Criteria for PVC ablation.

Thanks for taking my questions once again.

   What would be the criteria for recommending a PVC ablation? How many PVCs would one have to show in a 24 hour period for ablation to be recommended or does it depends on symptoms regardless of frequency?
    Once signing off on an  ablation for PVCs would a doctor be willing to perform such an ablation , even if it is not recommended and you are giving permission regardless of the outcome or does a responsible doctor ignore the patients plea and avoid a potential adverse reaction to the procedure?
     It is my understanding that even though one focus is responsible for about 60-80-% of all PVCs. Most person have mutifocal PVCs that occur from time to time. Is this true and the reason for most EP doctors not recommending ablation for PVCs?

    Would you agree that it is more abnormal not to demonstrate PVCs on a holter monitor for 24-48 hours, than to at least demonstrate a few.
    I also understand that sudden death is more likely to occur in person that hardly have any PVCs than in those that have them occasionally, have you seen any evidence to support this?

    i also understand that even though sometimes V-fib can be induced in a EP study in a normal heart, in these cases a ICD is rarely recommended or implanted, because of the very low risks of it occuring otherwise, Is this true?

    Thanks for taking so many questions, but I hate to see the  days when no questions are posted.

Thanks again.
        Hank.

  P.S. Do you think that the success stories of PVCs ablations in these far off land is true

[CCF-M.D.-RCJ]

Hank,

Thanks for posting once again.

Q1:"What would be the criteria for recommending a PVC ablation?"

I think the following is a reasonable criteria set:
Severe symptoms or demonstration of heart dysfunction from PVCs
Enough PVCs in a 1-2 minute period to allow for mapping
Unifocal PVCs -- meaning not a bunch of different types
Intolerance or inefficacy of meds
Otherwise being a candidate for an ablation

Q2:"Once signing off on an ablation for PVCs would a doctor be willing to perform such an ablation , even if it is not recommended and you are giving permission regardless of the outcome or does a responsible doctor ignore the patients plea and avoid a potential adverse reaction to the procedure?"

This is a tricky question, and each doctor will answer it differently.  We (meaning you and I, not just doctors) all have different aversions to risk.  Some people would say that a 99% success rate with a 1% complication rate is too high of a risk.  Others would say that an 80% success rate with a 10% complication rate is acceptable.  You and your doctor have to discuss these numbers to find out where you both are.  If the 2 of you are at different places, then consider seeking a second opinion.

Q3:"Most person have mutifocal PVCs that occur from time to time. Is this true and the reason for most EP doctors not recommending ablation for PVCs?"

Yes, many people have multifocal PVCs.  For any one person, however, a holter monitor can determine if you have unifocal or multifocal PVCs.

Q4:"Would you agree that it is more abnormal not to demonstrate PVCs on a holter monitor for 24-48 hours, than to at least demonstrate a few."

Studies of healthy medical students show that about 50-60% of these persons have PVCs in a 24-hour period.

Q5:"I also understand that sudden death is more likely to occur in person that hardly have any PVCs than in those that have them occasionally, have you seen any evidence to support this?"

I have not seen evidence for this statement, and it does not make sense to me as to why this would be true.  But it could be true.

Q6:"i also understand that even though sometimes V-fib can be induced in a EP study in a normal heart, in these cases a ICD is rarely recommended or implanted, because of the very low risks of it occuring otherwise, Is this true?"

Almost any heart can be made to fibrillate.  VF is not a reliable endpoint in an otherwise healthy person with a low-risk clinical story for VT/VF.

Hope that helps.  I also dislike days when no questions are posted.

P.S. Yes, some people experience significant relief from PVC ablation.

[glassheart46]

Taking a chance on posting again Hank!  Hope you don't get lamblasted like we both have in the past for POSTING to much.  However, I am very interested in hearing the doc answer on this one.  Good question!!

[Guenter]

I recall one person (I believe Dotty) posted two questions in separate posting and it created quite a response.  So I don't understand how that is different from this post where there are at least 7 questions.

[Momto3]

Well said! I sure hope this does not start up again...Thanks for asking the question that is on the minds of so many!

