Inappropriate Sinus Tachycardia

Hello, It's been awhile since I was on here.

I would appreciate it if anyone has any experience or words of wisdom with dealing with inappropriate sinus tachycardia years after ablation.

I had my ablation for afib and aflutter with Dr. Khaykin at Southlake in Toronto in 2012. I had some tachycardia in the first few months, rate around 120 bpm, but that settled with the meds. A few years ago, I started getting small runs of what I thought was afib or flutter, but not with the high heart rates I used to have with my afib. I was often able to get rid of them by using the Valsalva maneuver. Sometimes I ended up in the ER and was cardioverted. Sometimes they said it was flutter, sometimes afib.

I had a 14-day Holter monitor and it showed no flutter or afib, just tachycardia. The EP suggested it was Multifocal Atrial Tachycardia. But I am healthy and it seems that condition usually comes with people who have been very ill with other issues. I have been keeping these episodes to a minimum with 12.5 mg of Metoprolol at night and 25 mg in the morning.

A few days ago, I had an episode that I could not convert, no matter what I tried, cold shower, Valsalva, on my back with feet over my head and bearing down. Nothing worked. The paramedics said the ECG showed afib, but in the ER they said it was not afib or aflutter, just sinus tachycardia and that they could not use the paddles on that. So I am now in Inappropriate Sinus Tachycardia with heart rate of 135, waiting to see my cardiologist. I suddenly feel disabled, as I can't do much except sit, without being out of breath.

Has anyone had experience with this? I keep thinking that just a jolt from the paddles would fix me.

Thanks in advance,

Marg

It's not that they can't cardiovert you, but rather just won't. I don't know if that's a protocol or policy of some sort, or just an ER doc's decision. How long before you can see your cardiologist?

Hi Carey,

Thanks for replying. I sat at home totally disabled by the heart rate which stayed at 135 for two days. I felt that no one could or, as you say, would help me.

Then all of a sudden my HR increased to 160 to 170. So I went back to the ER and this time got seen by a doctor who cared. He gave me a Metoprolol drip and within ten minutes my HR had gone down to 79 and stayed normal. I saw my cardiologist today who said from looking at the ECG printouts that I was in afib when I went in on Monday and by the time I went back on Wednesday, I was in flutter. Since I have been ablated for typical flutter, this one is atypical flutter. He wanted to start me on amiodarone but I was very leery about that. We settled on Multaq which I know is not as effective.

I remember reading about the dangers of side effects from amiodarone and also the disappointment in the effectiveness of Multaq. I am not sure whether I made the right decision.

Marg

I think you made the right decision. It's worth trying the Multaq before graduating to amiodarone. And if the Multaq doesn't work, I would suggest asking to try flecainide next, not amio. Amiodarone should be a last resort.

The reason he wanted to try amiodarone and Multaq was because they are both able to prevent both afib and aflutter. Does flec also prevent aflutter?

Also, I am on Metoprolol and you are supposed to be careful taking that and Multaq together but my cardio didn't mention that. I put a call in to him today but have not heard back.

Don't want to fill my prescription until I hear.

Quote
Marg
The reason he wanted to try amiodarone and Multaq was because they are both able to prevent both afib and aflutter. Does flec also prevent aflutter?

Yes.

And people take Multaq with metoprolol all the time. It's really quite safe.

I have similar at around 135 bpm. Episodes are self terminating and usually under15 minutes, but I did recently have one that lasted an hour and a half. Early in the experiment, but finding that 120 mg of Diltiazem ER daily prevents them from happening. If things start to go to south it might be back to the ep lab, but in no rush.

Jim

Can Milton help PVCs?

I don't know if Milton can help but Multaq might.

I can’t type worth a darn with my double vision being on Tenormin. Thanks Carey. You figured it out.