PSVTs

Just saw my results from a Holter monitor test. Only significant finding is PSVTs. I can't remember having seen that finding before. 

I have a history of PVC induced PMT (pacemaker mediated tachycardia.) Here's my question. Would PSVTs indicate that PMT is happening again?


4 Comments

Paroxysmal Supraventricular Tachycardia (PSVT)

by Gemita - 2021-11-12 14:56:31

Gotrhythm,

I am sorry to hear about this, but hopefully you are otherwise fairly well?

PSVT is an arrhythmia that I unfortunately get often in the course of the day.  As you know, it is a “regular” tachy arrhythmia that starts in the upper heart chambers.

Would PSVT indicate that pacemaker mediated tachycardia (PMT) is happening again, since I note you have a history of PVC induced PMT?   I do not believe we can assume that this new finding confirms this, since runs of PSVT can be a common finding for so many of us with electrical disturbances. If PSVT is a new finding for you, I feel it would be prudent to have longer term Holter monitoring to establish whether these episodes are becoming more frequent and of longer duration since that might require surveillance and treatment.  Are you on any beta blockers or calcium channel blockers to help calm these down?  Sometimes that is all that is needed.  I eventually had an EP Study done to look for causes for my arrhythmias, but this is invasive and not usually recommended unless an ablation is done at the same time.  

Do you have any other frequent arrhythmias or is your heart fairly steady at the moment apart from the PSVT? 

I am sure you are keeping well hydrated.  Try to go easy on caffeine/any alcohol.  Both of these can trigger my SVT runs and other arrhythmias.  I would also recommend you get your electrolytes checked and bloods in general.  No harm in that.  Many of my atrial tachy arrhythmias have been triggered by premature atrial beats.  My higher base rate setting of 70 bpm has really helped to control these little pests.  Maybe this could help you too?  Also have you had a recent echocardiogram to check heart structure and function?  That might be a good idea.  Relax and avoid stress as much as you can.  Lots of good food, fresh air and gentle exercise, music and enjoyable company.  How does that sound?  I wish you well Gotrhythm

PSVT => PMT

by AgentX86 - 2021-11-12 15:08:05

I'm no expert but I don't think the two are related at all.  PMT is a path from the second lead of a pacemaker, retrograde through the AV node, then sensed by the first lead of the pacemaker, which then fires off another ventricular beat. Rinse - repeat

PSVT or Paroximal SupraVentricular tachycardia (litterally meaning a self-resolving tachycardia from above the ventricles, i.e. the atria) is just a catchall for any low duration (minutes to months) atrial tachycardia, AF, AFL, etc.  They might pass through the pacemaker but I'd think would be too fast to make it back up the AV node to retrigger the pacemaker.

Just thinking here but for the second lead of a PM to fire, the AV node has to either be too slow or broken.  If it's broken, there is any conduction so there can't be any retrograde conduction => no PMT.  If it's slow, the SVT would outpace it.

Again, I'm not an EP so can only read and guess at level of detail.  It's worth a chat with your EP.

 

Did you ever resolve your PVC induced PMT?

by Gemita - 2021-11-13 02:42:18

https://www.ncbi.nlm.nih.gov/books/NBK560831/

Gotrhythm, I don't know whether you saw another member's post recently on the subject of pacemaker mediated tachycardia (if not, scroll down and see under member Lizzie).  I found the above link on PMT simple and helpful although I appreciate you have personal experience with this condition. 

Hopefully any longer term monitoring will confirm what is going on and help identify any potential, treatable triggers.  By the way, did you ever resolve your PVC induced PMT and/or pacemaker syndrome?  If so, how?  

Many thanks

by Gotrhythm - 2021-11-13 13:12:46

Thank you both for the discussion of PVST. As you know I'm a great believer that the more you know when you go in the EPs office, the better questions you will ask and the better understanding of the condition you will come out with.

Gemitra: You always blow me away with the breadth of your understanding of arrhythmia issues! Thank you for the discussion of things I can do to keep my system on an even keel. Yes the PVC induced PMT was resolved. Apparently my heart just doesn't like being paced in the ventricle. So for a long time, since my AV node was functioning well, the EP simply turned off the ventricle lead.

All was well for a couple of years until my heart developed symptomatic Type 1 heart block. Then the EP turned the ventricle lead back on and reprogrammed the PVARP, but knowing the recalcitrant nature of the ventricle, made the PVARP the very widest possible--almost dangerously wide but it worked. Since then, even with occasional spells of bigeminy, trigeminy, quatrageminy, there have been no PMT episodes. (except possibly the last three months.)

The reason I'm questioning now is that I had hyatal hernia surgery last Feb, during which the pacemaker had to be put into safe mode. When the settings were restored apparently the tech decided for himself that the old settings (which were very unusual) couldn't be right and gave me some nice safe little old lady settings. It took two trips back to my usual techs to get settings I could live (happily) with. Now I'm wondering if he messsed with the PVARP.

I'll also confess to a little PTSD. Why the original PMT was so hard to diagnose, I only vaguely understand, but it took two years while being told I was wasting medical resources and treated like I was crazy. Even a 30 day Holter showed something not-normal but not recognizable PMT. A second 48 hr Holter showed 40,000 PVCs but not PMT.

I didn't know enough then to even ask about PMT. All the doctors were doing to their best and I don't blame anyone, but the feelings frustration and helplessness are easily triggered. Still, those feelings are not useful. I'd rather have information that will lead to an answer. That's why I'm asking y'all.

AgentX: Your grasp of the techinical always makes me wish I could take you with me to appointments. Thanks for the discussion of what is happening in PVST.

 

 

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