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Dr. Abby, When I was talking to my cardiologist and he gave…

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Dr. Abby, Hello. When I was...
Dr. Abby,
Hello. When I was talking to my cardiologist and he gave me the results of my holtor monitor test, he reccommended 2 types of treatment : medication and then the second form of treatment was a catheter ablation procedure. I informed my mother (who is a nurse) about this and she wanted me to get a second opinion, because she does not want me to have this procedure if it is not neccessary. She has a friend who is a cardiac nurse and her friend said that for the type of arrhythmia that I have , she had not heard of that procedure being done for it. Please let me know your input on this issue. Thanks !!!!
Submitted: 8 years ago.Category: Medical
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Answered in 2 hours by:
6/12/2010
Doctor: Anthony Bray, MD, Doctor replied 8 years ago
Anthony Bray, MD
Category: Medical
Satisfied Customers: 10,341
Experience: 14 years experience in the field of Family Practice
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Hello!

You will get a second opinion if you see an electrophysiologist. This is a cardiologist whom specializes in the study of the electrophysiology of the heart.

The RF ablation procedures were done initially for SVT (supraventricular tachycardia).These are being done at some centers for control of atrial fibrillation as well. These two arrhythmias are the ones in which I have patients referred for and whom underwent these procedures. Most of the patients that I have had with atrial fibrillation are still mainly treated medically.

I hope this information helps. Further questions are welcome if you have others. I will be happy to get back with you if you have further questions. If my answer has been helpful and to your satisfaction then please remember to oppress the "ACCEPT" button. thank you and Best Regards,

Anthony Bray MD

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Customer reply replied 8 years ago

I went to go see an electrophysiologist back in February, actually about 2 or 3 days after my cardiologist called me with my test results. I am going to list the majority of my results here for you to review .

Predominant rhythm was Sinus Rhythm

Average heart rate was 83 bpm with a range of 49bpm to 150bpm

Rare isolated SVE beats - (6 total)

my results from my holtor monitor tests are as follows :

9:49:45pm = SVPB 81bpm

11:14:26pm = tachicardia 100bpm

11:25:49pm = tachycardia 100bpm

11:31:32pm = SVPB 89bpm

4:41:18am = Min heart rate 49bpm

4:55:50am = Longgest RR 51bpm

4:55:53am = bradycardia 50bpm

8:40:07am = Dizzy 117bpm

4:17:27pm2 = Max heart rate 150bpm

As I stated ealier to Dr.Abby , my mom wants me to get a second opinion because she does not want me to have this procedure if I do not need it. However, as I also stated to Dr. Abby , I have still felt bad (even with the medication) off and on - Especially ever since Memorial Day morning. I do not know if you can understand these results or not, but if so (or if you could please get an opinion from another doctor) , could you PLEASE let me know your expert opinion ASAP , so I know where I stand on this issue ? I told Dr. Abby that ever since Memorial Day morning, I have felt pretty bad (nausea , extreme fatigue, palpitations, a little tightness and shortness of breath, as well as a little pain in my neck and numbness in my leg/foot area { I do not know if this is related or not} ) PLEASE LET ME KNOW ASAP what you are able to find out ?

Doctor: Anthony Bray, MD, Doctor replied 8 years ago

Hello!

Based on your holter results I do not see an indication for an ablation procedure.Your symptoms would not appear to be explained by these holter results. These holter results are essentially normal. Everyone may have a few PVC, PACs (supraventricular ectopic beats) Your range in heart rate is nothing out of the ordinary. (Note that while the resting heart rate is 60 to 100 the slight bradycardia is normally more associated with healthy hearts and the tachycardia is normal with exertion.Tachycardia with exertion is normal physiology)

I would have to agree with your mother in that based on the holter results I don't find any indication for an ablation procedure! The reason for your symptoms does not appear to be explained by your holter results here.

I hope this information helps. Further questions are welcome. Best regards,

Anthony Bray MD

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Customer reply replied 8 years ago
well, in your opinion then, why would my cardiologist send me to an electrophysiologist then if he did not feel the procedure neccessary? Also, why (if I am on medication for this) , would I feel like I have been for almost 2 weeks now ? I am still short of breath some and I am extremely tired all the time and I can still feel palpitations in my heart area all the time and occassional tightness in the area. I am just trying to find answers to why I am feeling like this.
Doctor: Anthony Bray, MD, Doctor replied 8 years ago

Hello again!

