Ask the Cardiologist

Q. Advice and risks associated with ablation therapy in wolff parkinson syndrome

On Feb 10th I am having cardiac ablation at Monash Hospital. I am my local hospital and am concerned about complications associated with the procedure, such as insertion of a permanent pacemaker, if the procedure is nsuccessful. I am 24, and in otherwise good health. I have attacks at least once a day of arrhythmia and tacchycardia, none of which have caused hospitalisation (yet).

What I am struggling with is finding someone(s) who has had the procedure so as to get a more personal description of what I am facing.

Would you please advise regarding accurate case studies whether they be good or bad. I am really at the stage where I need some balanced information so as I can make an informed decision; Importantly, my own decision.
Any help would be tremendously appreciated.
Yours sincerely,

A. I can understand your concern and worry about having an ablation. It is the rational way to think about it. There are complications and risks involved.

First, lets review the procedure:
     You will go to the hospital having nothing to eat that morning, you will have an IV started in the arm and then go to the EPS lab. The nurses will give you sedation through the IV and you will be able to sleep through the procedure for the most part.
     The doctors will numb the skin in the groin and sometime the neck or under the collar bone with local anesthetic and place IV sheaths there to allow for catheters to be placed into the heart. There is no or very little pain once the local anesthesia has take effect. The doctor will try to start the fast heart beat and you will feel a racing heart. They will then do the ablation which may take from one to six hours (usually less than two).
     The risks are real, but rare. Over 90% of patients have a successful ablation without any complication. The risks of heart attack, stroke or other serious problem are less than 1%, the risk for needing a pacemaker is 1-3% and that depends on where in your heart the extra fiber to be ablated is. Someone who has episodes every day would notice a great improvement in their life after a successful ablation. In general the risks of medication therapy (drug side effects) would be at least as great as catheter ablation and in general most specialist would advise ablation for a young person with symptomatic WPW.
     I think you are doing the right thing to consider an ablation, which offers a chance at life long cure.

Q. My wife took two blood pressure readings today.
The first one was:

Systolic-130
Diastolic-70

which was taken by a registered nurse at our local Pharmacy store. The second was was taken on the machine at another Pharmacy about 5 hours later. She is claustropohobic and was hesitant to put her arm in the machine but did and the reading was

Systolic-174
Diastolic 83
Heartrate(Beat?) 70.

Would appreciate any comments on these two readings. Also, I took my blood pressure on the Pharmacy's machine as well.My reading was as follows:

Systolic 139
Diastolic 94
HeartRate(Beat?) 98.

Any comments on this? Thanks for any information you can send.

A. As far as your wife’s BP: The first reading is normal. The systolic reading (top number) on the second reading is high - this may be due to her stress. As for your reading the diastolic (bottom number) is high and should be re-tested for this value, if consistent would mean mild hypertension (high blood pressure).

Q. If you have a partially collapsed lung, would it affect the heart muscle? Can you have a collapsed lung for an extended period of time (perhaps months) and still be able to function somewhat normally?

A. Yes a collapsed lung can cause trouble for your heart. It would have most effect on the right ventricle which pumps blood to the lung. Although unusual, one can have a pneumothorax (collapsed lung) for some time before it is diagnosed. One is usually short of breath with this problem.

Q. From tests I know I have Pvc, Pac, and Cuplets (not sure of the spelling), my doctor tells me those are not harmful. I had a halter monitor a year ago, the doctor said I had 4,000 Arrhythmia in the 24 hour test. It took several days before I could use the monitor because it was already in use, I know I wasn’t experiencing as many by the time I had my test.

I’ve been on Inderal since 1981, I’ve been taking 40 mg 4x a day. The doctor has just increased my doseage to 160 mg a day, it hasn’t helped at all.

My heart does things I don’t understand and it can be worrisome like today. It was late in the afternoon, I was reading and was falling asleep when I felt my heart beating very fast but very lightly in my chest. I realized my whole body was shaking, just a few minutes later my heart suddenly changed again and started beating very slow and this time I could feel my heart beat in my neck and ears.
My doctor wants me to come back in three months to see how I’m doing on the increase in Inderal, that seems so far away. My heart will beat normal for several months without any problem then it will start all over again with what feels to me really severe Arrhythmia. Like when I start feeling dizzy and lighted headed as I do now. Those symptoms started I think about about a year ago.

My question is what do you suggest I try regarding my situation, I’m really at a loss and could use any suggestions or opinion you might have.

A. There are some general things that a person with arrhythmia can do to improve how they feel. The first is to avoid any excess stimulants, such as caffeine, alcohol or tobacco. Chocolate may also be a stimulant for some. Regular and adequate sleep is also important. Perhaps the most important treatment is to exercise as much as possible within your doctors guidelines.

In general, in a person with a normal heart, the arrhythmias (irregular heart beats) you mention are not dangerous. I think you need to be sure your heart exam is normal and then ask for an exercise prescription.