Paroxysmal Supraventricular Tachycardia: Treatment Options

Arrhythmia

Hello Doctor,
I am a 24-year-old female.
A week ago, while rushing to take a national exam, I suddenly experienced a gradual darkening of my vision and broke out in a cold sweat.
I was later taken to the emergency room, where the doctor informed me that my heart rate was excessively high, reaching about 160 beats per minute.
After receiving a dose of medication, my heart rate returned to normal.
Following an electrocardiogram, an echocardiogram, and a 24-hour Holter monitor report, the doctor stated that everything was normal.
However, the doctor mentioned that although this was my first occurrence, it was a case of paroxysmal supraventricular tachycardia, and that it would likely happen again, though it is uncertain when.
The doctor believes there is an extra electrical pathway in my heart and recommended catheter ablation.
I have been prescribed medication to lower my heart rate for emergencies.

I would like to ask if it is necessary to undergo catheter ablation after the first occurrence, or if there are other methods, such as exercise, that could help improve my condition.
I apologize for the lengthy message, and thank you very much!

Miss Peng, 20~29 year old female. Ask Date: 2020/08/28

Dr. He Dongjin reply Cardiology

Hello, since there is a first occurrence, there will be a second.
Current medical advice suggests electrosurgery; in fact, medication or invasive treatments are merely means to an end.
The goal is to ensure your safety and prevent further episodes.
It’s like having a ticking time bomb in your body, uncertain of when it might explode.
Would you prefer to quickly defuse it, or live in constant fear of it going off and only address it after it explodes? Would you want to worry about it for a lifetime, or spend 1-2 hours to resolve the issue fundamentally? You decide.
Personally, I would choose to deal with the pain quickly rather than prolong it.
Wishing you peace and safety, and the Changhua Hospital is concerned about you.

Reply Date: 2020/08/28

More Info

Paroxysmal Supraventricular Tachycardia (PSVT) is a condition characterized by episodes of rapid heart rate originating above the ventricles. It can be quite alarming, especially when it occurs suddenly, as you experienced during your exam. Your symptoms, including the feeling of darkness and cold sweats, are common during such episodes due to the heart's rapid beating, which can lead to decreased blood flow to the brain.

In your case, the fact that your heart rate reached 160 beats per minute indicates a significant tachycardic event. The good news is that your subsequent tests, including the echocardiogram and 24-hour Holter monitor, showed normal results. This suggests that there are no underlying structural heart issues or chronic arrhythmias, which is reassuring.

The recommendation from your doctor to consider catheter ablation (often referred to as "electric burn" or "burning" the extra electrical pathway) is a common approach for managing PSVT, especially if episodes are frequent or severely impact your quality of life. Ablation is a minimally invasive procedure where a catheter is inserted into the heart to destroy the abnormal electrical pathway causing the tachycardia. It has a high success rate and can provide long-term relief from symptoms.

However, it's important to note that not all patients with a first episode of PSVT require immediate ablation. Here are some considerations:
1. Frequency and Severity of Episodes: If your episodes are infrequent and manageable with medication, you might opt for a conservative approach initially. Many patients can control their symptoms with lifestyle modifications and medications.

2. Medications: Your doctor has prescribed medications to help control your heart rate. These can be effective in managing symptoms and preventing future episodes. It's essential to follow your doctor's instructions regarding medication use.

3. Lifestyle Modifications: While exercise can improve overall cardiovascular health, it’s crucial to approach it cautiously. Some individuals find that certain activities can trigger their PSVT. It may be beneficial to engage in moderate exercise, focusing on activities that do not provoke symptoms. Stress management techniques, such as yoga or meditation, can also be helpful.

4. Monitoring: Since this was your first episode, regular follow-ups with your healthcare provider are essential. They can monitor your condition and determine if your PSVT is becoming more frequent or severe, which may necessitate further intervention.

5. Patient Education: Understanding your condition is vital. Knowing how to recognize the onset of an episode and when to seek medical help can empower you to manage your health effectively.

In conclusion, while catheter ablation is a highly effective treatment for PSVT, it may not be necessary after just one episode, especially if you can manage your symptoms with medication and lifestyle changes. It's essential to have an open discussion with your healthcare provider about your concerns and preferences regarding treatment options. They can help you weigh the benefits and risks of ablation versus a conservative management approach tailored to your specific situation. Always prioritize your health and well-being, and don’t hesitate to seek a second opinion if you feel uncertain about the recommended treatment plan.

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Hello, you can start by monitoring your condition for a day and take a small amount if you feel uncomfortable. Changhua Hospital cares about you.