[bigmick]

I will also be most interested to read the Doc's response to Hankstar's well-put (as always) questions. Keep up the good work HS.

BM

[CCF-M.D.-RCJ]

Please feel free to ask as many questions within a given post as you like (within reason -- I'm only human and do have to see patients on occasion).  It would be polite to other readers if a person grouped all of their questions within one post, as Hank so deftly did here today.

This site only accepts 2 posts from forum participants per day, but each of the 2 posts can contain a significant amount of text, certainly able to accomodate at least 4-5 questions.  So if you have multiple questions, place them all within your one post so that another person can also place a post.  Again, if you need a guide, check out what Hank did today.

As an aside, I've personally emailed Dotty to invite her back.  She was lambasted, somewhat rudely, because she placed 2 posts in one day (not 2 questions, but 2 posts).  We have corresponded, and I hope to see her name back on this forum soon.

[pvcgurl]

Hi all. This is my very first time here.  I suffer with PVC's.  I get them alot.  Sometimes 3 in a row.  I have had an echo on my heart and they said it is normal and healthy.  I know very little about PVC's and why people get them.  I hate them.. I can feel everyone one and it sends me into a Panic.  I get them atleast every 15 minutes.  Usually one but sometimes more.  Does anyone else get them that frequently?  Or can anyone else feel them really strong like me.  It feels like my heart stops and then kick starts again.  I am scared that I am going to have a heart attack or something.  I was reading about the ablation.  What is that?  I would love to hear from anyone who is going throught the same thing as me.  You can also email me at ***@****

[nurse12hr]

What a great group of people here--pts. and Doc alike.

Hope the sniping at multiple posters ceases.  If you are persistent and try at the right times (between 8a-10a EST) you will get through eventually.  If you have an emergency, you should be calling your own doc, anyway.  This forum is for information, and we can all glean something from almost every post, no matter what the topic.

[Kristin391]

I am very confused about this whole notion of PVCs.  I have always understood and MDs have confirmed that PVCs in the absence of ischemia, cardiomyopathy etc. or symptoms are harmless.  I have had many PVCs for many years and have learned to ignore them. When my cardiologist listens to my heart, he always asks me if I can feel them because they are so prominent.  I can feel them but I refuse to give them much consideration. It is amazing to me that anyone would consider an ablation for something that is fairly benign. I really don't think I am such a tough person. It is just a fact of my life.

[CCF-M.D.-RCJ]

This is a great quote, partially because it helps demonstrate a point about how statistics can be misleading.

The quote that you provided is:
" In fact more cases of sudden death occur in people who do not have frequent PVCs".

Similar, and also true points, are the following:
"more people who do not drive drunk die in car accidents than the drunks"
or
"more people who are healthy die of sudden cardiac death".

These statements both sound shocking, but the reason is pure strength of numbers.

There are just so many more non-DUI drivers that they die more frequently in car accidents on an absolute basis.  If there are 100 million drivers in the US, and only 100,000 DUI drivers, then even if the drunks are 10 times more likely to die in a car, there still will be many fewer drunks dying in accidents.

Make sense?

[glassheart46]

Yes, all of my post ablation symptoms are now gone.  Ya!!  I now am only left with a few pac's, or pvc's daily which are of very little concern to me.  I still can hear my heartbeat but was told by the ENT man that my hearing is just more accute then usual.  You are certainly very well informed and know your stuff Hank.  Keep up the good posting.  You are of as much help as the docs on this site and I for one salute you!!

[dodgybeats]

Great question!!  I just wanted to comment that during an EP study I had done 5 years ago I went into VF - a totally unique experience I must say.  Because I was sedated during the procedure I was not in any pain but I certainly felt the defibrillator go off.  The EP doc said this happened because he really gave my heart a good work-out and he said it responded just fine, he was trying to make it go into V-tach.  He said he paced it really really high and that's when I fibrillated but he was not worried at all.  My GP freaked out though when he read the report.

[Cathy7]

Hi all...

