2nd opinion appt for SVT ablation

ok so after my horrible experience with the last egotistical bastard EP who didn't even look at my chart before making a decision, I went for a second opinion about the ablation.
I have to say, this new doctor is awesome. He was so personable and seems to know what he was talking about. He said that the part of my heart that is acting up has a very good success rate if I get it ablated (SA Node) and since I already have a pacemaker, he doesn't see a problem with getting it done and helping me get some relief. He even brought in a colleague for a 2nd opinion of his answer. They both agreed to the ablation. I called the other doctor to cancel and scheduled with this guy. Funny thing is I was able to get in this Tuesday for the ablation (same day the other dr scheduled me for). I feel really good about this dr for sure and I am so glad I went for a 2nd opinion

5 Comments

Me too

by Theknotguy - 2014-11-20 04:11:03

I'm glad you got a second opinion too.

Hope everything goes well. Let us know.

SA node ablation

by golden_snitch - 2014-11-21 02:11:49

Hi!

What, that guy said that an SA node ablation is necessary and an easy thing to do???

First of all, SA node ablations/modifications are VERY rarely done today. There was a time back in the 1990's where they were done more often - with bad outcomes. SA node ablations are usually only for patients with a permanent sinus node tachycardia, a tachy that runs all day long and which did not respond to any drugs (most importantly Ivabradine, which is a direct sinus node inhibitor). SA node ablations are a last resort therapy. SA node ablations are very often not successful in the first attempt. Actually, I do not know any sinus tachycardia patient who had less than three SA node ablations. My SA node ablations led to superior vena cava syndrome requiring open heart surgery, and I know two other patients in whom that happened. Plus, once the SA node stops functioning, you need the pacemaker's rate response, and especially for younger, more active people that does not come without compromisis. A pacemaker rate response is never as good as a functioning SA node.

I'm being seen at a center where they perform about 2500 ablations per year. The EPs there say that they hate SA node ablations, because of the bad outcome, and they do them in only the worst worst cases. They see about 1-3 of these cases per year. Just that you get an idea of how rare these ablations are. My sinus node was doing 120-140bpm non-stop (24/7) when my SA node ablations started.

Last but not least, EPs who can give you an appointment for an ablation within less than a week, do not seem to be that busy --- good EPs are busy. Usually, when you go to a big EP center that does lots of ablations, you need to wait several weeks for an appointment. I'd not go anywhere where they offer me an SA node ablation within less than a week. That sounds very odd to me.

Just went back and read your first post, and there you talk about SVT episodes. SA node ablation is definitely not the way to go for that. SVT episodes can be anything: AVNRT, ectopic atrial tachycardia, atrial flutter, WPW syndrome, AVRT. Ablating the SA node won't help for that. Ablating the SA node only treats sinus tachycardia. And again, even if you had sinus tachys, you'd not ablate the SA node when you only have episodes. SA node ablations are, once again, only for very bad cases of non-stop sinus tachycardia.

Inga

Thanks

by flowerapril429 - 2014-11-21 07:11:05

Thank you for your input. Let me give a little more information.
The only reason he got me in within a week is because one of his patients canceled due to getting open heart surgery Instead otherwise I would have had to wait until mid-feb for my ablation.
I am in a constant tachy which is starting to enlarge my heart which is why my original doctor sent me to the EP to get the ablation. I not only have SVT but I am always in a sinus tach. Of 120-140 every day with no relief from medication (I have tried them all with no help) so this is why I am wanting the ablation. I am at my last resort as I would never just want to have a procedure that is unnecessary. I have been to the ER many times for adenosine and the bills are racking up so right now, this ablation is something I am willing to try for relief. Even if it doesn't work100%, I would be even happy with 50%.
I am already pacemaker dependent for my low heart rate so if destroying my SA node keeps me pacemaker dependent, I don't mind.
Thank you again for the information, it's always appreciated.

Thanks

by golden_snitch - 2014-11-21 08:11:07

Thanks for the background, that explains a lot. From the first two posts I could not understand at all why you want an SA node ablation for SVT. You talked about SVT episodes, not about constant tachy. And there was no info about that in your profile, either.

Just don't get your hopes up too much. I was extremely disappointed when the first attempt did not help at all. The SA node cannot be ablated completely as it's not really a node, but rather an area covered with pacemaker cells. You cannot ablate each and every of these cells.

What often happens is that the sinus node recovers from ablations. My first SA node modification was not successful at all; second was successful for a few weeks, then sinus tachy was back and even faster than before; third attempt destroyed large parts of the node, resulting in an AV-nodal escape rhythm. Pacemaker was put in 6 weeks later. Five months later, inappropriate sinus tachy was back again. After the fourth ablation I was doing okay. Overall, more than 120 radiofrequency applications in the SA node area. As I said, I do not know any sinus tachy patient who got relief from one procedure. So, if you do the procedure now, be prepared (also with regards to the costs) that you might need a second or even third. In this regard, SA node ablations are a bit like Afib ablations.

Good luck!

Inga

LOL

by flowerapril429 - 2014-11-21 09:11:54

No worries, Guess it is time to update my page. Its been a little over 2 yrs.
Thanks again

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