Currently in hospital - Sudden case of Slow VT ?

Hi all i have had a PaceMaker for 20+ years and was recently diagnoised with ARVC (acute right ventrical cardiomyopathy) - As fellow PM's know, i felt that my heart was not acting normally as i felt that it was racing for small bursts. i contaced the device care team after a transmission and asked them if they noticed anything during those specific times . they confirmed they did notice a fast HR but nothing being reported as abnormal by the PM.

Long story short i went to my ElectroPhysiolist for a check up and had the same issue come up during the checkup (luckily) - i got admitted and was told that i have 'slow VT' meaning VT in the 120-140 beats range. My device is not programmed to start paciing if heartbeat > 140 and therapy/shock at over 170 and since this was not within those parameters it was not doing anything. 

Longer story longer - they switched medication from metroprol to sotalol and no signifcant changes have been noticed (i am still in hospital) i kept getting into slow VT almost every hour., PM has been adjusted to account for the slow VT and it paces me out when i go into it but the option presented to me is to get an ablation in the next couple of days as a long term fix.

I am boggled that i jumped from a normal no episode no events in almost a  year to persistent slow VT, admitted in hospital for 48hrs possibly more and needing an emergency ablation. Anyone else has had a similiar experience ??
i am also not sure abt Ablations - any questions i should be asking of the EP's ? thanks


6 Comments

low dose Amiodarone?

by BOBTHOM - 2021-08-22 00:33:53


You might want to ask about taking a low dose of Amiodarone.  It's worked (mostly) for me. It is one of the best anti arthymic drugs they have but does have serious long term side affects. They have suggested ablation to me several times but I keep reminding them that I already have severe wall damage from a previous MI and I was not comfortable doing more permanent damage (the ablation kills areas of the heart muscle to stop/reduce the electric flow through that area). But depending on your other conditions it may be the best option for you.  For now, be thankful your device hasn't shocked you!  Good luck, hope it works out for you.

amiodarone side effects ?

by ak - 2021-08-22 01:41:31

Hi @Bobthom - thanks so much for the prompt reply, amiodarone has been suggested and i took a while ago and had some side affects like feeling dizzy, nausea etc , i am goign to bring it up with the EP again , maybe over time my body might adjust to it better. i am 50/50 on a VT ablation at the moment. not sure with ARVC where RV is suppose to deteriotie over time anyways if this might be the best solution. 

small update / re amiodarone

by ak - 2021-08-22 17:24:09

still in hospital and sotalol seems to be doing better than metroprol but still not out of the woods and VT ablation still on table and to be decided based on the next 24 hours of how sotalol works. 

spoke with my EP  regarding amiodarone and at my age ~mid 40's they do not recommend it due to its long term side effects and toxicity, that is in line from what i have learned as well. 

on a completely side note - vt ablation has been brought up several times as a safe option and i am slowly being conviced of it although the pesimist in me thinks how much is based off the wide profit margin of treatment with medicine vs surgery :?

Ablation

by Ram - 2021-08-25 20:27:44

I have a friend who has had a pacemaker for 22 years and 4 ablations for different issues with AF.  She has never had a problem, very athletic and in her mid 80s.

Ablation

by AgentX86 - 2021-08-25 21:40:51

There is a big difference between an ablation for atrial arrhythmias (I've had three, plus the A/V) and a ventricular ablation. My EP didn't even want to talk about it for my bigemeny PVCs.

@AgentX86 ? Artrial Ablations vs Ventricular Ablations

by ak - 2021-08-26 11:16:05

Can you help explain a bit more , i thought they were about same or Artrial would be harder since its a bit more harder to access than ventricular. 

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