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pvc's and couplets
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pvc's and couplets

can pvc's and couplets cause fatigue....??
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242509_tn?1196926198
Unlikely to do so, unless they occur thousands of time in a single day, in which case they may, by causing a PVC induced cardiomyopathy. But provided you ejection fraction is normal, your prognosis even with many PVCs is good.
27 Comments
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Avatar_n_tn
Based on personal experience, yes they can if you are having them in the thousands as the doctor stated.  I was having pvc's in the 25 to 30,000 per day range (with no cardiomyopathy on echos) and having significant fatigue. Of that number 2/3 were in bigiminy and/or trigiminy. Since having an ablation 5 weeks ago, my fatigue is gone and I am feeling stronger every day.  
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Avatar_n_tn
Did you get an ablation for PVC's only?  I'm considering doing this for my pvc's but I'm terrified of the procedure
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Avatar_n_tn
Yes, my ablation was for PVC"s only.  I actually had two of them as the first one didn't work.  The second one they burned the same places as the first but had to use a larger tip and make deeper burns than the second one.  So far the second one has been 100% successful as I am no longer having "any" pvcs.  The procedure for most people is not bad at all. You normally would only feel a slight discomfort from the local anestetic they use around the femoral vein/artery in the groin area and then you can feel the burns but it is like having heartburn for a few seconds. You also have to lay on your back for hours but that is tolerable.  That is the only pain associated with the procedure for most people.  Unfortunately I am one of the 5% of the population that has a nerve wrapped around my femoral vein so I was in pain for the 4 hours it took for the 2nd procedure (2 hours for the first one).  Most people feel nothing there though.  If you are having a significant amount of pvcs like I was (25-30,000)or if you are having significant side effects I fully recommend having the procedure.  It is well worth it.  By the way I had my second procedure at Cleveland Clinic and wish I had my first one there as the second one my not have been necessary.  
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Avatar_n_tn
Hi Gabby.  I too an a major PVCer since Oct 2005 - before that never had a single PVC in my life - since then I have been plauged by them.  Constant and in huge #s.  32,000 on one 24 hour halter and just under 19,000 on the most recent - pre-ablation.  Well I got fed up and went for a PVC ablation on July 20/07.  The first week was great - no PVCs, then had recurrance of bigem and trigem for about 2 weeks, then they went away for 3 weeks of bliss then slowly came back again for a week, then gone for 2 more weeks (more or less gone) and now back again but not as bad as before - I've had no halters but I know myself my current #s are about 10,000 to 15,000 per day still with some periods of bi and tri. esp at night  - I keep telling myself I am still healing and not to become too disheartened - I was realy hoping for a result like yours.  My EP told me what you have at 6 weeks is what you get but I have seen others that say its up to 3 months of healing and others say more.  Anyway just FYI; I am a RVOT PVCer and they burned (RF) two spots; one on the anterior wall (about 6 RF applications) and one on the posterior wall (about 4 RF applications).  Maybe at some point I might go for a second ablation as you have done - I am curious - was your 1st ablation experince like mine (i.e. not satisfactory)? what were your PVC #s before and after the 1st ablation? what are they now post the second (100% gone)?, how many areas did they burn in your case? all in the RVOT or elsewhere? How many actual RF applications (If you know)? - if you have time let me know - as you probably know yourself it is almost impossible to find any info on the REAL outcome of PVC ablation except from people who have been there and there are so very few of us about.
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Avatar_n_tn
Sorry to hear yours are not completely gone, but I too have heard 2-3 months before it all settles down.  I will be 6 weeks post ablation tomorrow and as far as I know I have not had any pvcs at all during that time.  I know I was hooked up to a monitor at Cleveland Clinic and the pvc counter still had 0 when I checked out the day after the procedure.  I have not felt any at all when taking my pulse, which is the only way I would know as I usually did not feel mine, I just felt exhausted all the time.  I have not been back and had an ekg or holter since the ablation though.  I am scheduled for a follow up next week.  My 1st ablation did not work at all.  He made 14 burns and the pvcs stopped for about 10 minutes but then started right back up in biginimy at the same rate as before.    I could not tolerate any more pain (was having vasal vagal reaction) so he stopped the procedure.  Before my 1st ablation I was having around 24,000 RVOT pvcs.  On my next holter I had about 29,000. As far as I know it was all RVOT.  We thought they had started up in the left ventricle instead of the right after the 1st ablation but come to find out during the second one they were all still coming from the RVOT. In fact the Dr.said he just reablated the previous burns but used a larger catheter to make the new burns.  If you are still having 10 to 15000 per day it might be worth it for you to try reablating especially if you are severely symptomatic like I was.  I swore I would never have another one after  unless they could find a way to anestesis my weird vein but it I start having them in the 10's of thousands again I will consider it.  You know I was just like you, I had never had them in my life and had never even heard of them or of an electrophysiologist,  and then all of a sudden I am having 25,000 a day.  Just goes to show you never know doesn't it.  Good luck.  I hope yours settle down without having to have a new ablation.  
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Avatar_n_tn
When I get many PVCs a day I do get tired, especially because I usually have sinus tachycardia with them. I spent about 2 weeks with over 3000 PVCs a day and a mean HR of 100 (never got below 70 not even at night). My cardiologist said it was as if I had been running for 2 weeks...
I've had great success with beta blockers. I took Inderal as needed for some time, then on a daily basis during a very bad PVC-tachy period last year. Now I've had virtually no PVC for months! Well maybe a hundred a day but what is a hundred PVCs??
So far Inderal has worked but it's reassuring to know ablations can be done, if necessary. My cardio though said he wouldn't like me to have an ablation since my PVCs come from the left ventricle.

