Thursday, July 1, 2010

PVCs and ventricular tachycardia in a healthy heart

I recently  received an email from a man who was having runs of ventricular tachycardia and had alot of questions. Here are his questions and my answers in hopes that someone else may benefit too.

His questions are in italics.

I'm a 24 yr old male. Echo, stress test, stress echo, holter, and event monitors have all been normal besides "PVC's and a 26 beat run of ventricular tachycardia at 127bpms that self terminated". I seen an EP today and he said that he thought it to be benign and called it Idiopathic Ventricular Tachycardia and I started asking questions and he said that just to be safe he wants to do an EP study next week. Can you explain an EP study?

An EP study is done to make a "roadmap" of your heart's conduction path. They give you medicine to make you sleepy then they place a catheter through your groin up into your heart. The catheter stimulates various parts of the heart and they can determine what part of the heart the arrythmia is originating from.

Here are some links about EP studies:

How safe are they to do? If he triggers a deadly arrythmia can they easily terminate it and keep me safe?

They are very safe to do as long as they are done in a EP lab with experienced staff in a center that does a lot of EP studies. You don't say where you are located. They are prepared for any arrythmia that might occur during the test.

What if he has to do an ablation, how safe is that?

Ablations can be done during an EP study. If they find the area of the heart where the arrythmia originates from then it can be "burned" with a special ablation catheter. This is a more specialized procedure and can have more risk but there are centers that do these procedures all the time.

Just how benign is "Idiopathic Ventricular Tachycardia"? Can it develop into V-Fib? How bad is it to have a 26 beat run of v-tach?? Can you share your personal experiences and opinions? I also have been experiencing what feels like angina for about 2 yrs now and thats why I had the whole work up but all the test for that came back negative. ??

Idiopathic ventricular tachycardia is VT with no known cause in a person with a normal heart. There are people who have VT who have a normal heart.

Any VT needs to be investigated. You need an EP study to see where your VT is coming from. Talk to your EP doctor about other tests that may be necessary such as an echocardiogram, TSH blood test. There are certain types of VT that are not likely to develop into VF because of where they originate from. It's possible that is what you have but it's hard to know that without seeing your EKG. Your EP doctor should be able to answer that for you.

26 beats of VT is long BUT (and this is a big BUT) at a rate of 126 it is a VERY SLOW VT which is MUCH less dangerous. Do you have symptoms with your VT?

As for my personal experience- it's a scary story but here it is:

also found on my copy of the cardionet report it says sinus rhythm with IVCD (Intraventricular Conduction Delay) and on the Diagnosis part it says (ICD-9): 426.9 conduction disorder, unspecified. sinus rhythm with IVCD shows like 3 different times on the report. and 3 different times had ventricular tachycardia 25 beats, rate 124BPM, all the v-tach reports had 25 beat runs with the highest rate 125BPM. does any of this offer any additional info for this v-tach maybe not being benign? does the IVCD pose more risk to SCD or v-fib with since i had documented v-tach?"

does that long of a run (25beats) make it dangerous? will drinking alot of alcohol make my Idiopathic v-tach dangerous? i've been feeling ALOT of pvc's today, and alot of long runs of them that make me extremely scared, is this common?? what could that be?

thank you SOOO much and appreciate your help and opinions.

Sounds to me like you have a definite VT problem without any specific cause and they need to figure out what the cause is. Once they do that then you will get more answers. When will you be having an EP study?

if they induce V-Fib during EP study can it easily be terminated and brought back to normal or is there a good chance that you could die from it?
They can terminate arrythmias in the EP lab. Just don't think about it. It's easier that way. I remember having the very same fear.

could it be Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy? how would that be diagnosed? would that fit my symptoms of left side chest pain, left arm pain, angina and the PVC's and VT and other symptoms that I feel? I have on one of my EKG's it says "T Wave Inversion now evident in Inferior Leads", what does that mean? ARVD?

I think ARVD is diagnosed with biopsy. Cardiomyopathy is seen on an echocardiogram.

I also have came across some information about "Idiopathic Ventricular Fibrillation", and "Primary Ventricular Fibrillation" where it has occured in people with normal hearts, structural and electrical, with normal echos, holters, stress test, ep studies, cardiac mri's, so my question is how can one say that PVC's, and NSVT are benign in NORMAL hearts but they still have these cases of sudden death "v-fib" in people with NORMAL hearts???
Those people have Brugada syndrome

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