Anyone with SVT and Afib. Need your Experience and Advice.

New here but not to afib. Five episodes starting at age 40 and I am 71 now. All either electro or naturally cardioverted. Never took meds in-between. Then starting this May I've had 15 Kardia documented SVT episodes lasting from 2 to 10 minutes. HR as high as 199. Most episode leave me fatigued from hours to days.

Plan is to try lifestyle changes first, but if that doesn't work looking into ablation.

One EP recommended an SVT ablation. I have also heard that some EPs might want to do a combination SVT and afib ablation. And one cardio told me that if I do an SVT ablation it might make my afib worse so he recommended meds. Another said an SVT ablation will not make afib worse. This all leaves me a bit confused!

Personally I'd rather just take care of the SVT now and take my chances with afib which has never been a big factor in my life. But on the other hand if an SVT ablation has a reasonable chance of making the afib worse, that's another story.

Welcome all comments and advice both as the type of ablation I should get as well as anyone's experience or treatment plan who has had both SVT and Afib. Also wondering if anyone just got rid of the SVT by lifestyle changes alone. I've gone 3 weeks without a major attack after changing to the FODMAP diet but the EPs suggest it won't hold. I've also been taking it very easy and worry once I return to normal activity the SVT episodes will return.

Lastly I live in the NYC, Long Island area. So any EP recommendations would be appreciated.

Jim

I’ve had both ablations. SVT first, then afib many years later. The SVT ablation procedure is a piece of cake compared to Afib ablation procedure. They discovered the afib during the SVT ablation. Many may disagree, but living with afib is a lot easier than SVT. If it were me, I’d get the SVT ablation as soon as possible. I am in LA, so cannot help you with finding an ep doc, sorry.

Good luck with whatever you decide!

Steve

Hi,
I've had both SVT and a-fib. I was told that SVT can degrade into a-fib. I'm not sure if this was my case or how they tell this, but I'm guessing in this case one would treat the SVT. I just had an ablation with Dr Natale and both were addressed. So far, so good! I don't know any docs in your area, but some here have recommended a doc in Pennsylvania. That's not too far from NY. Anybody?

Hi Libby, What factored into Dr. Natale deciding to do both an SVT and Afib Ablation as opposed to just a SVT ablation? Thanks.

Jim

Hi Steve, Forgive my lack of understanding in this topic, but if I understand you correctly, they found both afib and SVT during your first ep study and only decided to do a SVT ablation? If that was the plan why were they poking around in the left side of the heart to induce afib if they were just going to do an SVT ablation? Lastly, do you think the SVT ablation made your afib worse or do you think the afib just got worse on its own as you got older? Having both afib and SVT I agree that living with SVT is harder.

Jim



Edited 1 time(s). Last edit at 07/13/2018 09:43PM by mjamesone.

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mjamesone
Hi Libby, What factored into Dr. Natale deciding to do both an SVT and Afib Ablation as opposed to just a SVT ablation?

Natale would never do two procedures when he can take care of two problems with one procedure. There's no reason those procedures need to be done separately.

Carey: Natale would never do two procedures when he can take care of two problems with one procedure.
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Carey, unless I'm reading it wrong, Libby seemed to say that Dr. Natale performed both an SVT ablation and an Afib ablation on her at the same time. That would be two procedures as opposed to just doing an SVT ablation. Maybe Libby will comment.

This goes back to my original questions and concerns about SVT ablation with a history of afib. Do you do just an SVT ablation (right side) or in addition do you then go into the left side and perform an afib ablation. And if you do the former (just SVT ablation) is there a chance that your afib will actually get worse, i.e trading SVT relief for making your afib worse.

Jim

I Never had SVT before my first afib episode, 2.5 years ago. I even never felt any premature contraction.
Since my first afib episode, I've tried different meds, without success. I've been ablated for right atrial flutter, my PV have been cryo ablated, I've got a touch up RF procedure where one PV isolation has been corrected and my sup VC has been ablated too.
Now, I've still short episodes of various arrhythmias: PACs and PVCs mixed with afib, runs of atypical flutter, minutes of SVT (happily, not above 125 bpm)...
We're all different. Both my parents were afibbers, my mother still is (she's 90), my father left at 90, after a couple of strokes. I'm 60, my GP told me I'm healthy, no overweight, moderate BP, sportive without excess, no tobacco, very moderate alcohol intake...
I've seen 2 cardiologists and 3 EPs. None of them thought I could become a "complex" patient. Statistically, chances for a successfull ablation were great.
They were not.
I don't know what to do now. Any decision I make is at my own risk. Causes of afib are still a mystery and remedies don't cure the causes. They treat the symptoms.
Knowing this, would I still have ablations ?
Yes. Without any doubt.

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mjamesone
Carey, unless I'm reading it wrong, Libby seemed to say that Dr. Natale performed both an SVT ablation and an Afib ablation on her at the same time. That would be two procedures as opposed to just doing an SVT ablation. Maybe Libby will comment.