Cheers everyone
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Avatar_n_tn
Thank you for your response.  I assume that like me Beta Blockers were useless to you otherwise you would not have gone for your ablation.  Did you have any symptoms besides fatigue - I feel all the wacky beats both the premature ones and the recovery beats (drives me nuts).  My only other symptom is that I sometimes have a mild sub-sternal/left chest discomfort - I'm not a 100% sure if it is PVC related but it seems to be - I know it is not classic angina.  All my heart troubles started in 2005 after a bad flu in the spring of the year - as I was recovering I went into a sinus tach for about 10 days - had all the med tests was asked if I was on coke NO! everything came back negative except white cells were slightly up in keeping with a viral infection - I think I had a mild case of viral myocarditis - anyway I recovered and pulse went back to normal for a few months - that is until Oct 17, 2005 when all hell broke loose with PVCs - I am male and 43.  Do you have any idea how you may have "acquired" your PVC problem? - If you have time please answer
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Avatar_n_tn
I am very lucky.  For over a year I had severe PVC's, and they controlled my life.

A combination of just trying to ignore them, relaxing, and possibly when I started taking fish oil they have all but disappeared.  I suspect it was stress, then a worrying sprial that caused them, but the fish oil really seemed to help.
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Avatar_n_tn
No I have no idea why mine started.  I was actually healthier than I had been in years just prior to them starting.  My main symptom was the intense fatigue but I also had shortness of breath (when I was in constant bigminy or trigimeny), my muscles and bones had started to constantly ache, my head hurt a lot, my blood pressure stayed high and I was light headed a lot.  Most of that has completely stopped since the ablation though.  My blood pressure is still a little high but it is a lot lower now than preablation.  I had a bad reaction to beta blockers and couldn't take them.  I also tried a couple of antiarrythmics and had reactions to those so I could not use them.  
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Avatar_n_tn
Thanks very much for the back and forth.  Finding another PVC case so similiar to mine is not easy.  If you have time; I assume you had a clean MRI - mine was suspicious for possible ARVD - they found some small aneurysms in the RVOT - but I have no other signs except the PVCs and I personaly think that the aneurysms are from my scrape with viral myocarditis - but who knows, certainly the doctors don't - they just say you have to wait and see and go for a MRI every 3 years to see if there is any change.  As I am considering going for a 2nd ablation like you (but I will wait at least 6 months to let the current one heal) I would be interested in seeing a post from you in this thread in about 6 months - if you can remember to do that I would really appreciate it - I'd like to know if you are fully satisfied longer term and what if any your PVC count is at that time (hopefully 0) - PS how long did you wait between your 2 ablations?
Keep well
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Avatar_n_tn
Dear Gabby,  Can you tell us the name of the cardiologist who performed your 2nd (successful) ablation?  I've suffered from PVC's and V-tach for 3 years.  I'd love to see the results of any published clinical study, if one exists.  Thanks so much.
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21064_tn?1309312333
Just thought I'd chime in on this discussion.  I also had 2 pvc ablations.  The first one was partially successful, and the second one finished off the job.  Prior to the first procedure, I had 20,000+/day for a long time.  In my case, the first ablation was RVOT, and the post-holter monitor recorded about 6,000 pvcs.  I was thrilled, my doctor was not....Anyway, she also said it takes a couple of months, or longer, to be sure things have settled down.  Three months after my first ablation, I headed back for a second.  Based on the pre-ablation tests, all indications were that I still had foci from the RVOT that needed ablating.  However, during the EPS, it was discovered that it was in fact, an early LVOT problem.  The doctor went out to the waiting room to ask my husband's permission to ablate on the left side (a bit more complicated).  He said, "YES, she will not be happy if you wake her up and tell her I said NO!"  He was right!!  So, they applied 12 burns in the LVOT and today, I have very, very few pvcs.  It was truly a miracle for me.

