Q:
I am a 26 year old male, with PSVT. Without medication (COREG, and VERAPAMIL) this is a pretty recurring condition for me. With medication, I may go an entire month without an episode, but never much more than that. I am a Firefighter / EMT, and as such, this condition can be a bit of an obstacle for me. Especially with heart related conditions being one of the leading causes of line of duty deaths in firefighters. As I am sure you well know, most firefighters don’t die in a burning building from the fire itself, but instead of some incarnation of heart failure.
I have recently been considering discussing ablation as a treatment option for this issue with my doctor. Though I am aware of some of the risks (pacemaker) and the like, I not sure if this is a good option for someone in my line of work. And as such, have been a bit reluctant to discuss this with my doctor. But I have become quite interested in the procedure, as there is a hospital in my region (Greater Cincinnati – Good Sam.) that has very good options for dealing with heart conditions, such as minimally invasive procedures, and robotic assisted surgery.
So this brings me to you. I was wondering what your thoughts were on this treatment option? Is it something worth discussing, or do you think I would do better being satisfied with beta-blocker, and calcium channel blocker therapy? Any input would be greatly appreciated.
A:
I know all about firefighters and heart disease; lectured about it to the local fire department in 1999! There a number of reasons why firefighters are at an increased risk for heart disease, despite the so-called “healthy worker effect” (fire fighters have to undergo vigorous health testing before acceptance). Exposure to tars, CO, and other toxic fumes, as well as stress plus a lifestyle that frequently includes smoking and a poor diet, are some of the reasons.
You can read more about some of my conclusions here: Heart disease in Firefighters.
Since tachycardia is a normal initial response to an alarm, I can understand your concerns, assuming you don’t want to change professions! However, it seems you are pretty well controlled on your present medications, and sometimes it is better to live with the devil you know than take a new chance.
My recommendation therefore is to consult with a cardiologist and hear what he has to say with your particular situation in mind. It might also be worth to have an EP study to evaluate your PSVT in detail. This will tell you, whether you are a good candidate for ablation.
Hope this helps,
Dr T
http://www.cardiac-risk-assessment.com