What’s next

If the protocol is ICD pacer, Coreg and amiodarene, Whats next?  Ablation ? 


6 Comments

Not necessarily

by Gemita - 2023-09-07 17:45:55

Happygirl, 

Hello again, will you eventually require an ablation?   No not necessarily, especially if you don’t get another sustained VT episode or can find a way to prevent one from occurring say, for instance if they are exercise triggered, or caused by another treatable health condition or even electrolytes.  Are you actually taking Amiodarone?  Have they checked your ejection fraction recently?

As I stated in your previous post, you have the ICD as the ultimate treatment to stop this rhythm disturbance, so if you could find a way of tolerating an occasional shock, you wouldn’t perhaps require anything else, other than an effective rate lowering medication like your Coreg (beta blocker).  Unless VT occurs frequently you might not even need Amiodarone long term.  What do your doctors say about the best way forward?  Have they discussed an ablation?

What’s next?

by Happygirl8 - 2023-09-07 17:59:30

Gemita, thank you for respose ! Ablation has not been mentioned!  I haven't taken amiodarene yet! I'm just getting all the baseline tests first! I'm very confused! I know my EP doesn't  want me to have another VT episode. That's why he's prescribing amiodarone. It's preventative.  But I'm not having these episodes daily?  My heart is back to normal rhythm.  The ICD enabled my heart rhythm to go  back to normal after the episode ! I guess one episode is too many for him. So why did he implant an ICD? I thought that was the remedy? He said he doesn't want me to have these episodes so this is his recommendation.  

My ejection fraction was 50-55% in July.  It improved from 40% in April! I'm not scheduled for one but I wonder if after a VT episode that I recently had, my EF will go down? Does a VT episode effect the EF? I have an appointment on October 5 with my cardiologist , I can ask him when I can have another ECHO .  My insurance may not approve if it's sooner than a  year?  

Take your time to consider all your options

by Gemita - 2023-09-07 18:14:16

Clearly if your EP feels from monitoring that you are in danger of getting further VT episodes, he will want to prevent this from happening and then triggering a shock.  I can understand this, although in your shoes I wouldn’t want to go rushing in unless I had to. 

Believe you had a low ejection fraction at one time.  Your EP no doubt wants to stop any VT episodes from pushing your ventricles too fast and then this leading to heart failure symptoms over time, hence the recommendation of Amiodarone and/or an ablation.  But perhaps we can try stopping VT from progressing by lifestyle changes first?  As long as you feel okay and your heart is steady and in normal sinus rhythm for most of the time, I would be confident that you have time to consider all your options more carefully.

The ICD was implanted to prevent sudden cardiac arrest

by Gemita - 2023-09-07 19:07:33

Hi again, missed your question about the ICD implant.  Sustained VT if it is not stopped could quickly deteriorate into VF and cause sudden cardiac death.  This is why you have an ICD to stop any sustained venrtricular tachycardia episodes.  Yes although an ICD is certainly an effective treatment to stop an episode of VT, if your doctor can prevent a VT episode from happening in the first place, this is always preferable.

Update:  I have just seen your edit about ejection fraction.  Ventricular Tachycardia can adversely affect ejection fraction and lead to heart failure symptoms if not controlled, which is why you have been given medication and an ICD.  It really depends how often any sustained episodes of VT occur.  If they are infrequent, or non sustained in nature you could ask your doctor if it would be safe to wait and see whether episodes will settle before going in so heavily?  You could also ask about ICD settings and whether these could be adjusted to warn you of an imminent shock so that you could get to a place of safety?

What’s next?

by Happygirl8 - 2023-09-07 20:10:12

I got the ICD in April.  This was the first VT episode after 5 months.  It was about 4 minutes before I became totally lucid.  Since the episode, I'm pacing normal.  The EP clinic tracks the pacing.  They would call me if they noticed something that's not normal. Im not sure I want to wait and see if another episode will happen.  I like to exercise and right now, im afraid if I don't take a new med, exercise may trigger another VT episode. It's a lot to consider! 

What's next? It is your decision ultimately

by Gemita - 2023-09-08 03:33:14

Happygirl, follow your gut feeling and do what you feel is best for you.  With an arrhythmia there is often no right or wrong way to proceed because none of us knows what will happen or what could happen in the future.  Having an ICD, taking medication, having an ablation or doing "nothing" and focussing on lifestyle alone may all be possible treatment options, so how do we choose?  By trial and error in my experience.  

For example, some arrhythmia sufferers do well on meds alone, others need an ablation.  We are all so individual and our arrhythmias, like all electrical disturbances will continue to change over our lifetime.

I chose to do very little and it has clearly worked for me, since anti arrhythmic medication (Flecainide and Digoxin) eventually became "pro arrhythmic" and made my symptoms and arrhythmias far worse, so I eventually stopped both meds and now am only on a low dose beta blocker (Bisoprolol) with fantastic results from dual chamber pacing alone.  Sometimes doing nothing is a good option too.  I wonder what might have happened if I had gone down the route of further meds, including Amiodarone, and an AV Node ablation?

Whichever path you follow, trust yourself and your doctor and proceed with confidence because arrhythmias can be fuelled by stress and worry.  I send my very best wishes as always Happygirl 

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