Are PVC's the ones that feel like your heart is stopping and kick-starting again, as pvcgurl says?  I have a. fib, and I used to just feel the irregular booming like my heart is going to jump outta my chest, but now have the stop/kick-start feeling several times just preceding the a. fib. The last coupla months I have had the above, plus awful runs of tachycardia AND a. fib. that cause waves of such weakness that my knees buckle if I'm standing, and I feel like I'm passing out.  All I can do is lie still and hope it'll go away.  I can barely get enough energy to talk when I'm like that.  

These terrible weakness/fainting episodes are so bad and unpredictable (and I haven't been able to tolerate any of the meds), I'm scheduled for a thoracoscopic Maze procedure next week.  Has anyone heard of this new procedure where they ablate portions on the OUTSIDE of the heart?  Risk of clots/stroke are nearly zero, according to my heart surgeon.  The instruments and 'scope are inserted between the ribs on either side of the rib cage.  He gives this procedure a 70-90% success rate vs. the 30-60% I was quoted for the RF ablation procedure.

Any comments?

[Tony1]

I hate to ask this but when can someone post who lives in the Central Time zone.  I have been trying to post a question for almost a month now that I am concerned about but can never get on.  Again I am sorry to ask this by hijacking a thread but I really hope to get to ask something.

[bigmick]

Hankstar and CCF Doc: Whilst having previously read the info to which HS refers, and whilst also appreciating the anologies to which CCF Doc refers... I would simply point out (as per CCF Doc's response to the Qs initiating this thread) that the numbers here are approximately 50:50. (I.e. 50-60% of healthy medical students will show PVCs on a 24hr monitor.) It would accordingly appear - to me at least - that HS's assertion has some credence. Maybe a heart 'used' to a little arrythmia here and there is better able to deal with other more potentially problematic arrythmias if and when they appear.

Cathy7, I will be most interested to learn more about the procedure you will be having next week - please do let us all know more as and when you are able.... including, of course, how you get on during and after the procedure. (Just hijack another thread if you can't start one of your own (-:  )

BM

[bigmick]

Hi folks,

On another but related matter (and having not yet being able to initiate my own thread), can anyone here who has had short runs of NSVT - and have been aware of it at the time - please attempt to describe just how it feels. Is it light or thumping? Approximate HR - 100, 120, 140, 160 bpm? Can it be either symptomatic or asymptomatic? I'm a little anxious about NSVT since I had a 11 beat run of it recorded on a Holter 6 years ago..... I often get short runs of regular arrythmia (a few times per week - usually 2-4 secs, but occasionally up to 10 secs or so) and find myself anxiously wondering what it/they are. I should add that my last Holter of a year ago showed 32 PACs only, whilst earlier Holters usually showed mainly PVCs (always unifocal). I have also had 5 episodes of LAF during the last 4.5 years (all nocturnal, 3-4 hrs duration, and self-coverting. Is it likely/possible to get AF and NSVT going on in the same heart in a given time frame? I am on no meds. I do have a long history of anxiety states and OCD - I had a very violent and traumatic childhood.

Any and all contributions, views, and opinions will be gratefully received and appreciated.

Cheers,

BM

[mbimom]

Big Mick, before my ablation I used to have episodes of svt and for me it felt like a big thump in my chest and then it would beat very hard and fast 200+bpm. While it was happening you could not take a pulse it was too fast and I would become very dizzy and have to stop whatever I was doing and sit and wait for it to end, it would end with the same thump and then be over. I have not had it since my ablation.
  Cathy, I was wondering from you what an episode of a-fib feels like? Lately I have been having dizzy spells where I have passed out only 3 times in 1 1/2 months mostly I am able to just sit down and the dizzyness will go away. I am one of those people who for some reason can hear my heart beat in my chest when I am lying down and it is quiet. Lately I hear my normal heart beat and behind it I sometimes hear what sounds like a cat purring. My chest feels kinda hollow and fluttery when this happens. I always still hear my regular heart beat with it though. I did a 24 hour monitor but my appt. for results isn't till 2-25 so I am curious about what it could be. Does this sound like afib to you? Thanks.  Terri

[Kristin391]

What does Atrial Fib feel like?

