PSVT Ablation

PSVT Ablation – A Sweet Addition to Our Treatment Options

For years PSVT  (paroxysmal supra-ventricular tachycardia) has been a common and difficult problem for primary care physicians and cardiologists to manage.  PSVT ablation is now commonly used with a high success rate in eliminating the problem for patients where recurrent episodes significantly affect their lives.

First let’s be sure you understand PSVT.

PSVT is a condition where there is a tiny bundle of heart muscle cells that connect the atria of the heart to the ventricles of the heart in a place they do not belong.  In the normal heart there is a separation of the atria from the ventricles by fibrous tissue called the atrioventricular septum.  Unlike muscle tissue where when an adjacent muscle cell fires and contracts stimulating adjacent cells to also fire and contract, these fibrous cells are not contractile, and keep the atria heart muscle cells from triggering the ventricular heart muscle cells.   The only place where the electrical signal can pass from the atria to the ventricles is the Atrioventricular node (AV node) also called the Bundle of His.  This specialized bundle of heart muscle cells has the unique property of more slowly transmitting electrical stimulation of contracting myocardial cells so there is a momentary delay between the contraction of the atria and the contraction of the ventricles.   When there is an additional connection of cells between the atria and the ventricles the stimulus to the heart muscles to contract can circle back to the atria.  This can cycle over and over again very quickly leading to a very rapid heart rate.  This is called supraventricular tachycardia; tachycardia meaning fast heart rate, and supraventricular, meaning “above” the ventricles.  Because these episodes happen in sudden episodes, or paroxysms, the name paroxysmal supraventricular tachycardia is used.  It is also called PAT for paroxysmal atrial tachycardia, but generally PSVT is more commonly used.

Non Surgical Treatment of PSVT:

When a patient does have an episode of PSVT techniques to increase the tone of the vagus nerve, and thereby slow the AV node conduction are the usual things patients are taught to do to interrupt episodes of PSVT.  Techniques to provide vagal stimulation include carotid massage, the Valsalva maneuver whereby a patient holds their breath and grunts down hard with the diaphragm to increase intraabdominal tone, and applying a cold washcloth to the face.  Sometimes these methods are effective at breaking an episode of PSVT.  If these interventions do not work adenosine can be infused intravenously to abort attacks.  This is the most common emergency room intervention.   Rarely it is urgent that an attack be stopped, for example when a patient is having angina pectoris (chest pain caused by lack of oxygen and ischemia to the heart muscle)  from the extremely rapid heart rate, or if heart failure is occurring from the rapid heart rate, electrical defibrillation can be done in the ER.

In the past the only ways to treat PSVT with medications preventatively have been using medications to slow the heart rate response when PSVT attacks do occur, like using beta blockers, calcium channel blockers, or digoxin.  All of these drugs can have side effects, and often are not very effective.

Endocardial Ablation:

Today with the advances in cardiac catheterization and the use of endocardial mapping by cardiologists specializing in electrophysiology procedures to locate the aberrant fibers, techniques to destroy them have been developed.  This is usually done with a technique called radiofrequency ablation.  In this technique a high-frequency radio wave energy is applied to the abnormal cells, heating them to a temperature that they are destroyed.  This technique is effective in approximately 90% of cases where an aberrant connection is located, and is about as invasive as a routine cardiac catheterization.  In some cases where the cyclic rhythm originates within the AV node treatment is more difficult because of the risk of inducing complete heart block if the AV node is treated with radiofrequency ablation.  In these cases alternative methods of ablation are sometimes used.  Sports fans may recall that Carlos Silva, a major league pitcher for the Chicago Cubs had endocardial ablation for PSVT in the middle of the 2009 season.

If you are having frequent or prolonged episodes of PSVT that lead to emergency room visits maybe you need to discuss endometrial ablation for your PSVT with a cardiologist who specialized in electro physiologic mapping and treatments.

8 Responses to PSVT Ablation

  1. Tricia says:

    Excellent article!

