PSVT is back after ablation

[mcvallin]

I am a 25 yo male.  In june of 2006 I had an ablation for PSVT, which was effective immediatly following the procedure. (It lasted 5 hours and I was told post-procedure that it was hard to find the origin, but they got it)   Besides having PACs (which have subsided for the most part now) it seemed like the tachycardia was gone.  There were a couple times about 1-2 months ago where I thought I felt it happening, but it was for a very short amount of time.   Now, in the last 3 weeks, I've had runs lasting between 15-30 seconds.  I've also had 2 episodes in one day.  The frustration now is indescribable.  My doctor believes it is gone, but I know it's not.  My questions:  

-If I go back to my same cardiologist (or a different one), will I be put on another event monitor prior to being treated?  It's very difficult to catch my short (but prevelant) episodes.

-I'm thinking of trying another doctor. I'm wondering if that would be a good idea, since my current one knows my history and did the first procedure himself.

-Will I most likely need another ablation? What are the succuss rates of second ablations following failed initial ones?  Are failed ablations common?

I just want to be rid of this for good.  Any response is appreciated, including information beyond what I have asked.

[Michael J. McWilliams, M.D.]

The general approach would be to do a 30 day event monitor and try and capture and arrhythmia event.  This might not apply to you but more than 50% of the time when people tell their arrhythmia has returned, I put on the monitor and see a normal rhythm when they are reporting the symptoms.  I can't explain why, but I have seen this a few times in the last couple week.  They were all convinced it was back and every time they press the event button, the rhythm record was normal rhythm.

Unless you really don't like the doctor, it is probably worth staying with the same doctor.  They know what the did last time and where it was.  Success rates very for ablations depending on anatomy and the rhythm being treated.  Just because a heart rhythm returned does not mean that they did it wrong. If you like them and trust them, go back.  

You need to know what the current rhythm you will know if you need another ablation.  The success rates depends on what the rhythm is -- it would vary from 98% to much lower if it is complicated.

The probability of a failed ablation depends on what the ablation was treating.  It is more common to need repeat ablations for rhythms  like atrial fibrillation.  

At this point you need a monitor to figure out what is going on.

I hope this helps.

[heart2]

I read your post with much interest.  I am considering having an ablation for PSVT.  I am on a beta blocker but it doesn't work as well as it did when I first started it.
  
I would recommend that if you feel like you are having these runs go back to the doctor you trusted to ablate the PSVT.  Tell him/her your symptoms, and insist on an extended length monitor...capturing 24hr/day for several days.  

I had one for 14 days and by the time I got to the hand held device to document the "episode" it was frequently over with.  However, the monitor itself had already captured the abnormal rhythm.  I had runs lasting from a few beats to sustained over close to a minute.  I went about my normal routine and I just couldn't drop what I was doing to pick up the device to answer all the questions on my Cardionet touch screen.  

Sometimes PSVT episodes are as short as 6 or 7 beats...at a high rate like 190/min you only have about 2 seconds to grab your button and push it...when the event monitor starts to record, the event could be over.  This is why an "event" monitor will frequently not capture an abnormal rhythm.  

If you are having ANY PSVT a continuous reading monitor will catch it.  Just make sure you get the doctor to have you wear it for longer than a couple of days.

I wish you the best of health.  Let us know how you make out.