AIVR/PVCs

I would like to ask the following questions for my friend LG.

What could cause AIVR to come on and how does it go away? Could it be caused by drinking alcohol?

After having a successful abaltion for SVT about 4 years ago, could this ablation unmask AIVR and possible PVCs even after all this time?

After being prescribed drugs like flecainide and lopressor for this problem and still being symptomatic what should one do? Is AIVR intermittent? Are there any other drugs more effective than flecainide for AIVR and PVCs?

Can one lift weights, jog and exercise with AIVR ? ARe there any restrictions? How bad would the symptoms have to be , before deciding to go to the ER? Is AIVR ablatable and what can an anxious person with AIVR and PVCs do to live anormal life when so symptomatic with this problem?

Even after being told that your heart is strong and healthy by an EP , could this AIVR and PVCs still pose threat into degenerating into a life threatening arrhythmia and would taking the flecainide increase the risk of this happening?

Could taking flecainide and lopressor impair the hearts ability to respond to exercise in the normal way, if the drugs does not appear to be working, should stopping them cause any problems?

Thanks for taking the many questions. Iknow it is a lot answer, but any kind of insight would be appreciated.

  Hank on behalf of LG.

[CCF-M.D.-RCJ]

Hank,

Thanks for the post, as always.

Q1:"What could cause AIVR to come on and how does it go away? Could it be caused by drinking alcohol?"

AIVR stands for Automatic IdioVentricular Rhythm.  AIVR is distinguished from VT only by the speed: AIVR is < 100 bpm, VT is > 100 bpm.

There is very little data on the causes of AIVR, but one would presume that the causes would be similar to that for VT.  I suppose alcohol could lead to the development of AIVR if the intake was so excessive as to lead to a cardiomyopathy.

Of note, AIVR is classically associated with the acute recovery phase of heart attacks, where its presence may even be seen as reassuring.  In fact, it is called a "reperfusion rhythm".

Q2:"After having a successful ablation for SVT about 4 years ago, could this ablation unmask AIVR and possible PVCs even after all this time?"

More likely, the AIVR is not AIVR at all, but actually, a slowly-conducting, partially-destroyed, accessory pathway that is masquerading as AIVR on the EKG.

Q3:"After being prescribed drugs like flecainide and lopressor for this problem and still being symptomatic what should one do? Is AIVR intermittent? Are there any other drugs more effective than flecainide for AIVR and PVCs?"

This problem needs to be diagnosed definitively with an EP study.  If indeed it is AIVR, then it should be ablatable.  If it is a partially-recovered accessory pathway, then it should be put out of it's misery.  Further drug trials are likely to be less than fruitful.

Q4:"Even after being told that your heart is strong and healthy by an EP , could this AIVR and PVCs still pose threat into degenerating into a life threatening arrhythmia and would taking the flecainide increase the risk of this happening?"

Normal heart VT is generally considered to carry a good prognosis.  If you were to ask if I thought patients with normal-heart VT had any increased risk for sudden death as compared to persons without, I would answer Yes, but the absolute increase in risk is very small.  It has been noted that flecainide does not seem to carry increased risk in patients with normal heart VT.

Q5:"Could taking flecainide and lopressor impair the hearts ability to respond to exercise in the normal way, if the drugs does not appear to be working, should stopping them cause any problems?"

Yes, the lopressor can impede the maximally obtainable heart rate.  Stopping these medicines needs to be done in concert with an EP doc who knows the details of the case.

Hope that helps.