What Libby said is Natale did one procedure and addressed both SVT and afib in that one procedure, which is exactly what I would expect a competent EP to do. There's no reason to do two separate procedures when the only difference is which areas are being ablated. All that would accomplish is doubling the cost, doubling the risks, and doubling the downtime for the patient. You're thinking of these things as very different procedures when they're not. It's very common for ablations to involve work in both the right and left atria even when SVT isn't an issue.

Yes, an ablation for the SVT only could worsen the afib since trauma and inflammation are always the enemy of afib, so that's just another reason to do it all in one procedure. There's really no good reason to do two procedures and if an EP thinks he needs to do two then I would find another EP.

Hi all,
In the past I have documented sinus tachycardia, SVT, and a-fib. Now that I think this through, a right sided EP study was done in Minneapolis last summer. The EP said he thought I had SVT that degraded into a-fib. I went into a-fib easily, but he couldn't induce SVT so he aborted the procedure because he said we hadn't discussed the risks of going to the left side. I was super bummed at the time, but am glad he didn't proceed. I wasn't anti-coagulated.
Re Dr Natale: What I know is that he ablated the areas that were being naughty no matter SVT or a-fib. He found both tachycardia and a-fib and ablated PV's, coronary sinus, SVC and one other spot I can't remember at the moment.

@ Carey: What Libby said is Natale did one procedure and addressed both SVT and afib in that one procedure, which is exactly what I would expect a competent EP to do...Yes, an ablation for the SVT only could worsen the afib since trauma and inflammation are always the enemy of afib,
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Hi Carey, I think we're having an issue of semantics here. When I referenced "two procedures" I was talking about an SVT ablation (right side) and an Afib ablation (left side) during the same operation. Not two different operations at different times.

As to doing only an SVT ablation, two EPs told me that would be their strategy because: (1) my afib is secondary to the SVT. In other words, let's get rid of the SVT and we'll deal with the afib later, with drugs or an ablation if it becomes a problem; and (2) SVT ablation is shorter, less invasive procedure with better outcomes. And historically afib has never been much of a problem with me so this seemed like a sound strategy.

On the other hand, one cardiologist mentioned something like you did that once you ablate SVT, you could aggravate afib. That's why I'm posting here to get more opinions and thank you for yours.

Jim

Hi Libby, Thank you for the clarificcation. Sounds then like Dr. Natale performed both an SVT and Afib ablation on you during the same operation.

Looking back, how satisfied were you with Dr. Natale's ablation and how much time did he personally give you to discuss things prior to the procedures.

Jim

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mjamesone
Hi Carey, I think we're having an issue of semantics here. When I referenced "two procedures" I was talking about an SVT ablation (right side) and an Afib ablation (left side) during the same operation. Not two different operations at different times.

Okay, I see. However, you're thinking of these as very different things when they're not. An afib ablation very often involves work in both the right and left atria. Fact is, SVT and afib are close cousins, and SVT very often progresses to afib. I thoroughly disagree with your EPs who would deal with the SVT and then wait and see what happens with the afib. That's just an excuse to do an easy ablation and put off the complicated one until later -- at your expense in cost, risk and dealing with the disease.

Find an expert ablationist who knows how to deal with both problems at once and be done with it. There's absolutely no benefit to doing multiple procedures and a lot of reasons not to.

Carey, I appreciate your thoughts. But as you know, even within the EP community, the value of a left side afib ablation versus the risks is debatable. The one EP I talked to said he rarely does afib ablations because of uncertain outcomes and the potential for multiple operations, except when the patient is in their 20's. He does however perform many SVT ablations because it is less invasive and the success rates are much higher. I do understand that Natale and many other EPs have the opposite point of view. I don't see it SVT ablation as an "easy" choice by the EP but just a point of view. Before my SVT I was offered an afib ablation by several EPs over the years. I decided against it each time because my episodes were many years apart and did not effect my lifestyle.

Jim

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mjamesone
The one EP I talked to said he rarely does afib ablations because of uncertain outcomes and the potential for multiple operations, except when the patient is in their 20's. He does however perform many SVT ablations because it is less invasive and the success rates are much higher.

If an EP told me this, I'd be looking for an EP from the top tier.

I've heard the same argument given to friends for flutter ablations - do the flutter first and see if it helps the afib. I referred these friends to Natale or in one case his protege', Sergio Pinkski. One my friends got that argument from an EP at a teaching hospital. All are happy with their outcomes.

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mjamesone
But as you know, even within the EP community, the value of a left side afib ablation versus the risks is debatable.

No, actually, it's not. I don't know who told you that but they're wrong. That conflicts not only with clinical experience but research data as well. Ablation is recognized as superior to drug therapy. Also, you should put this left side vs. right side thing out of your head. Afib can originate in either chamber. In fact, I've had an afib ablation that involved only the right side. And yes, an SVT ablation is easier than an afib ablation. It just is. Afib ablations are the most difficult, most complex ablations of all.

What is true is that there are many EPs out there doing ablations who shouldn't be. That's why you should only consider the most highly experienced EPs at the largest centers that do thousands of ablations per year. It's not a procedure that anyone should be doing at community hospitals, but the reality is they do.

