Update on PMT and PSVT

I communicated my concerns to my EP that some settings had been "accidentally" changed, and that I might be having PMT and sent a Merlin transmission. They have assured me that the PVARP is correct and the pacemaker mode is DDIR--which I had forgotten. So no PMT.

Thanks again to all who replied to my post and to this forum in general. When questions come up, it's so comforting to have knowledgeable, sympathetic people to talk things over with and figure out what the next question should be.

Guess I'll add PSVT to the alphabet of arrhythmias I have going on.

Just because I'm naturally curious, I do wonder if the PVCs and PSVT are interacting in some way? Some of the PVST episodes feel very like the PVC induced PMT, including the heavy thump.



by AgentX86 - 2021-11-19 20:13:02

It must feel good that your EP has eliminated the possibility of PMT.  I'm not sure how SVTs and PVCs could interact.  SVTs are a tachycardia, after all.  PVCs are a slow arrhythmia (like PACs).  I'd think that any tachycardia would bury PVCs in the QT interval.

My thoughts

by Gemita - 2021-11-20 04:36:43

Hello Gotrhythm, Technically I cannot explain what communication may exist between your upper and lower chamber arrhythmias when they feel so out of control but your question is an interesting one.  You sound as though you might benefit from an EP lab study for some serious mapping if your symptoms, duration and frequency of your arrhythmias increase.   I hope though they will settle with lifestyle measures and vagal manoeuvres (like coughing) alone since an EP Study although useful, would be invasive unless they decided to find the source of your PSVT at the same time and ablate.

As a matter of fact, I often feel as though my upper and lower chamber arrhythmias are communicating in some way since when one arrhythmia starts it seems to trigger another.   One day I was very unstable and had 18 recorded fast Atrial and Ventricular tachy episodes.  The first technician said it looked like SVT with 1:1 AV conduction, then fast AF (220 bpm) with aberrancy (bundle branch block pattern - an irregular wide complex tachycardia was seen), then the Medtronic rep said it all looks more like multi focal atrial tachycardia.  Now what does all this mean?  Chaos!  So I can believe anything is possible with electrical disturbances of the heart and unless they can actually map all this “when it is actually happening”, personally I don't think anything can be ruled out.

Just one more thing, once I had a surface 12 lead ECG done which confirmed "frequent PVCs".  However when my EP read the ECG he quickly said they are not PVCs but PACs with aberrant conduction (right bundle branch block pattern).  So "in hospital" surface ECGs don’t always get it right and these need to be ideally confirmed by a doctor trained in reading ECGs of paced patients.  If indeed your PVCs were to turn out to be PACs instead with say something like aberrant conduction, could that explain a connection with the PSVT?   I think this is all so complex Gotrhythm and that there might be some overlap/differences in interpretation of any results.  It is a vast subject and we are still only touching the surface.

So yes with complex, multiple, chaotic arrhythmias, coming from different sites we can expect them to feel like one and the same arrhythmia at times.  

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