SVT/Flutter and Ramblings of my mind....

Here is the Holter Report, not reviewed yet by the EP. I have many questions when I see him again. I for certain felt many flutter-like episodes but it is all read as SVT. Does it matter? Or is the management the same? Oddly enough, after stopping all of the medication trials, my episodes have actually lessened. Is it possible that the anti-arrhythmics were making it worse?? Many, many thoughts rolling around in this brain of mine.
My last Holter in February only showed 700 SVT episodes in a week, this one showed almost that many in one day! It seems that the episodes have lessened and I would like to think that maybe it will get better in its own. Has anyone noticed if there is a cyclical pattern to their episodes, or that they worsen and improve and worsen and improve? Thanks for listening!!

They're going to need to catch your arrhythmias on a 12-lead to make a definitive diagnosis between SVT and AFL. AFL is a type of SVT, after all, so distinguishing between them with a single-lead device probably won't be possible. Although ablations for the two would be different, the medical management is about the same. What's also different is SVT isn't usually a prelude to afib while AFL is, and SVT isn't usually progressive.

I doubt the meds increased your episodes. Not impossible, but unlikely.

Have you ever tried to stop your tachycardia with a Valsalva maneuver? SVT often responds to it. There's also carotid massage, but don't try that on your own or from stuff you find online. Ask your EP to show you how because first you need to know if it's safe for you to do so. Bad idea if you have a lot of plaque in your carotids.

Thanks Carey, and sorry for all the questions. This is all kind of new to me. I have not had any luck with Valsalva, ice, blowing in a balloon/straw/ec. The EP said Atrial Tachycardia is super tough to stop and doesn't usually stop with Valsalva. Thanks for the info on Flutter as well. I will be talking with the office tomorrow to make a follow up and see what the next steps are. I really appreciate the information. This site has been very usueful.

Well, here is the reply from the EP.... Now I feel anxious..

"Because we may need to ablate extensively in the left atrium, I would also recommend starting a blood thinner like Eliquis 5 mg by mouth twice daily. You should be on the blood thinner for a month before the ablation. At your earlier ablations, you had some atrial fibrillation during the case, which can be non-specific. I am also suspicious that your atrial tachycardia is from the left side, not right side. To lower the risk of stroke, I would recommend blood thinners before and after the ablation. Your last echocardiogram was 4-5 years ago. Given the amount of SVT on the Holter, I've also ordered an echocardiogram to make sure your heart hasn't been effected by the SVT. I've also started the process to get you scheduled for the ablation."

What is the procedure for going into the left Atrium? My husband and I are in the middle of building an addition on our house and we are doing it all ourselves. What kind of increased risk will I be at from the Eliquis? Thanks for all your expertise!

Being on Eliquis before and after an ablation is completely routine and expected. Going into the left atrium is also very routine. They get there by using a needle on the end of a catheter to puncture through the septum, the wall of tissue that divides the left and right atria. The Eliquis creates very little risk for you and in this case it actually lowers your risks. Doing an ablation without it would be irresponsible and dangerous. This won't interfere with your home building for more than 2-3 days for the procedure itself.

Your EP said nothing that should make you nervous or alarmed.

Pretty much all AF is in the left atrium. Flutter can be in both atria. In order to not have to perform open heart surgery, they go in through your femoral vein and up into the right atrium, where all the veins empty into the heart...except for the pulmonary veins, which are most often the 'bad spots' that need attention in the other atrium...the left one. They're called veins, even though they bring oxygenated blood from the lungs back to the heart for distribution around the body. They're veins because they return blood to the heart...the de facto definition of a vein.

They enter the femoral vein, right side, shove the catheter into the right atrium, and then manipulate the catheter to abut up against the face of the septum separating the two atria. They pierce that wall, and enter the left atrium where the work must be done. All this means bleeding, and if you're essentially in AF the whole time, you're at risk of a stroke just from the AF alone. Now, with burning and puncturing going on, there's blood that could potentially coagulate. That's why they want you on blood thinners. And, they'll give you more right before your procedure, although it will be Plavix or heparin, sometimes both. I had both for my angiogram. And five baby aspirin the 12 hours prior, but I had been ordered to cease Eliquis the prior morning.

There is always a risk of bleeding with Eliquis, but the far worse risk is if the blood anywhere causes a stroke, and that's Eliquis' job. Most of us here have been on two pills a day for literally years with no deaths or severe near bleed-outs that any of us have shared here. I have had numerous scrapes, cuts, contusions since being put on Eliquis in late 2017. Somehow, I'm still here...typing away.

SVT often responds to the "Modified Valsalva Manuever". A partner helps, but I've done it successfully by myself, lying on floor and propping my legs up on a couch, chair, etc. If you have an adjustable bed, that might also do it. Easy to find syringe barrels to blow into, but anything that constricts your breathing helps. Tends not to work with aflutter or afib, just SVT.

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Jim



Edited 1 time(s). Last edit at 11/06/2023 09:09AM by mjamesone.

Thanks Jim. Unfortunately I have the more uncommon Atrial Tachycardia that does not respond to vagal maneuvers! the Metoprolol has quieted it down some and I will just hunker down and wait for the ablation. Thanks for the reassurance about it all. I starts the Eliquis and am doing just fine.