I got it a year ago...started with some chest discomfort extreme fatigue and inability to tolerate any activity.  I couldn't carry a couple of books and walk a few steps without stopping.  I thought I had the flu and kept working through it all.  I could feel my heart beat very irregular and rapid but since I have always had a lot of PVCs I didn't think much about it.  I waited five days before I went to the Doctor, then my rates were over 200 and ended up in the hospital for rate control and diagnoses.  Now I get atrial fib periodically and it just feels very rapid and irrigular..sometimes I get dizzy but I have learned to adjust.  More frequently now I get atrial flutter which is very regular but persists over a 100 until there is intervention.  All in all, the lesson here is to not ignore the symptoms and get it checked out.

[sheryl1945]

Dear Hank - Don't ever stop posting!  You ask intelligent questions and your own personal research makes you knowledgeable and I derive  great comfort from you.  The doctor is so terrific -- and I appreciate these fora very much.  Best of luck to you, Hank!

[wingtip]

Hate to piggyback, but chances are slim that I'll ever get through and its more of a business question.

If I have given up on the local doctors here in Buffalo, and just want to get my meds straight once and for all, how long does it take to get diagnosed at the Cleveland Clinic?

How does one go about starting the inquiry?  Do you have to drive to Cleveland, Is there a phone interview process that I can pay for that will help determine if its warrented.

[Linda123]

Great questions from Hank as always, all questions most of us on here are hungry for the answers to, great answer from the ccf and a very kind, thoughtful, generous and reassuring comment from him also later on about posting.
The world feels a nicer place for both of you.
Best Wishes, Linda

[arthur]

The purring sensation...

When in afib, that sensation is the feeling you get from the atria fluttering away at a very high rate.  The ventricles only pick up some of the signals, so you get an irregular heart beat.  That's classic afib.  However, if you have a perfectly normal beat, and you still feel a purring sensation (at the center of your chest and deep), then you may have a pulmonary vein focus (located to the rear of the heart) which represents a small area of actively-firing cardiac muscle/electrical cells.  At times, this focus will affect your normal pacing, and at time it may not get its abberant signals through.  It's unusual to feel the focus, most people just feel the fluttering atria.  In may case, even after an rf ablation to remove one of the offending foci, there's still at least one left that's active enough to occassionally present itself as a purring sensation...disturbing but not dangerous.  Talk it over with you cardio or EP.

-Arthur

[Momto3]

Hi Fred,

I hope you are able to post your question today. As you may remember, I have had 2 pvc ablations.  A few days ahead of the 2nd ablation, my pvc frequency dropped wayyyy down.  A mixed bag of emotions for sure...good that they dropped, bad that the ablation could be postponed.  I was concerned that I would not be having enough ectopic activity for the doctor to map the problem area.  I let her know what was going on and she checked with the "ablator". Their response: "As long as you are having some, we will be OK".  Don't know about the scientific theory behind this, but we also decided a little chocolate the night before could be "helpful".  I hope you are able to find some relief for your pvcs.  Are you in the Cleveland area?
connie

[Momto3]

WELCOME BACK!  I am so glad to see you have decided to post again!  Just wasn't the same without you!  Happy Valentines Day to a gal with a BIG heart!!  connie

[2monkeys]

