PVC causing cardiomyoapathy or vice versa

[mary2]

I am writting about my husband who is 45 years old without any symptoms and was told that he has benign PVCs in 2001. Later (2004) one of our friends (MD) told us to do holter and echo which showed 20000 uniform PVCs and echo was read as having low normal EF. Exercise stress test was fine and PVCs disapeared during exercise which we were told is a good sign. Stress echo was read normal. We repeated several holter all showing between 15000 to 22000 PVCs (same type). He also had two MRIs read as low probability of ARVD and no evidence of scar tissue (again told this is good?). Last november his EF dropped to 45% and his EP doc decided to do ablation, saying PVCs may be causing cardiomyopathy. Ablation was succesful and now have only 100 PVCs per day. However,  EF, 3 months later, did not show significant improvement. Still 40-45%. He is on coreg and lisinopril.
Is this a bad sign? Did the PVCs caused irreversible damage? Is it possible that EF will improve? Was the cardiomyopathy causing uniform PVCs? I read that may be the cause but the PVCs are usualy diferent types. Would the MRI show scarr tissue if he had cardiomyopathy? Have you seen any similar cases? What is a long term prognosis of someone with EF of 40%?

Thank you

[Forum-M.D.-MJM]

Hi Mary,

Sounds like your doctor did a great job with the ablation.

Is this a bad sign? Did the PVCs caused irreversible damage?

There is no way to know for sure at this point which caused which.  If the ejection continues to decrease despite the decreased PVCs, it is like the cardiomypathy is not caused by the PVCs.  There is a decent chance that it will stablize, but only time will tell.

Is it possible that EF will improve?

It is possible.  

Was the cardiomyopathy causing uniform PVCs?

Same as above.  We cannot tell now.  If the EF stabilizes it is possible that it the PVCs caused the cardiomyopathy.

I read that may be the cause but the PVCs are usualy diferent types. Would the MRI show scarr tissue if he had cardiomyopathy?

Not necessarily.

Have you seen any similar cases?

I have seen PVC induced cardiomypathy and have seen the EF  improve after ablation.  At this point, you don't know for sure what the cause was (PVC or cardiomypathy).  At this point all you can do is maximal medical therapy (beta blocker, ACE Inibitor).  It sounds likely that the PVCs caused the cardiomyopathy, but it will take time to know.

What is a long term prognosis of someone with EF of 40%?

It depends on many factors that you do not know at this time, like the cause, if it continues to progress or it improves.  There is no way to know for now.

I hope this answers your questions and that your husband continues to improve.  Good luck and thanks for posting.

[tickertock]

This is a very good and interesting question, Glad your husband's ablation was a success. I've read also that frequent PVCs usually above 15-20% of your total heartbeats for along period of time can cause cardiomyopathy and that ablation is usually recommended for these rare individuals ( usually successful from what I gather). I think 6- 12 months is generally the amount of time in which one would see an improvement in EF, though could be longer or shorter give or take a few months, this is just my understanding I'm not a MD. A also gather that an EF of 45% is just a mild decrease in heart function and if no other underlying pathology is present ie. dilation, CAD, etc. would be probably regarded as "normal" for that individual unless it deterioates or some other underlying pathology presents itself.

[mary2]

Thanks to both of you.
Yes, the EF of 40-45% is not horrible but when you read  about cardiomyopathy, the disease is chronic and progressive with high mortality. For a 45 year old that means shortened life.  The worse thing is there is no known cause and the treatment just slow the progression.

[Carey01]

Ok-- This one concerns me.  Everywhere all over this website it says that PVC/PAC's are benign.  This makes it sound like they can CAUSE cardiomyopathy.  Am I reading this right??  That sets me waaay back in my "its nothing to worry about" strategy!!

[anacyde]

I know there's at least one forum member here who experienced a PVC-induced cardiomyopathy and recovered completely.  Hopefully the person will see this and post :)

[mary2]

The PVCs in structurally normal heart are usually benign.
However, there are several reports in medical literature about PVCs induced cardiomyopathy. Most reports are on patients that got better after ablation.
The question is how many people have PVC and cardiomyopathy (whatever came first) and are not getting better (with or without ablation) and are not reported in the literature (so even MDs don't know). My husbands first MD rejected my concern and we looked for another PCP who eventually ordered echo.
My suggestion to all of you with frequent PVCs is to have echo and holter done on a yearly basis.

