 
Re: SVT ablation in relation to Afib ablation
January 02, 2018 07:56PM
I've heard that the SVT ablation is much simpler and with a high permanent success rate. Does this mean I could do this with my local EP in Fargo? 

Maybe an SVT ablation is much simpler and maybe it isn't. It took 7 years and 6 ablations before my SVT was finally fixed.

First, you have some unknowns. SVT is actually a class of arrhythmias encompassing atrial flutter, atrial tachycardia, and paroxysmal SVT. You can't tell from an AliveCor reading which of those you have. It's a little more complicated than what I just explained but that's the gist of it. A more thorough explanation can be found here.

If your SVT is typical right-sided flutter then yes, it's a simple ablation procedure almost any EP can manage. If, however, it's atypical left-sided flutter, all bets are off and it's probably not a simple procedure.

How do you know which it is? You don't until an EP gets you in the lab and maps it. And now that a small town Fargo EP has you on the table and finds that it's not a simple typical right-sided flutter, what happens next? Well, he's going to ablate something. Three EPs did that to me 4 times and got it wrong 4 times.

I don't think any ablation should ever be done by a low-volume EP in a low-volume center. In fact, I don't think ablations should be done in such settings at all. Ablation is a complex procedure that requires years of training, years of experience, and thousands of ablations to develop true expertise. That's not usually possible anywhere except large, busy centers that specialize in afib ablations. Do yourself a favor and skip the B team. Go right to the A team.
Re: SVT ablation in relation to Afib ablation
January 15, 2018 11:32AM
Carey, our history and experiences sound very similar.
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