I can understand your cardiologist referring you for testing based on your symptoms.You may have over interpreted the cardiologist stating possible scenarios....of this I don't know. The obtaining of the holter monitor based on your reported symptoms does make sense to me but based on the holter monitor I do not see an indication for an ablation procedure at all!!

You may be on a beta blocker for your symptoms..is this correct?? These would be first line drugs to improve palpitations or tachycardia. Sometimes even the simple taking of a magnesium supplement over the counter(magnesium oxide 500 mg once a day ) may help to stabilize the heart's rhythm and reduce PVCs or PACs. It is also possible that your heart may not have acted up as it otherwise has during the holter monitoring. This does happen quite often.

I hope this helps. Further questions are welcome if you have others. Best Regards,

Anthony Bray MD

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Customer reply replied 8 years ago

I guess I just don't understand any of this stuff. I guess I thought because my cardiologist referred me to the electrophysiologist, and both doctors (my cardiologist and the electrophysiologist ) both agreed that it would be wise to get the procedure done. When I talked to my cardiologist over the phone and he said that he wanted to do both forms of treatment on me (medication and the procedure) , I figured there was a reason for that. I thought that I would not be sent to another specialist unless there was a reason for it. I am just tired of feeling like this and want answers and I really want to get better fast !!!

Doctor: Anthony Bray, MD, Doctor replied 8 years ago

Hello again!

I can understand that you want answers to your symptoms. I'm not sure what the whole story is that underlies your symptoms. I can tell you that what you have reported to me in terms of your holter results is no indication for an RF ablation procedure. I don't know if there is other evidence out there that alters this picture or not.

Based on the holter report I support your mother's position that at least as far as this piece of evidence goes you would not appear to need this type of procedure.

The holter report may not represent the final answer of your case and I realize this as well.

You are at least in part in that frustrating arena of symptoms without a clear diagnosis. In this be thankful for some of the things which it is not! Often patients in their frustration fail to realize some of the horrible maladies that have been ruled out in the process.

Did you also have an echocardiogram done? Are they possibly worried about subaortic stenosis? This is another condition in which a different type of ablation type procedure would be indicated.This is a condition in which the center septum of the heart becomes too thick and may obstruct the flow of blood. This is a potentially dangerous condition. I don't know if this might be the concern behind some of the comments that you have relayed to me. I realize that I may not have the whole picture in terms of all of your history and results....

I hope this information helps. Further question are welcome if you have others. Best Regards,

Anthony Bray MD

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Customer reply replied 8 years ago
I don't know if this helps or not, but when I went to go see my cardiologist, he did an ultrasound of my heart, and an ECG/EKG on me (I can't remember which one but it was one of them) as well as the holter monitor test.
Doctor: Anthony Bray, MD, Doctor replied 8 years ago

Hello again!

The ECG and EKG are just two different ways of expressing electrocardiogram. This looks at a brief picture of the heart's electrical activity.

The ultrasound is the echocardiogram which uses sound waves to bounce off the heart and this gives a picture of the heart's muscle wall thickness, and valves and the doppler version can also look at the flow of blood through the heart. If you had been diagnosed with subaortic stenosis then this is the test that may have found it. I don't know if that is the case of if you were suspected of having SVT (supraventricular tachycardia) or atrial fibrillation. These three entities are the main ones that come to mind when the subject of an ablation procedure is discussed. Note the type of ablation for subaortic stenosis is not the same as the type of procedure for arrhythmias.

I hope this helps some. It sounds that you need to get back with your cardiologist and clarify what exactly he/she was talking about. As I noted , I can tell you that based on your holter results I find no reason for discussing an ablation procedure. I don't however know what your ultrasound results showed. It might be that the cardiologist was discussing scenarios and not a definitive plan of action. It is common when are stressed out and worried about their health(and especially their brain) that what we say and what people hear may not exactly match!! So I think the first step is to call or meet with your cardiologist and it would probably be helpful for your mother to be present as she is a nurse and so some of the discussion might be helpful for her to participate in.

I hope this helps. Further questions or discussion is welcome. Best regards,

Anthony Bay MD

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