I anaesthetise in a large Cardiac Cath/Interventional Radiology suite on a fortnightly basis (but ironically enough, not for cardiac procedures, we just need the suite for the work we do).
There is a lot of relatively high level medical terminology in your post so it would appear on face value that you are well informed of the underlying issues. Where I work the ablations are all done by subspecialty Cardiology Electrophysiologists. It is not a "benign" procedure in that there are some uncommon but pretty nasty complications, I have seen them crack a few chests open for pericardial effusions/tamponade which can be a tad scary.
In saying that, I have had a few friends that I swim with have ablations done and they have generally sailed through with no major issues. One friend went into SVT hopping out of the pool at the end of a session and would not cardiovert with all the standard vagal manoeuvres we tried. Called an ambulance, offered to do the IV for the ambulance crew, which I think then gave them some performance anxiety and my friend then cardioverted with the stimulus of the IV line going in without local etc.

Coincidentally I’m the associate chair for research in my dept of … anesthesiology 💁
I’ve talked to my colleagues in cardiac anest but they rarely see athletic patients. Heard similar issues from them but for the typical patients they see (overweight, etc).
My SVT tends to remain pretty low HR (150 during an effort) and cardioverts with a couple of coughs or vagal maneuvers. But it’s unnerving. I also deal with a lot of anxiety so still unsure if managing anxiety might lead similar or even better results than ablation.

It is a small world! I was thinking to myself when reading the post that it sounded like I was talking to a colleague given the amount of medical terminology in the post! Adjunct Prof here, but on the other side of the world to you!
I am no expert in these areas but I would have thought that if you had a re-entrant pathway then ablation would be the more definitive treatment? Anxiety can be difficult to control in our field of work (as I sit here after a 24 hour on call) and both our jobs and training can be highly caffeinated affairs!!
Best of luck with all the investigations and treatment, it is always unnerving being on the other side of things as medical practitioners!

I’m on the non clinical side. But in my role I have to understand anesthesiology issues fairly broadly across all sub specialties. The rest of my job is focused on quality improvement and patient safety.
For someone trained in data science, anest is about the best clinical field because it feels like it’s an engineering job at times.
The advantage is I am not on call ever. My young kids ensure that I lack sleep just the same anyway :)

Anyhow, hopefully I can figure stuff out. First hoping for no structural concerns (I’m terrified to be told I can’t work out anymore) and then we have an outstanding electrophysiology division here. But still good to hear other very active people went through and it got fixed.

I think this is what Dan and Paul Thomas(twice) have had, both recovered and are riding well once again. I wouldn't blow off the blood test so quickly though, really study it, and past ones. Keep a close eye on the magnesium and sodium levels, as well as the potassium. They could all be green, but what doctors never look at or even think about, is if you are at the bottom levels. The place where one workout could put you under and have an affect on your rhythms.

That is what tripped me up over two decades ago, and they just rushed and put a pacemaker in me. Now I may well have needed one, but once I sorted out my levels, I went nearly 15 years not using it hardly at all. To the point we talked about taking it out. But of course things have deteriorated and now it is on over 50% of my life(usually sleeping, or at low HR's). But it is amazing what those levels can do to you, along with stress, sleep deprivation, coffee, and alcohol can do to your normal rhythms.

SO just make sure you have all those ducks lined up before doing something as drastic as surgery. But also sometimes you are just fucked, and killing that small part in your heart will fix you up for awhile. Good luck Francois, and the anxiety you will have over it is also a major contributor to bad rhythms, so do what you can in that dept too. Either medically or through some sort of therapy/ meditation.

Definitely not ignoring the blood tests. Also checking thyroid function which can lead to arrhythmias and the like.
If I can avoid ablation, I will. That’s what I did with my AFib once I figured the trigger and also once I realized it was vagally mediated which means I can cardiovert by just jumping on the treadmill and hit > 140bpm. Ironically in anesthesiology, overdrive pacing is exactly how AFib is managed.
The catch is that anxiety might be harder to manage than SVT. Not been very successful with meds.

Thanks for the best wishes though.

I've sent dozens of patients for SVT ablations over the years-almost always to good outcomes and low procedural risk, but there have been a few instances of bigger trouble...

My son has PSVT/avnrt-at a rate of ~220 when it acts up, which is rarely at this point, but fortunately he's young *(and knows and avoids triggers now) and can tolerate that rate. As you know, slower rates are somewhat better tolerated.

Success rates are quite good. ~95% success. Definitely need an echo to look for structural heart disease.

