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How to manage tachycardia?

Q: One of my relative (aged 25 years) is suffering from tachycardia. After the initial investigation, doctor asked him to undergo an Electro-physiological study. EP study diagnosis was inconclusive and the doctor said it could be either a junctional or atrial tachycardia. The patient is now on metaprolol 100 mg a day. He gets a regular missed beat on some days, some days he will be normal. This missed beat started after the EP study. Kindly tell me if the missing is due to catheterisation, if so how can it be diagnosed? Also what are the treatment options for him? Which hospital is the best for the same? Kindly advise.

A:I do not think so. EP study cannot start a new problem. Though it is not clear also whether only EP study was done or an empirical slow pathway ablation was done. The nature of tachycardia, if it is still there / dropped beats needs to be diagnosed. What I would suggest is using a transtelephonic 15 day non-implanted loop monitoring. Though the efficacy of this mode of investigation would depend on the frequency of symptoms. If the symptoms occur couple of times every week then this is good. If the symptoms occur daily then a 48 hours holter would suffice. The tachycardia must be caught on a ECG, so whenever he has an attack of tachycardia, he should try to get an ECG done. Treatment if any can only be suggested after the ECG and the nature of the symptoms is revealed.

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