Uncertain Future

Here is my situation. I have Atrial Tachycardia/SVT. I had a 14 day Holter that showed a 20% average burden of Supra ventricular Ectopy. I had an 11% burden of SVT. I have, on average, 20-30,000 ectopic beats every day, and 6-700 runs of SVT per day. Most of my episodes occur at night. From 10pm to 6am, my hourly burden of PACs/SVTwas 30-80%, every single night. It averages 50% at night. It starts in the evening around 8pm and then keeps me awake constantly. The meds have all been a disaster. I have had two ablation attempts with failure to induce.

Had my follow up today for the post-procedure Pericarditis. The EP wanted another 3 day Holter while on the Metoprolol, not sure why, maybe just to confirm my claim that the Metoprolol wasn't working. It was confirmed.... Still have 20% burden of SVT/Ectopics, with an additional 11% burden of tachycardia, and 500 or so episodes of SVT per day. The runs were shorter on the Metoprolol, but that is about all that changed. So he said I could just stop the Metoprolol. The only plan for now is to try the TENS vagal stimulation (which he was fine with), take Propranolol for sleeping, and call him if it gets worse. The next med to try is Sotolol. For now I am just going to wait and see. I'm tired of the meds. He thinks it could be from increased vagal tone but the Norpace doubled my SVT.


I honestly don't know what to do. The meds are all worse than the heart issue. The ablations have been a failure. Unless I can get someone to do an ablation at night, when I am actually having the SVT. I am hesitant to try that again. But the massive amount of PACs/SVT are super terrible too. Any suggestions? Thoughts? I know that SVT won't kill me, but it sure feels like poo.....

I am on the waiting list for a consult with Natale. My EP was familiar with him but said that he and his colleagues are skeptical of his reported success rate. He didn't think it was wrong to consult him, but he seemed skeptical. He said that I really need an EP study at night, but who is going to do that? He also said that until my SVT is bad enough to cause cardiomyopathy or be frequent enough in the daytime to fix, I really do not need to worry about I because it will not harm me and treatment is purely to relieve symptoms. While this may be true, the frequency and intensity is enough to cause serious distress , anxiety, and sleeplessness. I feel really discouraged and at a loss. I will wait for the consult with Natale, but I very much fear another failed ablation attempt. The last one was truly awful...

Sounds like you need to find an EP that will do a study/ablation at night, pass on on doing another one during the day. That sounds kind of hard to arrange, as all of the supporting staff is on a daytime routine, even if the Dr. was willing.

Also I wonder if by going in to an EP lab at night, it might not produce the same symptoms as being at home at night, but you would just have to try. Another idea would be to stay up all night prior to an EP study scheduled during the next day, then you would be tired, like you are at night.

Keep trying and going through your options.

If you can manage, try getting your sleep cycle rolled around so you are up all night and sleeping in the daytime?

that was something my husband suggested. If I end up being a candidate for another ablation, I think I will have to try.