[Fionajnz]

I am recovering from a post partum cardiomyopathy, slightly different fish, but same problem.  My EF was 45% when they found it, though it was probably much less, as they estimate I had the issue for at least 4 mths prior to finding it.  I think about 4mths on, with meds I had only progressed to EF of 50% or so.   Reported symptoms during pg but OB did not even come close to figuring out what was going on.  

It has taken me over a year to get an EF back to 60% and I am having another echo in a wk or so.  I have PACs and PVCs (which I initally felt alot but not so much now, when they did the last holter, I had thousands of them, but felt very few - I am lucky in that I do not think its my last breath either, so that helps when they do happen and I feel them).  I think its mostly about time and as the Doc said, maximising the meds for the best results, but you cannot expect miracles initially.  We live at altitude so am not sure if that impacts recovery time, but I suspect so, as when I went to almost 10 000 ft a few wks ago, I REALLY felt symptomatic.

I was 41 when dx'ed and had lots of other serious health issues emerge too, of a myopathic nature.  I totally refuse to believe that this issue will shorten my life, I have way to much nagging of my hubby planned and family events I plan on seeing, to check out any time soon :-).

I hope that your hubby is back to his old self soon and in the meantime, keep your expecations realistic and think positively, I am convinced that helped me/us get through it all.

Fiona

  

[Momto3]

OMYGOSH!!  Your husband's story is nearly identical to mine!!  I can't believe it!!  I think this is only the first or second time someone else posted of a similar experience....

I was having 20,000+ pvcs per holter exams when my EF dropped to 40%.  My pvcs were multiform, but it appeared that there were 2 dominant foci.  In 2003, I had 2 successful ablations.  It took about 6 months after the 2nd procedure for my EF to return to normal.  After 3 years, it's still 55-60.....I also took Lisinopril.  The doctor wanted me to take a BB too, but it turned out not to be necessary.  Today, I'm still taking the Lisinopril and a BB as needed for really bad pvc days.  

Hope he continues to see improvement!!

connie

[mary2]

Connie,

did you have echo done at 3 months post ablation? If so, what did it show?
How many PVCs do you have now?

Also where were your foci?  Left or right ventricle? Most common 'benign' ones are in RVOT (right ventricular outflow tract).

Thanks

Mary

[Momto3]

I had several echos before and after each procedure.  Even after the second ablation, my ef was 50ish.  I had the second echo in November 2003 and in April 2004, the ef was back up to 55%.

I have no idea how many pvcs I have now, I know it's nowhere near what i had before....probably hundreds compared to thousands/day.  t been a problem at all.

My first ablation was for RVOT and the second was for LVOT (they initially thought it was a second RVOT foci, but turned out to be left sided).

Does your husband have another echo scheduled?

connie

[mary2]

It seems that your EF improved shortly after 1st ablation and then even more after 2 nd ablation.

Yes, we will have another ECHO in few months.  I guess we just have to live with uncertainty.

Thanks for your response

[Momto3]

I didn't really see significant improvement in EF until 6 months after the 2nd procedure....I think your husband still has time to see more improvements.  Mine kinda went from 40-45-50-55/60, but mostly after the 2nd procedure.  I had the first ablation 7/2003 and the second 11/03.  Hang in there, you may very well see continued improvement.

[EchoTech]

Try not to stress out about the ejection fraction numbers so much.  The real question is can you live your life  they way you want without getting short of breath or running out of gas.  If you have an EF of 45%, but you can do everything that you did before without much consequence, then it is not great, but don't let the number hold you back from life.

Good night and good luck.

[linny32]

I just want to say pvc's dont cause cardiomyopathy.. im a 32 year old with dilated cardiomyopathy. my ef is 33% and i have pvc's at about 4,000 .. im on toprol and atacand.. i have been to 5 different doctors. they say in my case its caused by a virus, but in other cases it can be genitic or pregnacy.
       i really dont like to hear that our mortality rate is low, or that our life will be shortened i have two small children and i would like to be around for a long time to watch them grow... the doctors say with treatment this can improve.. so thats what im hoping..