Tachycardia

Atrial tachycardia

by AgentX86 - 2023-03-22 23:11:47

That's the way these things go.  They don't get better and do get more frequent. Yeah, it really sucks.  I went many months without significant sleep.  It got to the point that I couldn't function and thought I'd have to retire (I since have, five years later). Did I say that it sucks?

A new beta blocker might work.  It's worth a try but I an ablation may be in the cards.  I'd do it sooner rather than later.  As things get worse, the chances of a successful ablation go down.

Be sure your EP knows how it's affecting your Quality of Life.  That's very important information for your medical team.  If they're just treating the tachycardia, 100bpm with occaisional tachycardia episodes may be "good enough".  A poor QOL speeds the search for a solution.

Knock off the alchohol and anything that gives you indigestion.  These trigger episodes for many people.

Yes, there are many of us who went through the wringer.  In my case, it was atypical flutter with a slow AV conduction which caused an arrhythmia something like Afib on steroids. I went through the whole thing, including a maze (which stopped Afib and traded it for flutter).

Make sure your EP listens to you.  If you sign up for an ablation, make sure you have someone who does a lot of them (>100 per year, and >1000 lifetime).  Experience matters more for the outcome than just about any other procedure short of brain surgery.

Discharged

by Grantbibby98 - 2023-03-22 23:32:14

I was discharged by my EP on insertion of PM 5 years ago and had no follow up at all. I'm currently having to wait on an urgent referral from my GP as until now I had private health insurance, I'm not under an EP and haven't been in my whole time having one. Unfortunately I'm having to suck it up and ride through my tachycardia episodes until I'm seen and that will involve more tests when I can already tell them what needs to be done. 
mum QoL has been shot to bits since I've become more symptomatic and it's something I will be making quite clear once I finally get an appointment, I may have to suck it up and self fund private health care if I want any chance of a normal life in the near future. Sorry to hear about your similar experiences, it's a horrible thing to have to go through, I know my rates aren't that high but the symptoms associated with them are what sucks most, especially as I can barely sleep or exercise.

you are right though they have just accepted that it's good enough, since June I've had a range from 60-152, according to the pacemaker, all sinus rhythm,no aryhtmias recorded at all, average heart rate of around 74, good enough in there eyes but what they don't know is I haven't exerted myself past walking up stairs in that time and lived quite sedentary. They also say that IST cannot kill you it's just bad in regards to QoL, I will start to push for the ablation or Ivabradine at my earliest convenience.

thanks again for your comment,

grant. 

Inappropriate Sinus Tachycardia (IST)

by Gemita - 2023-03-23 05:25:04

Grant,

I am so sorry to hear this.  I agree with both you and AgentX86, once we become “symptomatic” with frequent symptoms, it is the time to act and even if we don’t have “frequent” symptoms and only experience one bad episode occasionally, if that bad episode results in intolerable symptoms, then it may still be time to act.

If you scroll down several posts, you will see another member (mae11) is battling with IST too and is waiting to try Ivabradine.  IST can be difficult to manage and I attach a link is case it is of help.  I have heard that IST can be difficult to “safely” ablate or may recur from a different sinus node area, but this is often the case with so many of our arrhythmias, isn’t it, so you will need to find an experienced EP if you want to try an ablation.

Perhaps treatment for any gastric problem will help since a gastric cause of an arrhythmia is very common for many arrhythmia sufferers - it is for me too.  The alcohol won’t be helping either unfortunately, so those are two areas that you could perhaps look at.  I am also taking Bisoprolol for my arrhythmia (Atrial Fibrillation) which can occur at a rapid ventricular rate, but I find the more I take, the more likely I am to have worsening arrhythmias, so I have cut right back with EP’s knowledge.  I am doing much better now and my heart rate is surprisingly still under control, but it is all very trial and error with any treatment.  I hope the Ivabradine med will prove a better option for you.  

I had an EP Study and it was very useful in finding the location of my arrhythmias since I have several, although if they cannot induce the arrhythmia during the Study period, then this may hamper progress and lengthen the Study and/or ablation procedure time.  Fortunately I was experiencing AF during my study so they were able to pinpoint the exact area generating my abnormal heartbeats, well at least one of the areas!  An EP Study is invasive but it does provide a lot of useful information about the nature, location and treatments likely to succeed.  For example during my study they tried cardioversion (which failed after three attempts).  They also tried the anti arrhythmic med Flecainide which succeeded in stopping my arrhythmia immediately, so I was discharged on Bisoprolol and Flecainide.

