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Cath for PVC?
I am writing on behalf of my 68 yo mother, who has a hx of PACs/PVCs for years controlled with medication (B-blockers). Approx. 4 mos ago, she began having more frequent palps (from a few/wk to several/hr to to several/min.) She has worn a 30d Holter which confirmed PVCs. She is very active--walks 1 hr/day, good diet, good wt--very healthy. She denies chest pain or SOB, but states that she feels some mild, localized pressure during the dysrhythmias occasionally. Her PMH is insignif. really--hysterectomy 15 yo (no HRT), mild/mod OA. She has had elevated cholesterol but has taken Lipitor for years and it is well-controlled. Her cardiologist increased her Toprol XL fr/25 mg/d to 25 mg BID, which had some transient positive effect that lasted ~2d b/f degrading back to pre-increase frequency. She asked her cardio about an EP study, but he's opted to cath her instead. Would a less invasive procedure such as a stress test or cardiac CT be reasonable b/f cath? She just doesn't seem like a candidate for occluded arteries based on her S/S--Would an EP study be a reasonable place to start b/f a cath? Any thoughts would be greatly appreciated.
No problem -- Anytime we can help by sharing information, that's great!
I had frequent PVCs and I was multifocal (more than one foci). The first procedure was for RVOT (right ventricular outflow tract) and the second was for LVOT. Ventricular tachycardia (VT) arising from the region of the right ventricular outflow tract (RVOT) is sometimes amenable to ablation. Once the ablations were performed, my EF improved steadily over the next year and the CM resolved.
Hi to your Mom!! :) )
I had frequent PVCs and I was multifocal (more than one foci). The first procedure was for RVOT (right ventricular outflow tract) and the second was for LVOT. Ventricular tachycardia (VT) arising from the region of the right ventricular outflow tract (RVOT) is sometimes amenable to ablation. Once the ablations were performed, my EF improved steadily over the next year and the CM resolved.
Hi to your Mom!! :) )
Thank you both SO much for your input. I'm going to e-mail this along to my mom so that she can see that she's not alone and that there may be other options to explore first. If the cath is best, then fine. I just want to be sure we're making the appropriate choices here. Unfortunately, I was not with her when the physician arranged the cath and she was so blown away by that news, she didn't really discuss it much with him. I agree that sitting down with him is a good idea to discuss just exactly what he's seeing on her EKGs.
I was pleased to hear of Verapamil being effective for you fizzixgal--that's fantastic. I had an SVNRT ablation about 2 months ago and although it really wasn't bad at all, my mom's a little reticent to go that route unless there are no meds that will work.
Momto3--I'm like you--I try to be good and exercise but she puts me to shame! I appreciate the input re: MVP/MR. I'm pleased that the ablation worked for you--pardon my ignorance, but what did they ablate? A random area of ectopy or was there an errant pathway? How is your CMP? Has it resolved? I'm sorry to be so nosy, but...this is my mom!
I had posted this question for the cardiologist as well, and he seemed to reinforce what's been discussed here. He thought that it might be a good idea to discuss it further with the physician to sort of get an idea of what he's thinking, but that a non-invasive test might be a good place to start. She has an appointment with another cardiologist for a second opinion just be sure we make the right decisions.
Cowgirl37 also suggested that it may be a brand vs generic metopropol issue, which I'll be sure and discuss with her--it certainly is something to think about.
Again, thank you much for your posts and sharing your experiences with us. I know firsthand how much it helps to have others to give their input and talk about what's happened with them.
I was pleased to hear of Verapamil being effective for you fizzixgal--that's fantastic. I had an SVNRT ablation about 2 months ago and although it really wasn't bad at all, my mom's a little reticent to go that route unless there are no meds that will work.
Momto3--I'm like you--I try to be good and exercise but she puts me to shame! I appreciate the input re: MVP/MR. I'm pleased that the ablation worked for you--pardon my ignorance, but what did they ablate? A random area of ectopy or was there an errant pathway? How is your CMP? Has it resolved? I'm sorry to be so nosy, but...this is my mom!