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mjamesone
Hi Steve, Forgive my lack of understanding in this topic, but if I understand you correctly, they found both afib and SVT during your first ep study and only decided to do a SVT ablation? If that was the plan why were they poking around in the left side of the heart to induce afib if they were just going to do an SVT ablation? Lastly, do you think the SVT ablation made your afib worse or do you think the afib just got worse on its own as you got older? Having both afib and SVT I agree that living with SVT is harder.

Jim

Jim,

I had SVT from the time I was around 12 yo. I finally had it taken care of through ablation around 43 yo. At the time of the ablation, I went into afib. I lived with afib for about 10 years and had it ablated at 53 yo. I am now 60 and until very recently have been both SVT and afib free. Had a bit of an afib breakout a few weeks back. Doc put me on beta blockers which has helped tremendously.

Hope this clears it up for you. And yes, if it were me and I had the choice, I’d do the SVT ablation first and then do the afib ablation. Done properly, the success rate for both are very high, I would not hesitate to have both done though. No reason( except financial, if you don’t have insurance) not to.

Steve

Thanks for the clarification Steve. Just two follow ups. Do you think the SVT ablation caused the afib or did you have afib prior to the ablation. Also, would you recommend that I first do an SVT ablation and at a later date do an afib ablation if that becomes a problem, or would you suggest I have both the SVT ablation and afib ablation at the same time. Thanks.

Jim

For me SVT and afib come in the opp. of most i guess. I get an afib induced arrhythmia 1st then if that runs on for more than lets say 5 hours or so....bang it morphs into a much faster and more debilitating SVT...like the frying pan into the fire....i am getting an afib ablation with Dr. Natale in DEC. most likely, so i hope he addresses both like has been talked about in this thread......thats the only reason why i started about feb. this year to chew 1x150 mg. propafenone when i get an ARR. instead of swallowing 2 or 3x150 mg. like most do in the PIP mode cause it was taking too long to convert that way (3-5 hours) and that put me in danger of that SVT chain reaction.
Now when i get ARR. it lasts an ave. of 45 min. in the chew mode instead of swallowing and waiting to convert and with less drug used....win win.
Amazing how dif. hearts react.

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vanlith
so i hope he addresses both like has been talked about in this thread.......

I'd certainly bring it up with him. Don't keep quiet.

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Carey
Afib ablations are the most difficult, most complex ablations of all.

Atypical (left-sided) flutter is no walk in the park either.

George i certainly will but i am hoping if afib is removed then the 2nd part.......SVT for me will be also cause it never gets to that point without the afib to start with, but i will let Da Vinci know.

Ty George

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vanlith
George i certainly will but i am hoping if afib is removed then the 2nd part.......SVT for me will be also cause it never gets to that point without the afib to start with, but i will let Da Vinci know.

Ty George

Understand. I'm pretty sure he'll do an isoproterenol challenge after he's fixed the afib to try to stimulate any other bad actors.

mjamesone,
I'm very satisfied with my outcome so far. I'm nine weeks out from my procedure, off the anti-arrhythmics and have no issues!
As far as discussion beforehand, my understanding from him was that he would hunt for all causes of my rhythm issues. I was at a point that I needed to just trust him and let go to de-stress. I didn't question a lot.

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mjamesone
Thanks for the clarification Steve. Just two follow ups. Do you think the SVT ablation caused the afib or did you have afib prior to the ablation. Also, would you recommend that I first do an SVT ablation and at a later date do an afib ablation if that becomes a problem, or would you suggest I have both the SVT ablation and afib ablation at the same time. Thanks.

Jim

I had afib prior. But it was pretty well masked by the SVT and was kind of like afib lite. It got worse as the years went on. I cannot answer your second question, only your ep doc can. If they see both SVT and afib on your ekg’s and are willing to do both at the same time, sure, why not?

Just know that the SVT procedure is done in twilight and only lasts about an hour or two. Afib procedure is general anesthesia and can last many, many hours. You have a Foley catheter, stay in the hospital overnight, etc. it’s a biggie! With an SVT procedure you go home at the end of the day. Very different.

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Socalsteve
I had afib prior. But it was pretty well masked by the SVT and was kind of like afib lite. It got worse as the years went on..

How soon after your SVT ablation did your "afib" light turn into something worse? In other words do you think the SVT ablation made your afib worse or do you think it was just time.

Jim



Edited 1 time(s). Last edit at 07/15/2018 03:44PM by mjamesone.

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mjamesone
In other words do you think the SVT ablation made your afib worse or do you think it was just time.

It's extremely unlikely that an SVT ablation would make afib worse. There isn't really a mechanism by which that could happen. The fact is that people with SVT tend to progress to afib eventually. The two probably share a common underlying basis.

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Carey

In other words do you think the SVT ablation made your afib worse or do you think it was just time.


It's extremely unlikely that an SVT ablation would make afib worse. There isn't really a mechanism by which that could happen. The fact is that people with SVT tend to progress to afib eventually. The two probably share a common underlying basis.

What Carey said!