NSVT issues again

NSVT (non sustained ventricular tachycardia)

by Gemita - 2021-04-28 20:13:52

Hello Hayden

I am so sorry you are feeling anxious following your ZioPatch results.  I will try to help in whatever way I can because I understand how anxiety can build inside us and destroy our peace of mind, adversely affecting so much in our lives.  Shall we just go back over what has happened?  This is how I see your situation Hayden, although of course I am not in your shoes and I do not know how you are really feeling.

Firstly do you mean that PVCs were only present for less than 1% of the time of ZioPatch monitoring?  This would be a good sign.  Your doctors do not plan to change anything because they perhaps do not see a reason to do so which means the results of monitoring were of no real concern.  So far so good. 

I note that you had a few episodes of 4 beat NSVT.  With PVCs I often get runs of NSVT and my doctors are not concerned at all.  Short runs of NSVT are actually quite common and often go unnoticed.  I think you mentioned that you didn’t feel the occasional run of NSVT, although clearly you feel your daily PVC palpitations and I think this is the area which is really causing your symptoms.  With this in mind, I would focus on your PVCs not your brief, infrequent NSVT.  So how to manage your PVCs should be the question and that is less scary for you than how to manage the NSVT.  After all a 4-beat run of NSVT is only just 1 beat more than the minimum 3-beat requirement to be classified as a NSVT.

Also your heart may still be healing and trying to cope with your new pacing system and your new medication.  Have you asked about the possibility of increasing your minimum heart rate setting to try to outpace your PVCs?  I think I mentioned this before.  It can work well and then you might be able to eventually stop your beta blocker?

Now let us tackle the next stage of your post.  I guess you feel that cause 1 can be ruled out because you have a new dual lead pacemaker and yet you still get palpitations.  Cause 1 in my opinion cannot be ruled out just yet.  It is still early days, your heart is still healing and you are taking medication for the first time which can have an enormous impact on your heart rhythm.  Some people cannot tolerate beta blockers at all and they can even cause worsening rhythm disturbances at first until the heart settles down, or the beta blocker may even need to be changed for another beta blocker or a different medication completely or, even, stopped completely, so there is still plenty they can do to control your palpitations.  I just ask you to please stay positive Hayden.  This is not the end of your journey but the start.  

Cause 2, the worsening of your block or the cause for the worsening of your block is due to cause 2.  It is only at this point a very remote possibility and I know we discussed this privately and you would be asking your team about this when you next meet.  I would put any serious cause for your palpitations firmly out of your mind and focus on what you can do to help yourself while you wait for your next follow up appointment with your doctors.  

Anxiety can cause many unwanted symptoms, including ectopic beats (PACs - premature atrial contractions) and (PVCs - premature ventricular contractions).  In your case, in the absence of any identifiable heart disease/ischaemia, valve disease, your anxiety will be a strong trigger for your ectopics including your NSVT (non sustained Ventricular Tachycardia).  In normal hearts NSVT, especially brief runs, usually has a benign prognosis.  The block will be taken care of by your pacemaker.

So to conclude, I believe you will be fine and that you are experiencing primarily anxiety induced ectopic beats causing your palpitations and symptoms.  I believe too that your body is still settling down to dual chamber pacing and beta blocker treatment which may need some adjustments.  I think you would benefit from some talking therapy to help clear your mind of negative thoughts.  Let all your fears out, speak to your doctors also about your main fears about the causes of your disease and how this might progress.  I have often found the fear of what might happen is always worse than the reality.  You are young and fit but we have to find a way to help control your fears and the way to do this is to keep talking about them.  Try not to internalise your fears - get them out in the open.  Don’t forget we are always here to try to help you.  I had frequent palpitations and symptoms before pacemaker therapy which took some months to settle after implant and medication adjustments.  But they are now well controlled and I hope it will soon be the same for you too.

Hello Gemita,

by PacerPrice - 2021-04-29 20:34:33

Thank you so much for your message as always, you have really helped. 

My anxiety has been really quite bad recently, and this news had definitely not helped.

Yes, PVCs where only seen in <1% of the time while wearing the ZioPatch (for 14 days). 

I have had NSVT in the past, on a treadmill test specifically, and now 2 other episodes of it of 4 beats in 2 weeks, and I do believe the PVCs I experience can cause it, and the anxiety I have can cause PVCs. The doctors phoned today and said they are not worried, just monitoring as normal, but it could be a combination of my complete total, hyper awareness and anxiety over my heart that causes some of these issues. They also said that my heart is healing and changing to the operation and new dial lead system implanted only 3 months ago, which could cause this. Hearing that the NSVT was really reassuring as as you said, it is only 1 best into the range of NSVT. Tackling PVCs is something I would really like to do, as these flutters and skipped/ extra beats reslly effect me, I could be having a great day, and even relaxing, walking or doing exercise, I will feel a palpitation and anxiety instantly hits me. Especially when exercising, even mild cardio exercise like running for a short period of time ( even seconds) i try and avoid as i will feel PVCs. 

I have asked about increasing the pacemaker heart rate, and it is definitely something that can be tried in my next appointment. I think this may help and if there's a chance it would allow me to come off me medicine that is great, as the beta blocker is really effecting me physically. 

I think the 1st cause could still be an option, and as you said my heart is still healing and the medication is still relatively new. I really hope this is the case.   

Cause 2 would not be great and a very worrying option for me, and after my phone call, being told how my heart is structurally perfect and that the NSVT is causing no real concern and no change to my treatment, is really good. I have read that NSVT in a structurally normal heart can be, and usually is, benign, so this is reassuring. 

Thank you so much for your message Gemita, it really really helps,

I hope you are well,

Hayden 

Hayden

by Gemita - 2021-04-30 08:29:24

I have sent a private message to further support you.  You know yourself really well and that is half the battle already won.

I am glad you are talking to your doctors and they are being kind and supportive.  They really would step in and do more if they felt you needed  help to stay safe.  

Doing nothing and waiting patiently for our problems to naturally resolve is called "watchful waiting" and this policy is sometimes the kindest and the best way to treat some of our symptoms, especially if more serious causes for these have been firmly ruled out.  To go rushing in (as my old cardiologist used to tell me) with the sledgehammer is hardly the best thing to do when the body is trying to heal itself and to come to terms with any intervention and any new diagnosis we may have to face.

Stay happy and well