I had posted this question for the cardiologist as well, and he seemed to reinforce what's been discussed here. He thought that it might be a good idea to discuss it further with the physician to sort of get an idea of what he's thinking, but that a non-invasive test might be a good place to start. She has an appointment with another cardiologist for a second opinion just be sure we make the right decisions.
Cowgirl37 also suggested that it may be a brand vs generic metopropol issue, which I'll be sure and discuss with her--it certainly is something to think about.
Again, thank you much for your posts and sharing your experiences with us. I know firsthand how much it helps to have others to give their input and talk about what's happened with them.
I've had MVP/MR for about 30 years, and I do know the criteria for diagnosiing MVP has changed somewhat. Maybe that's why the discrepancy in diagnoses?? I'm not familiar with how (or if) ischemia relates to PVCs, sorry. She's in her 60's and in good aerobic condition!! That's awesome! I'll just hide over here under this rock....I mean, I walk and try to stay active, but I wouldn't say I'm in good aerobic condition...Kudos to your Mom!!
I don't think an EPS earlier would have been helpful. In my case, I had PVCs, in the thousands, for years. I had them so often that they were "normal" to me. I have several copies of Holter reports, but only one of the reports quantifies the PVCs (22,000+), the rest just say frequent. Even when I had tens of thousans/day, the doctor was not concerned, nor did we discuss an EPS. Not quite a year after the Holter with 22,000 PVCs did the CM show up, and only then because I was having an echo for the valve. When I was diagnosed with the CM, there was VERY little literature or documentation which suported the idea that frequent PVCs could result in CM. In fact, most of the doctors (and I) thought it was the mitral valve regurg. causing the CM. But, not the case...it was the PVCs. The only thing an EPS would have shown is a lot of PVCs from multiple locations (which we already knew). I had two ablations and the PVCs are barely noticeable (to me) now. I get them, but compared to before, it's not significant.
I agree with fizzixgal, I'd have a "heart-to-heart" with the doctor to find out why he believes a cath would be beneficial under the circumstances.
connie
I don't think an EPS earlier would have been helpful. In my case, I had PVCs, in the thousands, for years. I had them so often that they were "normal" to me. I have several copies of Holter reports, but only one of the reports quantifies the PVCs (22,000+), the rest just say frequent. Even when I had tens of thousans/day, the doctor was not concerned, nor did we discuss an EPS. Not quite a year after the Holter with 22,000 PVCs did the CM show up, and only then because I was having an echo for the valve. When I was diagnosed with the CM, there was VERY little literature or documentation which suported the idea that frequent PVCs could result in CM. In fact, most of the doctors (and I) thought it was the mitral valve regurg. causing the CM. But, not the case...it was the PVCs. The only thing an EPS would have shown is a lot of PVCs from multiple locations (which we already knew). I had two ablations and the PVCs are barely noticeable (to me) now. I get them, but compared to before, it's not significant.
I agree with fizzixgal, I'd have a "heart-to-heart" with the doctor to find out why he believes a cath would be beneficial under the circumstances.
connie
Pumpbumps, I really do feel for your mother as yes, I was always aware of them, 3-4 every minute on average as you say, and they were making me so miserable I knew I couldn't keep living that way. The only time I didn't feel them was when I was asleep, and I thought I was getting fewer during exercise, but the Holter showed they didn't vary much regardless of activity.
I was also taking beta blockers, for many years for MVP syndrome, and switched from nadolol to metoprolol when the PVCs started and found, like your mom, that they seemed to help at first and then no effect. Higher doses made me feel worse, drugged and even tight chest. Finally I was switched altogether from BBs to Verapamil, and less than a week later the PVCs were gone. I had a followup Holter a few weeks later that showed 3 or 4 during the 24 hrs. My EP still wanted to do the EPS study/ablation but I had read too many bad outcome stories from people whose PVCs had gotten worse after PVC ablation, so no thank you, not as long as the meds work for me!
