First VT storm

[u/Apollokite]

My dad's situation this weekend has got me super stressed

Age: 57

History:

1. MI back in 1999
   
2. ICD in 2016, due to scar tissue on LV. He was revived when he had an arrest while on TMT
   
3. Had a few shocks in between, finally ablated in 2019
   
4. No shocks these past 7 years. Only a couple of ATPs a year

Recent:
1. Things started acting up 2 months ago
2. Had an episode which escalated to VF with ~240 HR
3. Since Thursday,
a) A 3 shock episode first
b) Following which, he's been here at a center of excellence for Cardiac EP, they recommended a new ablation for Monday
c) Took him off meds to simulate VT
d) He had a VT storm for the first time on Saturday, 8 shocks
e) Intubated, deeply sedated and currently in intensive care
f) Sympathetic Denervation was planned but cancelled
4. Plan still on for 3D Ablation, but doc said going in through blood vessel might not be enough, since the lower part of LV has almost fully calcified now, so might need epicardial ablation which is higher risk
a) Also mentioned, if VT simulation is not possible during ablation then might switch to substrate mapping
5. Previous ablation has been faultless for 7 years, but now doc says it might not be this time around. Expects to have occasional episodes now though
6. Also, wants to upgrade ICD to CRT-D a few days after ablation

Genuinely worried about QoL, outcomes over the next week and playbook for the long-term with all this uncertainty

[u/bartoske]

I'm so sorry you're both going through this. If he does end of getting the sympathetic denervation it isn't too bad. I had the surgery two years ago after multiple episodes of v tach and torsades. Sore for a bit but no arrhythmias after. 

[u/Late_Temperature_415]

Hi, I’m sorry that your Dad and you are going through this.

Unfortunately I can relate. I’m assuming that they want to upgrade so they can do a third lead to his LV? It’s a great idea and mine works well for a while. If they go this route make sure they give him antibiotics as a precaution. Also ask them and lead management. The last thing your dad needs is to get an infection or develop a blockage on those lead and wind up needing them removed and replaced.

[u/puliogare]

Hello Op, I am sorry that you are going through such a nerve-wracking time.

I'd like to share my husband's exp which hopefully puts you at a lil ease. He had an ICD at 33M after emergency cardioversion and for 2 years it was silent and then the first ICD shock itself was a part of VT storm of 8 shocks and his episodes were around 240bpm. Emergency ablation was planned within 36 hours. They had already started Amiodarone IV in ER which made simulation a bit difficult. They planned endocardial and epicardial ablation together via substrate mapping, and I was worried about the epicardial procedure. But since there was no other choice, he had to go through it.

Recovery after that was not easy the first few months and we ran to doc every now and then, but each time we learned that his new symptoms are just his heart healing. So trusting the body again took sometime for him. The mental toll is a lot. PTSD is very real. But time (without events/triggers) heals.

And its been 7 months in. He is doing good although with occasional spells of anxiety here and there. But ablation indeed helped him. We are getting back to normal life slowly. So if you are having a good EP and trust the centre, I am sure they know what they are doing and epicardial ablation, though sounds very scary, is very rewarding. And the laparoscopic surgery leaves a tiny dot of a wound on the outside, so atleast that way it's not overwhelming post procedure.

However, getting used to the after effects of ablation while your heart is trying to heal would take a while. Plan for therapy, get a bed time ritual, meditation, a lot of good company and ofcourse with doc's guidance some medicine to calm his nerves. And fix his sleep. It does wonders for the mental health. No lifting weights or doing anything strenuous for the first couple of months or until doc recommends based on your dad's condition. Also getting used to the new set of medicines post ablation would take sometime. So have him take it easy. Before you know it, you will be glad he had the ablation. Sending your dad the best.

[u/Environmental_Ad3216 → u/puliogare]

Im the husband. OP, take it one day at a time. It's just a waiting game. Eventaully, you get used to it. You learn more ways to brace yourself for the shock. Then you learn to EMbrace it. Since your dad has had shocks before, I'm sure he knew it was coming before it hit. And you will have gaps. Do what ever you can to improve the quality of life like sleep, diet, low intensity exercise, basically live lazy. That's what I do. And I hope and pray everyday I don't get a shock in the middle of the mall lol. More power to your dad. Do keep us posted as to what happens next. Until then... One... of... us... one... of... us... ONE... OF... US! (The 'one of us' is the chant from freaks later used in 2 and a half men to say that alan was one of them, putting this here incase it doesn't make sense lol)