I wish you all the very best Grant  

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872261/

Coping

by Grantbibby98 - 2023-03-23 05:52:57

Hi Gemita,

thanks for your message.

I've read through that article many times and also many others over the past two years, I've had to advocate for my health quite a bit of this time due to being so young and often dismissed. Starts to make you feel crazy after a while but I know I'm not! 
Ive always wondered about the gastro link as I always find myself belching quite a bit during my episodes and the cheats tightness reduces with the release of air, unsure if there is a link but it's another route to pursue.

I don't drink at all really, I haven't drunk caffeine in two years either, I'd say my diet could be improved but not sure where to start there.

I never really consider myself to have an arrhythmia as it's always sinus rhythm, even backed up by my data from the pacemaker showing no episodes of any kind, including SVT. It wouldn't be hard to induce tachycardia, an exercise treadmill straight into an EP study would definitely show the extra pathways, if there is any. 
I do find that my problems are worse at night, I have multiple episodes of chest tightening, shortness of breath and an innapropriate rapid pulse rate, I reduced my bisoprolol as I thought it could be due to low blood pressure but that's just an assumption. 
I'll keep this post updated as I learn more, hopefully Ivabradine does provide some much needed relief.

I found this article to be very interesting in regards to gastro-cardiac link:

https://myacare.com/blog/what-is-roemheld-syndrome

thanks,

Grant

Thank you for the link Grant

by Gemita - 2023-03-23 06:38:33

Grant, yes I am all too familiar with the Roemheld Syndrome as a potential cause for my gastric symptoms and this seems to be quite a common occurrence.  I know one person who has been officially diagnosed with Roemheld Syndrome.  

I have had a gastric intervention (Nissen Fundoplication) for gastric reflux which could not effectively be treated with Proton Pump Inhibitors in the past.  I also have oesophageal high pressure contractions and when these cause problems, my arrhythmias increase, so this is why I understand the gastric/heart connection so well.  

I am glad you are finding out as much as possible before you move towards an ablation.  I was seeing a neuro-gastroenterologist at University College Hospital London for my gastric triggered arrhythmias and she in fact recommended an ablation for the arrhythmias.  But my symptoms have  vastly improved since pacemaker implant (at St. Thomas' Hospital), because I was found to have bradycardia induced arrhythmia which my pacemaker seems to be effectively treating.  My base rate of 70 bpm helps to outpace these slower, pausing premature beats which frequently lead to AFib.  I used to take antiarrhythmic meds as well as my beta blocker until they stopped working.  Now I am only on Bisoprolol, a daily PPI (Lansoprazole) and my anticoagulant Edoxaban (low dose for low body weight - under 60 kg).

Arrhythmia worse at night as your heart rate naturally falls and any reflux occurs?  Do you know how high your Base Rate is set at night?  

Recommendations

by Grantbibby98 - 2023-03-23 06:51:07

Is there any doctors that you could recommend that you've found to have listened to your concerns and provided effective treatment for your condition? 
In regards to my base rate, it's set at 60 and my heart will always drop to that upon sleeping, the issue is getting to sleep in the first place, maybe it's because I can feel the sensations in my body more at night or maybe sleeping too soon after eating, there are so many variables that my head may explode. 

If you can get into London and can afford a one off private consultation, might be worth your while

by Gemita - 2023-03-23 07:44:59

Grant, my EP is based at Guy's & St. Thomas' Hospital:-

https://www.guysandstthomas.nhs.uk/our-consultants/jonathan-behar

Jonathan Behar is my new EP.  He seems very caring and capable and handles stress extremely well as I witnessed when I saw him recently with a full waiting room.  He certainly won't go rushing in without trying conservative measures first, although if he hears that you are so symptomatic, he will support you in any way he can, including preparing you for an ablation.  This is what he told me.

I would also recommend doing a web search for Professor Mark O'Neill and Professor Richard Schilling who will have both NHS and Private practices in London.  Both are excellent EPs.

Try postural changes at night, turning from side to side to help stop the palpitations, propping yourself up on pillows might help as well as taking sips of tepid water to help move any food that might remain in the lower gullet.  I take Bisoprolol in the morning so that if it lowers my heart rate it won't matter so much because I am moving around, keeping my heart rate up naturally during the day.  If I take at night when my heart rate naturally falls, the Bisoprolol will lower the rate even more and I tend to feel more in the way of palpitations as a result.

Please don't overthink any of this, since it will make matters worse, but you need to speak to someone urgently.  You will need to get your GP to refer you to a private consultant.  The GP may charge for this + the one off consultant's fee, but afterwards you could always ask whether you could be seen at the private consultant's NHS hospital?