HELLO I JUST STUMBLED ACROSS THIS FORUM AND WAS READING AND WAS SO IMPRESS WITH HANKSTARS ANSWERS THAT I JUST HAD TO WRITE. SO PLEASE EXCUSE ME BUTTING IN AND ASKING SOME QUESTIONS THAT MAY NOT BE PART OF YOU ALL'S DISCUSION. I HAVE ALWAYS BEEN SUCH AN ACTIVE PERSON IT ALL CAME TO A HUGE HAULT 10/13/03 WHEN I WENT TO ER THINKING I WAS HAVING HEART ATTACK EVER SINCE I HAVE BEEN SEARCHING AND TRING TO REMEMBER THE PERSON I USED TO BE.  I HAVE HAD EKG'S ABNORMAL BUT NORMAL WHAT DOES THAT MEAN?  BLOOD WORK LOOKS GREAT, ECHO LOOKS GREAT, TREDMILL LOOKS GREAT.  NOW I AM ON ZOLOFT THEY THINK IT IS STRESS RELATED, BUT I HAVE LIVED WITH WORSE STRESS THAN IN THIS MOMENT OF MY LIFE SO WHY NOW DO I HAVE THIS ATTACKS- MY HEART JUMPS!! IT RACES AND BOUNDS OUT OF CHEST SO FOR THE FIRST 2WEEKS I WAS GREAT ON MEDS THEN WAM!!! IT CAME BACK EACH TIME IT HAPPENS IT LASTS 5TO 10MIN. SCARES ME TO DEATH, MY QUESTION THEN IS DID ALLTHESE TEST MISS SOMETHING OR AM I HAVING THE WRONG TESTS DONE.  I LOOK AT MY CHILDRENS FACES AND WORRY I WONT BE THERE FOR THEM-IF YOU HAVE AND ANSWERS FOR ME I THANK YOU!! AND AGAIN I AM SORRY FOR JUMPING IN. WENDY

[2monkeys]

HELLO JUST WANTED AGAIN TO THANK HANK FOR WELL...EVERYTHING IT SOUNDS LIKE NOT ONLY FOR ME BUT FOR ALOT OF PEOPLE YOU ARE A SOURCE OF COMFORT. THANKS AGAIN AND BEST WISHES FOR YOU AS WELL!!!WENDY

[regan]

Hi Hank. You wrote that the atenolol you take might aggrevate the pvc's in the future. Can you elaborate on this for me. I just started taking this to minimize my pvc's. I really don't want to take it if it can make them worse. Please explain this to me. Thank you - April

[regan]

Thanks for the comments. I don't mean to sound paranoid but are people with pvc's more likely to develop a life threatening arrythmia. If I decide to not take the atenonol and live with the pvc's would I be putting myself more at risk for developing a dangerous arrythmia. I am having a hard time deciding to continue taking the medication. My pvc's come at any time. More stressed, less stressed. Doesn't seem to matter. I do know they get worse when I am sick with a fever.

[Squimsy]

I've recently been through all the testing for all the wierd and wonderful goings on in my chest, and the cardiologist observed extrasystoles, which occasionally came in runs of 10 to 15 seconds.  The advice that I was given was that he would prescribe a low dose Beta Blocker that would give me symptomatic relief only, but that he would prefer me to try to get used to them without medication as there was no clinical benefit to me taking them.  

It was suggested by another poster here that it may only be insurance coverage that was restricting doctors treating this condition, I don't believe that this is the case at all.  I'm in the UK, and am fortunate enough to have Private Healthcare, which means that you get to jump the queue to see doctors, and as everybody here has NHS treatment as a matter of course, the only way they can flog the private insurance is to do so without financial limitations that you have over in the states.  That means that whenever you have a problem they literally get you in for any test or treatment that they can get away with to milk you for as much as they can.  Like I said before, in the eyes of my Cardiologist (who could have operated for a rude amount of money if he could possibly justify it), PVC's didn't even warrant a Beta blocker.

Best regards

Sq

[mrsww]

You said:

"Sound like if singing or straining cause your heartrate to drop you could have an high vagal tone"

I have the same thing happen, plus add to that, -hard laughing- at comedians and such.

It has also been said that a damaged Vagus Nerve may cause these things (pvcs).

http://www.bartleby.com/107/illus793.html

So how did *my* (and others) "normal" Vagal Tone go from -normal- to high; and how do we get it back to normal??

you or anyone my email me at

sally67011yahoo.com

[mrsww]

You said:

"Sound like if singing or straining cause your heartrate to drop you could have an high vagal tone"

I have the same thing happen, plus add to that, -hard laughing- at comedians and such.

It has also been said that a damaged Vagus Nerve may cause these things (pvcs).

http://www.bartleby.com/107/illus793.html

So how did *my* (and others) "normal" Vagal Tone go from -normal- to high; and how do we get it back to normal??

you or anyone my email me at

sally67011yahoo.com

[pengu]

A related discussion, R on T was started.