Ventricular Fibrillation in nonsichemic cardiomyopathy

[DottyCece]

I have an extensive cardiac history.  I started with uncontrolled Atrial Fibrillation and severe mital valve regurgitation about four years ago. I had the valve replaced but there were problems with how the valve was seated.  I developed CHF and in eleven months after the first surgery had to have the valve re-done.  During that time I had persistent Atrial Fib Flutter that required 10 cardioversions, an attempted atrial flutter ablation that failed and did have a pacemaker for sick sinus syndrome.  After the second surgery, I did well for about two months and then developed signs of CHF which grew worse over three months.  On ECHO, I had an EF of 30%.  I then had an AV node ablation and was pacemaker dependent.  After a few more months I did get a bi-ventricular pacemaker and a ICD.  On EP students it was found that I had easily induced V-fib. I did do a holter monitor and there were nonsustained v-tach on that which is how I ended up with the ICD.  Anyway, over the next year and a half I made significant improvement.  My EF increased to 50% and my symptoms improved remarkably. I am on coreg, lisinopril diuretics, electrolytes etc. Recently, I had two episodes of V-fibrillation that required shocks.  My question is why would this happen now when my function has imporved significantly.  In my mind, I never thought this would happen.  It is scary.  I do have lots of PVCs, bigeminal at times.  Should I be on an antiarrhythmic?  I really prefer to not be shocked which is absolutely no fun.  I appreciate any insight you could give me.

[Forum-M.D.-MJM]

Hi Dotty,

I am glad to hear that your heart function and symptoms improved.

My question is why would this happen now when my function has imporved significantly.

Anytime there is scar in the heart, there is increased risk for ventricular tachycardia or fibrillation.  Your heart function improved but there is probably still some scar.  It is fortuante that you had the defibrillator.


In my mind, I never thought this would happen. It is scary. I do have lots of PVCs, bigeminal at times. Should I be on an antiarrhythmic?

If you had a single appropriate shock, I would wait it out.  The options are standard heart failure therapy, adding an anti arrhythmic, and a VT ablation (if it was VT not a VF).  For a single event, I think the risk of side effects is high enough on anti arrhythmic drugs that I would prefer to wait. If you have mroe events, then I would consider medications.  You should already be on a beta blocker and if not, you should start one.  Consider the antiarrhythmic medications only if you have to.

I hope his helps, thanks for posting.

[Momto3]

Hi!  I had hoped that you were still on your path to feeling increasingly better!  You have certainly had more than your share of cardiac problems.  I'm just so sorry to hear that your ICD had to kick in.  The good news is that you were shocked; the bad news is that you were shocked.  Talk about bittersweet.

Has your EP suggested antiarrythmics to reduce the chance for these type of events?  I'm hoping this is just minor setback and that in no time you will be back to feeling much better.  Perhaps the CC doctors will be able to offer some suggestions.  Please take care!  We're here for you.

Connie

[mary2]

The VT/VF happens for many reasons. You had few surgeries and cardiomyopathy and although the EF is better, scar tissue may cause an arrhytmia. The good thing is that you have IACD which will make you very safe. Shocks, if frequent can be diminished by antiarrhythmics... so talk to you cardiologist.

Hope things settle for you soon

[bama jane]

I am so sorry you are going through a rough time now. I hope things settle down for you. I know how life altering these things are. You seem to be a very brave lady!

[threeboys]

I am on coreg 25 mg BID and enalapril as well. The Toprol XL stopped working after 6.5 years. I am on the HCTZ and potassium for my kidneys, I have hyperparatyroidism too.
I was on Dig for 3 years.

Anyways, Thank-you again, I usually try not to worry about my EF, except for it dropping, I know that 45% is pretty good.

amy

[PikaPika88]

The scar that you all mentioned, is the open heart surgery scars or the ablation scars?   Or any kind of scars in the heart?  

The scars would take how long to cause the event of VF or VT happens?  What happen they're so many wpw/svt babies or young children had their pathway ablated without ICD?  

When the cardio that day told me the ablation scar could show as a heart infarction.  I was cried and upset for a while.   I want my heart have a full function like everyone else.

[mary2]

Scar can happen from surgery or from cardiomyopathy or infarct. Ablation do cause small scars but are almost never a cause of arrhytmias. So, as much as I understand the ablations are not the cause of VF/VT.

I don't think you should worry if you had succesfull ablation.

[PikaPika88]

Dr can't guarantee it wouldn't come back.  If they're very young, they still have a great chance to grow (anything).  I was in mid 20s when I had my ablation.  The pathway grew again!  

[SunshineNAustin]

A related discussion, CHF/Cardiomyopathy/COPD, now lung nodules and now  Arrhythema started was started.