Here's a study from Germany-
https://www.ncbi.nlm.nih.gov/...articles/PMC9054935/


Main findings of the study
The main findings of our analysis of 12,536 patients with (37.2%) and without SHD (62.8%) undergoing SVT ablation within the multi-center German ablation registry can be summarized as follows: (1) Patients with SHD differ with respect to baseline characteristics (older, more co-morbidities, higher amount of previous antiarrhythmic drug failure) and ablation procedure performed (more patients undergoing ablation for atrial flutter and ablation of the atrioventricular node for AF treatment). (2) Overall acute success rates were slightly lower in patients with versus without SHD, while complication rates were similar. (3.) During one-year follow-up, mortality and rate of MACCE were higher in patients with SHD.

Overall acute success rates were high (95.8% vs. 96.6%, p = 0.027) in patients with and without SHD.
Death, myocardial infarction or stroke (MACCE) occurred in 10 patients (0.2%) with and 6 patients (0.1%) without SHD (p = 0.066). Other major complications prior to discharge were rare (57/12523, p = 0.4%) without difference between patient groups (0.5% vs. 0.4%, p = 0.34)


There hasn't been any updates to the Rx guidelines for psvt
Top Things to Know: Guideline for the Management of Adult Patients with Supraventricular Tachycardia
Published: September 23, 2015

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1. Data are not well-defined for the epidemiology of SVT, but best estimates indicate the incidence is approximately 2.25 per 1000 persons
2. The 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients with Supraventricular Tachycardia replaces the 2003 ACC/AHA guidelines for the management of patients with supraventricular arrhythmias. It utilizes new knowledge from clinical trials, treatments and drugs, and updates or replaces recommendations.
3. Paroxysmal supraventricular tachycardia (PSVT) is a clinical syndrome characterized by the presence of a regular and rapid tachycardia of abrupt onset and termination.
4. Women are 2 times more likely to have PSVT than men, and people >65 have a 5 times higher risk than younger people for PSVT. There are approximately 89,000 new cases per year and 570,000 persons with PSVT.
5. Atrial fibrillation is not included in this guideline, because supraventricular tachycardia generally does not include AF.
6. SVT describes tachycardias with atrial and/or ventricular rates > 100 bpm at rest. Examples include the following:
   
   • Inappropriate sinus tachycardia,
   • Atrial tachycardia (including focal and multifocal atrial tachycardia),
   • Macro re-entrant atrial tachycardia (including typical atrial flutter),
   • Junctional tachycardia,
   • Atrioventricular re-entrant tachycardia (AVNRT), and
   • Different accessory pathway-mediated re-entrant tachycardias.
7. SVT symptoms, which often start in adulthood, may include fatigue, syncope, light-headiness, palpitations, and chest pain. Quality of life may be affected, as well, based on the frequency, duration, and timing of the SVT. In one study, 57% of patients with SVT experienced an episode while driving, and 24% of them considered it to be an obstacle to driving.
8. The cause of SVT may be discovered from a 12-lead ECG done during the tachycardia episode. Often SVT is diagnosed in the emergency department.
9. Treatment options may include drug therapy, ablation or observation. Factors such as frequency and duration of the SVT as well as the symptoms and potential complications play a role in the treatment decision. The guidelines include several treatment algorithms that address acute, ongoing management.
10. The treatment options for SVT are specific to the type of arrhythmia and treatment can be nuanced. Shared decision making is stressed in this document with attention to the patient’s preferences and treatment goals and their individual situations.

Good luck to you!

Meds are unlikely going to be an option for me since my RHR is 34-35.
I don’t have any other symptoms besides the HR bump and so far it’s not been affecting performance. Actually I didn’t use an HRM years years and decided to put one on a few months ago just out of curiosity and noticed the bumps then.
I’ve had short bouts of PSVT (4-5s) for some time that seem to come when sleep deprived.
So maybe ablation won’t be the route.

Bumping just in case some old guy has some thoughts on this, or maybe Dr. Larry Creswell if he's still around.

I just have an anecdote. I had a young (late 20's) cycling teammate who had arrythmia issues. He got the mapping done, and had something like 3-4 ablations. None of them worked. The Drs. at some point told him it just wasn't worth doing any more. So he got a pacemaker installed. The pacemaker didn't end his lifestyle as a competitive endurance athlete. But it sure limited his "top end," even with a modern "athlete mode" pacemaker, it just wasn't letting his heart reach its former healthy-rhythm peaks.

No conclusion I'm trying to push. Just an anecdote.

That's what I heard a few years ago when I got my first A-Fib. Since I found the trigger, since it was very rare (7 in 20 years), the electrophysio I saw said don't bother.
My understanding is that the mapping now is a LOT more robust these days and so it works a lot better.

Either way, I'm slow now. I just want to be able to workout so I can race my kids when they start doing sports :)

Not an old guy as I am female but I had an ablation for SVT in 2008. I was only 32 at the time but it was a great success for me. I haven't had a single bout of SVT since the ablation. The procedure was fairly uneventful but quite cool as you are awake. Please let me know if you have any specific questions and I'll do my best to answer.