  2. Tawny says:

    I had an ablation for PSVT. I want to caution people about it.

    Before the ablation I had incessant PSVT episodes, one after another for hours with tens of thousands of PACs a day. Every other 4-5 beats.

    After the ablation I had way fewer PSVTs but the same amount of PACs. In addition, my heart was so stressed out from the procedure itself I couldn’t get off the couch for several months and I felt like I was suffocating. (My heart couldn’t take the strain of simply walking around.)

    I was young and healthy, with no health issues before the ablation, except the PACs and PSVT. I had no structural problems with my heart. I am also not overweight.

    I am better but I still have many of the same problems. An ablation isn’t a guarantee your PSVT will be cured.

    They don’t mention that the cure rate they claim (90%) might mean having two or three ablations to get that cure.

  3. Karren says:

    I was diagnosed with having recurring PSVT. My episodes would occur 4-5 times per month and would last 8-14 HOURS per episode. After many-many trips to the ER my cardiologist finally recommended a specialist who specialized in electrical rhythms of the heart. He performed a cardiac ablation. I was extremely scared and hopeful this procedure would help. I am so very thankful my primary cardiologist recommended the specialist. The ablation was performed in January of 2002 and it is the best decision I ever made! Prior to the procedure the PSVT episodes were debilitating. I was nervous, paranoid about going out of town due to having an episode. When episodes did spring up it took an ER visit to stop them. I would be tired and almost bedridden for days afterwards. The episodes affected all areas of my life. Now, since the procedure, I am able to exercise without fear of episodes. I’ve ran a half marathon and training for a full marathon. I’ve trained for and received my black belt in Tae Kwon Do. I swim, surf and do things I never thought possible! The qualify of my life has improved dramatically after the procedure. I still have infrequent bouts maybe twice a year which last 10-15 minutes (sometimes 30) but I can manage them with techniques provided by my specialist. I highly recommend the procedure for anyone who suffers from PSVT episodes.

  4. Dr. Pullen says:

    I cannot give medical advice through this forum. You raise good concerns.

  5. Julie says:

    I’ve been having episodes of PSVT since I was 14 (I am now 37). I was diagnosed when I was 24 at an ER visit. Shortly after, I was diagnosed with MVP from a cardiologist. I continue to see this cardiologist yearly. I have had 2 echocardiograms since 1997, indicating MVP with mild regurgitation. I suffer from PVC’s and infrequent episodes of PSVT. Previously, my episodes of PSVT were occuring only once or twice a year, with episodes lasting anywhere from 15 minutes to an hour. But, since January 27 of this year, I’ve had 3 episodes: on Jan 27, lasting one hour. Feb 17- 5 minutes, and now tonight Mar 7- 5 minutes. I take a 1/2 of a 25 mg metoprolol when I have the episodes, but obviously with these 5 minute episodes, they end before the beta blocker can even kick in. My cardiologist has discussed ablation with me but due to the infrequency of the episodes and the fact that I don’t need to go to the ER, he does not think ablation is necessary.
    This condition has caused me to develop severe anxiety, panic episodes and an abnormal preoccupation and focus on my health and heart’s activity.
    I am wondering if you think in a situation like mine, ablation is a good idea, or at least an option to be explored.
    I am considering consulting again with my cardiologist to get a referral to the eletrophysiologist.
    I have also read that the newest method of ablation is cryo-ablation; freezing the problem areas as opposed to burning. And that if a mistake is made, the area can be warmed up again before the tissue dies.

    Thank you in advance for your response. I am in Northern California.

  6. Dr. Pullen says:

    Sorry, I’m from Puyallup, WA and don’t know the Chicago area at all. I suggest you ask your primary care physician.

  7. joyce says:

    Hi,

    I was diagnosed with PSVT a year ago. I’m looking for an excellent electrophysilogist in the Chicago area. I understand that this is a risky procedure, so I would like someone who has done many catheter ablations. Can you name a few for me? I would greatly appreciate it.

    Much thanks,
    Joyce

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