Electrophysiological Tests and Catheterization in Cardiology

Electrophysiological study and cardiac catheterization?

Dear Dr.
He,
I apologize for bothering you again.
My attending physician has many patients and doesn't allow me to ask questions; they just keep checking and prescribing medication.
To find peace of mind, I keep asking you, and I truly appreciate your patience in answering my questions.
I'm really grateful to you.
I would like to ask: during the electrophysiological study, several episodes of ventricular tachycardia (VT) were induced, but each lasted only about 2 seconds, which is shorter than the 4 seconds recorded on my 24-hour Holter monitor.
Why is this the case? If VT is induced but lasts for a short duration, does that mean it's not serious? What should I do? However, my doctor mentioned that this puts me in a high-risk category.
I am currently taking 40 mg of Esmolol twice a day; can this help prevent the occurrence of ventricular tachycardia?
I also feel that my symptoms might be due to autonomic nervous system dysregulation.
Can autonomic dysfunction cause transient VT? My attending physician suggested that vascular spasm might have occurred during the cardiac catheterization (possibly due to the insertion of the catheter).
I did not experience any discomfort in my chest prior to this; does that mean it’s not typical spasm?
Currently, my blood pressure has dropped below 100 while taking Esmolol, and sometimes it even falls to around 80-90.
I am very concerned about developing hypotension; could this lead to irreversible low blood pressure? I am also seeing a traditional Chinese medicine practitioner for what I believe to be autonomic dysregulation and am taking herbal medicine (once at noon and before bed, ensuring there is more than a two-hour gap from Esmolol).
Is this acceptable?
Lastly, could you please explain what ventricular ectopy means? (I couldn't find this information while researching.) I previously had over 2000 episodes recorded on my 24-hour Holter monitor.
Thank you very much for your answers, Dr.
He.
I am truly grateful and sincerely apologize for continually bothering you.

Jinzhang de ren, 40~49 year old female. Ask Date: 2023/10/22

Dr. He Dongjin reply Cardiology

Hello, ventricular ectopic beats refer to premature ventricular contractions.
Taking Isoptin (Verapamil) will not lead to irreversible hypotension.
The use of Isoptin is not only for arrhythmias but also to prevent vascular spasms.
There may be autonomic nervous system dysregulation, which is why traditional Chinese medicine is also being used.
I believe this is not a major issue; in fact, the real problem is unknown even to the doctors.
Is it spasms? Autonomic nervous system dysregulation? However, there is a concern about potential complications, which is why preventive medication is continuously taken.
Unless you are very confident that everything is fine, it is advisable to continue this treatment.
Changhua Hospital cares about you.

Reply Date: 2023/10/22

More Info

Understanding electrophysiological tests and catheterization in cardiology is crucial for diagnosing and managing various cardiac conditions, particularly arrhythmias. Electrophysiological (EP) studies are specialized tests that assess the electrical activity of the heart. They are often performed when a patient experiences unexplained palpitations, syncope, or other symptoms suggestive of arrhythmias. During an EP study, catheters are inserted into the heart through blood vessels, allowing for direct measurement of electrical signals and the induction of arrhythmias under controlled conditions.

In your case, the induction of ventricular tachycardia (VT) for a brief duration (around 2 seconds) during the EP study is significant. While it may seem reassuring that the episodes are short-lived, the fact that they can be induced at all indicates a potential substrate for arrhythmias. This is particularly concerning because even brief episodes of VT can lead to more sustained forms or can be symptomatic, especially in patients with underlying heart disease or structural abnormalities. Your electrophysiologist's classification of you as a high-risk group likely reflects this concern.

Regarding your current medication, Esmolol (伊抒婷), is a beta-blocker that can help manage heart rate and reduce the frequency of arrhythmias. It is effective in preventing episodes of VT, particularly in patients with autonomic dysregulation or stress-induced arrhythmias. However, it's essential to monitor your blood pressure closely, as beta-blockers can lead to hypotension, especially if you are also taking other medications or have underlying conditions that predispose you to low blood pressure.

Autonomic nervous system imbalances can indeed contribute to episodes of tachycardia and may trigger short bursts of VT. Stress, anxiety, and other factors can exacerbate these conditions. If you suspect that your symptoms are related to autonomic dysregulation, it may be beneficial to discuss this with your healthcare provider, who may suggest lifestyle modifications, stress management techniques, or adjustments to your medication regimen.

As for the concern about coronary vasospasm during catheterization, this is a recognized phenomenon where the coronary arteries temporarily constrict, leading to reduced blood flow to the heart muscle. If you did not experience significant discomfort or typical symptoms of angina during the procedure, it may not be classified as a classic case of vasospasm. However, it is essential to communicate any symptoms you experience during these tests to your cardiologist for appropriate evaluation.

Regarding your blood pressure readings, consistently low blood pressure (hypotension) can be concerning, especially if it leads to symptoms such as dizziness or fainting. While occasional low readings may not be alarming, persistent hypotension can lead to inadequate perfusion of vital organs. If your blood pressure drops significantly (below 90/60 mmHg), it is crucial to consult your healthcare provider to assess the need for medication adjustments or further evaluation.

Lastly, "ventricular ectopy" refers to premature contractions originating from the ventricles. The presence of over 2000 premature ventricular contractions (PVCs) in your 24-hour Holter monitor indicates that your heart is experiencing frequent ectopic beats. While occasional PVCs are common and often benign, a high burden can be associated with an increased risk of developing more serious arrhythmias, particularly in patients with underlying heart conditions.

In summary, while your brief episodes of VT and the presence of PVCs may seem manageable, they warrant careful monitoring and possibly further intervention. It is essential to maintain open communication with your healthcare team, adhere to your medication regimen, and report any new or worsening symptoms promptly. Your proactive approach to understanding your condition and seeking clarification is commendable, and it is vital for your ongoing care and peace of mind.

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