Carlos Silva and Endocardial Ablation for PSVT

This article originally appeared online at Dr.Pullen.com, part of the HCPLive network.

In the sports news this week was Carlos Silva, the pitcher traded from my local MBL team the Seattle Mariners to the Chicago Cubs last winter, who had to leave a game with what is reported to be supraventricular tachycardia. This type of very rapid heart rate comes intermittently in paroxysms, therefore the common name Paroxysmal Supraventricular Tachycardia (PSVT). In the normal heart the electrical conduction of the heart travels through the atria, pauses momentarily at the tiny bundle of tissue called the atrio-ventricular node (AV node), and then travels through the specialized conduction system of the ventricles to cause the ventricles to contract. In the normal heart this AV node is the only place that has tissue able to conduct the electrical signal from the atria to the ventricles. In patients with PSVT there is usually an abnormal area of heart muscle fibers through the fibrous separation of the atria from the ventricles. This allows the electrical impulse of the heart to race in a circuit from the atria to the ventricle then back to the atria and to the ventricle leading to paroxysms of very rapid heart rate. The heart rate in this condition can get to over 200 beats per minute in young healthy people, and can be very uncomfortable, at times going so fast that there is not enough time for the heart to fill well with blood between heartbeats and leading to reduced circulation. The rapid heart rate in older patients with a degree of coronary artery blockage can lead to ischemia of the heart muscle, with angina and even a myocardial infarction. Non-surgical treatment for PSVT includes use of medications to slow the maximum heart rate like beta-blockers or calcium channel blockers. Procedures like carotid massage and holding one’s breath and bearing down (Valsalva maneuver) that increase the activity of the vagus nerve, which slows heart rate have been used to interrupt paroxysms for years. More recently use of IV adenosine has been used in emergency room settings very successfully to convert PSVT to a normal rhythm

Carlos Silva had a fairly new surgical treatment for PSVT called radiofrequency ablation. In this procedure a cardiac catherization is done, the abnormal segment of conducting tissue is located by a procedure called endocardial mapping, and the ablation is done through the catheter to destroy the abnormal myocardial cells and prevent the circuit rhythm from occurring. This procedure has a high success rate and is well tolerated in most patients.

Silva may be able to return to baseball in a very short period of time if the procedure goes as well as it often does. Even if the procedure is not completely successful most patients with PSVT have fairly infrequent episodes, and full recovery from a cardiac catheterization is usually quick. I predict Silva is back on the mound before Sept 1.

Ed Pullen, MD, is a board-certified family physician practicing in Puyallup, WA. He blogs at DrPullen.com – A Medical Bog for the Informed Patient.