Arrhythmia and Diastolic Dysfunction of LV (E/A<1)

[ChrisAAA]

Hi – Looking for “unified” med view across my heart test data (Holter/Echo) to provide understanding and point to a plan to reverse both heart issues.

44 yrs male non-smkr, no prior hist. heart disease (or in parents), long hist. reg. cardiovas. exercise, BP 110-120/70-80, 10% overwt., little lfetme alcohol, 8 wks no caffeine (except heavy coffee 1998-04).  Docs say no prior/recent HA & no blockages.  Other DX is GERD (last endo. showed open LES upon entry).

QUESTIONS:
Are my significant arrhythmia(s) causing the Left Ventr. to be “stiff” (E/A < 1), or vice-versa ?  
What might be a good plan to reverse both w/o lifetime drugs ?
Is flecainide best choice for both issues and what are risks at 25 or 50 mg 2X/day–this medicine worries me?

*DETAILS
SYMPTOMS:  Heart runs btwn normal and “erratic” beats - Holter very hi PVC density w/freq triplets, couplets, occasional vent runs esp. early AM.  Nontrivial periods of bradycda.(35-45 bpm).  Either leads to consistent SOB charactrzd by “catching up” via 1 deep long breath every 4-10 mins.  Lower abdomen also “bloats & hardens” outward couple cm.  Slight chest & lft. upper arm ache at rest or exertion esp with erratic beats.  In AM the heart seems more unstable w/ detect. Vent-Runs.  Few times had very brief sharp pain in chest-awoke me in early AM, w rapid beats after. EP doc says "rogue pacmkr" undr Ventr.

Test: Echo normal excpt sugg. “mild” diastol. dysf. based on E/A < 1 thru mitral (LV).  Seems signf. to me based on stats I've seen.  Meds:  Protonx 40mg/1X, Ca/K/Mg, Aspirin, Niacin, Ativan 1mg 2X, Nitrospray (req'd 4 emerg

[Cleveland Clinic]

Chris,

Diastolic dysfunction is a spectrum of stiffness of the ventricle. It exist as a spectrum and there is no specific indication that it progresses along the spectrum. However, diseases that effect the heart such as hypertension or coronary disease can lead to increasing levels of stiffness. I wouldnt dwell too much on it as we see this finding often.

Nonmedical approaches for your heart health really lie in the common sense approaches that we preach every day such as good cardiovascular fitness, tobacco abstinence and a heart healthy diet.

With a normal echo and cardiac evaluation, the reason to treat your rhythm disturbance would be related to your symptoms.  Flecanide, will have no effect on your echo findings. Flecanide is a good medication to supress ventricular arrythmias, but I am caution to use it in people with a history of heart disease.

Hope this is a start

[ChrisAAA]

Thanks for the resp.   Dr. bkj - my follow up, if you have time:  

How does one "get off" a powerful medicine such as flecainide , safely, or once started, doe one have to take it indefinitely ?  

How would an EP doc ever ablate away arrhythmias if he/she cannot observe them in action during the procedure (due to presence of medicine e.g. flecainide) ?

RF Ablation, as a permanent fix without the side effects of heart drugs, is my choice, but EP docs are reluctant to attempt ablation if it looks like their chances of success are not good.

[Momto3]

I took flecainide for frequent pvcs and nsvt for a few months. Because of some bothersome side effects, my doctor switched me to rhythmol.  Took flecainide or rhythmol for a total of 7 months and then decided to try the ablation.

I had to stop taking antiarrythmics (rhythmol, in my case) about 5-7 days prior to the ablation. I was permitted to take Inderal 20mg if the ectopics were really bad.  

Any idea what percentage of your heart beats are ectopic?  Mine were about 24%.

I had 2 ablations (I was multifocal) and 3 years later, I have nowhere near the number of ectopic events.  The procedures were truly a blessing in my case.  Have your doctors said they are uncertain as to ablating with reasonable success?

connie

[ChrisAAA]

c – Thank you very much for your note.  To answer - two EP docs each separately made comments that they must see the erratic beats in live action in order to map them out and ablate the associated foci.  They did not speculate on whether my odds were good or poor.  In my case I think merely accelerating the heart rate will quickly reveal bigeminy, couplets, and triplets.  PVC density - under title “ventr. ectopy” Holter summary listed 33%.

Can you tell me likely side effects of flecainide and rhythmol  (what the man in the street is experiencing) ?   My top concerns are ability to think and exercise and general levels of energy and libido.   How dangerous to come off the meds ?

Is there an arrhythmia support group on the web (beyond this good one) ?

ChrisAAA

[Momto3]

ChrisAAA,

You're welcome.  For what it's worth, when my pvcs were at 24%, the doctor still wasn't set on ablating.  However, I ended up developing a cardiomyopathy about a year after that Holter and it became much more necessary to get the ectopics under control.  Cardiomyopathy is a rare presentation as a result of chronic, frequent pvcs.  

When I was on the flecainide, I remember it affected my central nervous system (WEIRD dreams, tremors, concnetration as I recall), but I don't remember why else I wanted to switch to another med.  I'll try and remember : )

Check out www.heartcenteronline.  There are some great folks over there (very supportive) who have lots of info on arrythmias and other cardiac stuff.

Good luck!!