I will share our (my wife's and my) experience.

Me: 42ish male (at the time), sudden onset Afib sitting at my home office desk, drug cardioversion of many flavors didn't work, shocked me back into rhythym next day. Metropopol (?) Rx for a couple month before deciding I couldn't be a zombie for the next 40 years while running a consulting business. Doc said OK we'll wean you off and I'll see you in 6 months when it happens again - which it did = cardioversion #2. Long story short, had what I'm told is a pretty extensive ablation, followed by zero complications or side effects, followed by the best race results of my 'career' after I got back into training. 8 years later still no effects, nor return of afib

Wife: 42ish female at the time - quite fit. Intermittent svt for years, which always went away on its own. then it escalated and wouldn't revert as easily...long story short, she has an ablation (different doctor) and said doctor zaps her AV node which results in bradycardia and basically only having an escape impulse which was keeping her alive. Followed by a pacemaker implant, running at 100% for the past almost 10 years. My point being, don't let them sugar coat any side effects or outcomes - a 1% chance of somethign sounds low, but when it happens to you, it's 100% and can be life altering - she is a personal trainer and was devastated by having this happen. Come to find out after the fact that this doctor has a history of this kind of result - kinda makes you wish that was public information somehow.

Anyway best of luck, consider all your options based on your life/lifestyle.

Thankfully I work at a big academic center and we have an awesome electrophysio division. They just don’t have a lot of patients that fit the profile of many on this forum.

I hope your wife is doing better now.

the good news is, she is. Took a few cycles to adjust all the settings properly...I think most doctors (hers included) aren't expecting people with pacemakers to need to get their heartrate up, but also be able to sleep...since she's 100% paced there was some fiddling to do. She needs a new battery in the next 6months so that will be interesting. But her day to day is a non-issue now. Even had another baby about 5 years post-implant!

That’s great to hear!

My wife (61) had cryoablation for her afib about 2 months ago. Everything went well and since then has had maybe one flutter incident that occured about week after the procedure. It didnt prevent her from going to Italy with her friends for 10 days a month after the procedure.

I had an ablation for SVT. It went very well. Basically a week easy/off and then right back into the flow of full training. No arrhythmias since.

More details: 25 year old male triathlete, I work in EKG/stress testing. Monthly bouts of SVT (5-30 seconds) during training/racing with no symptoms other than feeling the palpitations. I had AVNRT which my doc said is the easiest form of SVT to ablate. Since then I still feel PVC's and PAC's but no sustained runs of SVT. The only thing I felt with the procedure was the groin site and letting it heal while I rested on the couch for two days. All in all it was great for me, zero complications. I didn't need to have it done because the arrhythmias were just an annoyance. The EP gave me the choice if it would make my life as a triathlete more enjoyable.

ETA: as others have stated, make sure you have knowledge of the doc who will be doing your procedure. The cardiologist that I work with said "I would trust my life with Dr. S. He is the smartest guy I know. You are in good hands for your ablation." That gave me reassurance.

How far are you past your last covid vaccine dose?

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Training Tweets: https://twitter.com/Jagersport_com
FM Sports: http://fluidmotionsports.com

How far are you past your last covid vaccine dose?//

Ok I guess I will be the one to ask, why would this matter??

i was diagnosed with wpw by accident. i had hr's in to the 230-269 range as a 25 year old. my teammates at the time said it was from the wind causing my jersey to flap. i was active, i partied, i drank, and i raced. hard 5k's.. i always saw stars at the end. like legit stars in the cartoons...

long story short, i cut a superficial vein that wouldn't clot, my hr dropped to 18 and i passed out at the hospital. doctors obviously wanted to do an ekg to see why my hr was so low, and accidentally found that i had wpw. lol.

ablation the next morning. that was 14 years ago. 10 ironman, 26 marathon, cycled cross country since then...

should probably go get a followup now that i'm almost 40.

the ablation was painful, they wanted me awake for it. then after cussing a ton, they knocked me out. no activity for about a month and slowly got back into it.... i pretty much wear a hr monitor (watch) all the time now.

I ignored that one. A better question would be, have you had covid lately...

Anyhow, my echo came back spotless.

In late 2017 I had ablations for both afib and SVT. I was off the bike for a little over a week to allow the groin incisions heal, and then resumed training. In the last 6 years, I've only had a few minor episodes, typically lasting 2-3 seconds. Some of these I don't even notice and wouldn't know about at all except that they show up on Strava, and for all I know might just be glitches from my HRM...

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"I'm thinking of a number between 1 and 10, and I don't know why!"

Very encouraging! Given my echo it seems that I may or may not get an ablation. But if I do, then might not sideline me for too long.