Ventricular Tachycardia

I wanted to share my recent experience of a ventricular tachycardia (VT) episode and some learnings I gained from it.

Late June I was out on a bike ride, 35 miles around a park nearby, a ride I have done many times before. I'm a 60 year old male, and consider myself in good health. I had never been in a hospital prior. On that day after the bike ride, my head felt very groggy. The groggy head wouldn't go away. I called one of my kids to come over to the house. She drove me to urgent care. Urgent care in turn sent me to the emergency room. There I saw many concerned faces on the medical personnel attending me. I turned to look at the heart monitor behind me, and my beats per minute were between 210 and 220. Yikes! They first tried several attempts with meds to get me back in sinus rhythm. Neither worked. They then cardioverted (electric shock) me back to normal rhythm. My first learning, the shock wasn't terribly painful. Like being hit from behind by a professional football player for an instant, then back to normal.

Up to a hospital room for roughly 4 days...mostly the docs trying to figure out what caused the VT. The cardio plumber came in first. After angiogram my arteries were relatively good and not the cause of the arrhythmia. Next came the cardio electrician. He ordered an MRI, which I took that Friday, and Friday evening called me and told me they found some scarring on my left ventricle, I should come in Monday for an implantable cardio defibrillator (ICD). I started calling everyone and anyone I could think of that had some medical connection. A good friend of mine put me in touch with a friend of his, a critical care/pulmonary doc and this doc spent an hour on the phone with me that weekend. This doc was an angel; he was patient, told me I was safe and to think things through and get another opinion or two. Don't rush. I would up getting four opinions over the course of July.

During July I took some more tests for inflammation. At this time I had visited with three electrophysiology docs and one cardiac inflammation doc. They all said scarring and recommended ICD. But there were subtle differences in what they told me. The docs are not always on the same page. The scarring yes, but other items no. One doc told me my ejection fraction (EF) was borderline low...but every test I took showed EF to be good. One doc said absolutely will have another VT episode, one doc said 5% to 10% chance and another doc said 15% chance. On a CT chest scan I took for inflammation; one interpreting doc said nodules. Another interpreting doc, same CT scan, no nodules...artifacts from breathing during scan. This is not a perfectly understood science. Ultimately it's up to the patient to decipher the information presented from medical professionals and decide what is the best course of action to take.

My next phase was being put in touch with Shannon Dixon...I don't know how to explain him except to say he's an uber patient advocate. Shannon was positive, upbeat and provided some great comfort. We talked about a doc I had read about, Dr. Andrea Natale, at the Texas Cardiac Arrhythmia (TCA), in Austin. Shannon has a relationship with him. He put me in touch with Dr. Natale and got me a consultation. I went down to Austin and had a consultation and ablation procedure with him. Hasty? Maybe, but I couldn't see any downside. My research told me high volume ablation centers were the key to successful ablations and TCA fit that mold. Other friends, including some of the docs I saw in Denver and a friend from college who is a cardiologist confirmed this. He suggested I might not need the ICD. Blew me away, but I follow...he has a skill set that may provide an additional means to prevent additional VT episodes that others may not be as proficient in doing.

My sharings; find an advocate(s), preferably someone with a medical background or very familiar with health care. Someone whose interest is only you, with nothing to gain from a procedure. Second; do the research. I've been told to tone down the research and chill. Sometimes I take things out of context and get a little dark, but most of the time I'm learning about my situation and I'm convinced it helps me make better decisions.


So today, I'm in a better and safer place than where I was a week ago...with the ablation. The journey is not over and probably won't be completely. But for today, I'm in a good place. And tomorrow I'm going fishing! Thanks again Shannon for being one of those bright lights along the way.

Shannon is a beacon! He did for me what he did for you and I am so grateful.

I'm glad you are doing well and on the mend. Here's to many, many more miles on that bicycle.

Always nice to hear a story with a positive ending.


Did the ER staff even give you a sedative? Doing a cardioversion on a fully conscious patient is normally only done emergently when a patient is unstable, which it doesn't sound like you were.

Really have to watch your own back when it comes to ICD implants for VT so soon after a first episode. Even for cases where implant may be appropriate such as after an ischemic heart attack, the guideline is a wait of 6 months. It may be the best option for a center that doesn't have the VT ablation expertise since there are only 20 or so centers in the country that have high enough volumes. I had to do some research for my father in law after his MI 18 months ago. Glad he was able to recover without implant or major intervention. However, he is in his 90s and he is on the heart failure path. AF and PVCs are the norm.

Sorry for late reply...no sedatives for cardioversion. My choice, my bad I guess. I thought I understood from the nurse I would get some light pacing or shocks or such. So I begged off the sedation. Oops, 100J. Felt like a pro football player hit me from behind with a 20 yard start. Only lasted a fraction of a second, really not that bad. For a life saver, I'd do it again...in a heartbeat...arrrhh, arrhhh, arrhhh.

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denverbiker
Sorry for late reply...no sedatives for cardioversion. My choice, my bad I guess. I thought I understood from the nurse I would get some light pacing or shocks or such. So I begged off the sedation. Oops, 100J. Felt like a pro football player hit me from behind with a 20 yard start.

LOL... Oops!

I once asked my EP to skip the sedation. He just shook his head and said, "No, you would not like me much after that."

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Carey

Sorry for late reply...no sedatives for cardioversion. My choice, my bad I guess. I thought I understood from the nurse I would get some light pacing or shocks or such. So I begged off the sedation. Oops, 100J. Felt like a pro football player hit me from behind with a 20 yard start.

LOL... Oops!

I once asked my EP to skip the sedation. He just shook his head and said, "No, you would not like me much after that."

And I once had an ER doc .. an older guy ... who was nervous in dispensing the Propofol prior to my very last ECV prior to my second and last ablation years ago (knock on wood) .. he pushed the propofol much too slowly and I had told him I needed at least 110mg plus 150 joules to set things right and where I would not feel a thing.

Propofol is very short acting and instead of using my needed 110mg to really remain deep in dreamland, he used only 70mg pushing it in VERY slowly over something like 4 m minutes!! all the while muttering inappropriately about Michael Jackson having kicked the bucket using propofol .. completely off table and inappropriately as as sleep aid as well, not to mention with enough valium and other benzo's and sedatives to knock out and elephant and his quack doctor went up stairs to make a 20 minute phone call leaving Jackson alone to stop breathing and by the farm!

Seeing that I was still wide awake I asked the unsure ER doc to please hurrry up with pushing the 'milk of amnesia' and promptly closed my eyes thinking it might help me slip into anesthesia. Well the moment I closed my eyes I hear the doc yell across my bed to his nurse manning the shocker to "Push the Button" and even though I tried my best top yell back "NOOOO I'm Still AWAKE" I got blasted by 150 joules right across my chest in the single most violent experience of my life!! I levitated entirely off the hospital bed and felt like a small yield nuke had gone off in my chest about the same time as the 'Hammer of Thor' crashed into the top of my head!

The Doc instantly started blaming the poor nurses there saying it they had not been chatting with me I would have "fallen asleep", to which I quickly countered that with the right propofol dose, a detail of Howitzer cannons could fire a salute at the foot of my bed and I would have remained blissfully ignorant of any such cacophony in the ER!

The befuddled and embarrassed ER doc then fled the room never to be seen again, as the equally embarrassed nurses remained to take off the wires and such and finally discharge me, fortunately restored to NSR for the time being.

Morale of the story ...do not be shy about asking any ER doc about to ECV you to please be sure and confirm that you are fully out before any buttons are pushed!

Shannon