I can't help wondering why your mother's doctor is so anxious to do a cath... did he find signs of ischemia on her EKG maybe? (my cardio says an ischemic heart often shows ST segment changes after a PVC because it stresses the heart). Is her cardio someone you can sit down and talk with? I hope you find answers, and even more that she finds relief!
I was also taking beta blockers, for many years for MVP syndrome, and switched from nadolol to metoprolol when the PVCs started and found, like your mom, that they seemed to help at first and then no effect. Higher doses made me feel worse, drugged and even tight chest. Finally I was switched altogether from BBs to Verapamil, and less than a week later the PVCs were gone. I had a followup Holter a few weeks later that showed 3 or 4 during the 24 hrs. My EP still wanted to do the EPS study/ablation but I had read too many bad outcome stories from people whose PVCs had gotten worse after PVC ablation, so no thank you, not as long as the meds work for me!
I can't help wondering why your mother's doctor is so anxious to do a cath... did he find signs of ischemia on her EKG maybe? (my cardio says an ischemic heart often shows ST segment changes after a PVC because it stresses the heart). Is her cardio someone you can sit down and talk with? I hope you find answers, and even more that she finds relief!
I just went back and looked at you guys' posts again b/c it just hit me what you said--you have both had "thousands" to 8000 PVCs every DAY??? Good gracious--that's one every 10-20 seconds isn't it?!! Did you feel them all?! That's horrible. How were you not INSANE!? I have more than 5-6 a day and I'm very unhappy about it. What caused it and what on earth was done to correct it? Is it corrected? I guess you're both true experts on PVCs! Wow.
Thank you both for your insight.
Momto3--I don't really think he has good reason at this point. Her only complaint is the abruptly worsening PVCs. I did neglect to say that she's had MVP for years--at least 20. However, the cardiologist that wanted to perform the cath says that she doesn't have MVP but aortic stenosis..?...so.... I guess I can see why if she had cardiac ischemia then the PVCs might change and become exacerbated. However, she doesn't have chest pain, sob, etc. and is really in much better aerobic condition than I am at 41! Do you think if you'd had an EPS earlier you would have still developed CMP? Was there any kind of ablation performed during your EPS?
fizzixgal--I guess I'm thinking like you--they've become so frequent, she is losing her sense of well-being. I guess I'm just wondering if a cath is the most appropriate first step here--what about a stress test, cardiac CT or something else non-invasive? What were your results from the EPS?
Thanks to you both!
Momto3--I don't really think he has good reason at this point. Her only complaint is the abruptly worsening PVCs. I did neglect to say that she's had MVP for years--at least 20. However, the cardiologist that wanted to perform the cath says that she doesn't have MVP but aortic stenosis..?...so.... I guess I can see why if she had cardiac ischemia then the PVCs might change and become exacerbated. However, she doesn't have chest pain, sob, etc. and is really in much better aerobic condition than I am at 41! Do you think if you'd had an EPS earlier you would have still developed CMP? Was there any kind of ablation performed during your EPS?
fizzixgal--I guess I'm thinking like you--they've become so frequent, she is losing her sense of well-being. I guess I'm just wondering if a cath is the most appropriate first step here--what about a stress test, cardiac CT or something else non-invasive? What were your results from the EPS?
Thanks to you both!
My EP wanted to do an EPS for my PVCs when I was getting over 8000 per day, which is nowhere near enough to cause cardiomyopathy. But they were ruining my life and that was after ruling out CAD and ARVC with noninvasive studies.
Does your mother's physician's have reason to believe she may have CAD? Is her only complaint the PVCs? Has she had an echocardiogram? I'm wondering if the doctor wants to rule out potential causes for the PVCs that may be related to CAD???
Not sure how many doctors would do an EPS for PVCs. I had thousands/day for a long time which led to pvc-induced cardiomyopathy. That's when my doctor ordered an EPS...
Not sure how many doctors would do an EPS for PVCs. I had thousands/day for a long time which led to pvc-induced cardiomyopathy. That's when my doctor ordered an EPS...
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