Good luck to all of you who have had an ablation(s) and to those of you who are  contemplating having one (or another one).

Have a great day everyone!
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Avatar_n_tn
My doctor was Dr. Walib Saliba (I may have spelled this wrong) at the Cleveland Clinic.  I am very happy with the results of my RVOT ablation so far.  
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Avatar_n_tn
Sorry to take so long to get back with you I have been out on vacation and then just too busy at work to get on here.  To answer your questions, I had a heart CT instead of an MRI but it was clean.  I also had an echocardiogram but the only  finding on it was a mild mitral valve regurge.  On my last echo that had not changed so I just have to have it checked again in about five years.  I went to my electrophysiologist last week and he told me I can consider myself as having a "normal" heart now.  I waited about 9 months between my ablations but that was mainly because I didn't want to have the second one both for financial and pain reasons.  I ultimately had it because I was so fatigued and having so much muscle pain I couldn't function anymore.   I will be happy to come back on here in about 6 months and post an update but I may not know how many I am having, if any, because I am not due to see my Dr. for another year.  Momto3 has also had a lot of experience with these multiple PVC's and was a great support for me preablation.  If you have any more questions I'll be happy to help you out.  Good luck
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Avatar_n_tn
Thanks, Gabby, for your response!  Take care.
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Avatar_n_tn
Thanks for your posts.  You guys are inspirational to us PVCers who have had or are contemplating ablation.  Esp. you Momto3 as I have always (since Ive had this damn problem - 2 years now) read your posts with keen interest.  I think it is significant that even though you are in most respects cured via ablation you have not forgotten what it was like and you are still ready to provide advice and support to others who are still suffering with a problem you used to have.  So far I would say that my 1st shot at a RVOT PVC ablation (July 20/07) continues to have a poor review with me - I am still having very big PVC #s (15 to 20K a day is my estimate). I will (as Gabby did) I think wait about 9 mths to a year and if I still am having big #s go for a second burn.  Paul; I agree its hard to find objective data/studies on PVC ablation success.  It seems that there are only "feelgood" single case studies on the net.  They don't seem to publish the unsuccessful ones.  The only thing I can find that the reasearchers seem to agree on is that very big PVC #s if sustained long enough will cause a decreae in LV function (i.e. CM).  If I find anything I will let you know and you if you do can return the favor.  My own EP says that because most PVC's situations are not harmful the reseach money to fix the problem really isnt there as there is no real profit in it - in short its not much of a medical priority even if it does make alot of people miserable and negatively affect quality of life.   Anyway, we have to keep our chins up.  Best regards to all of you, and all on the forum.
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21064_tn?1309312333
Thank you so much for the very kind words.  I'm so happy when I can help someone else through the pvc maze.  It is a heck of a ride, for sure!

If you're first ablation didn't seem to resolve the problem, don't give up.  Had I given up after the first one, I'd be back on anti-arrythmics.  After the first procedure, I remember thinking how great it was when my holter showed about 6,000 pvcs (a far cry from where I had been).  My doctor did not share my enthusiasm and asked me how I would feel about a 2nd procedure.  WHAT??  I asked what she would do...and that's the rest of the story : )  You know what, she was right!  I was multifocal so she (and I) knew that it might take more than one ablation.  

Next month, I'll go for my semi-annual checkup and stress echo - Hopefully, everything remains stable : )
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Avatar_n_tn
Hello, i am a 31 yr old female recently diagnosed with RVOT. Although i am adjusting to life medically ie taking my beta blockers, attending appointments etc i struggle with knowing wether or not if the way im feeling are actual symptoms, i am constantly tired and since starting medication and i always seem to have a foggy head and terrible tension headaches. I often feel short of breath and feel like i have to almost gasp? I was told if i felt the symptoms that i should go back to A&E but they are not as severe as when i first was taken in and in fact i worry if they are even anything to do with it or whether im just a bit off.... i dont want to keep running to and from hospital if there is nothing wrong with me i would feel so stupid. I am not due to see my cardiologist till January, my GP knows very little about the condition so is wary to advise on anything. Also can hormones have any affect on RVOT? i have also been experiencing problem periods which always seem to coincide with my RVOT episodes?
I feel like im going mad...am i ill , is it really dangerous?  i know my heart rate was dangerously high i was told if i did not go in when i did then it would have killed me. I just feel in limbo at the mo, ablation has been mentioned to me but im not sure.
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21064_tn?1309312333
Sorry to hear you're feeling tired and foggy.  That very well could be from adjusting to the beta blockers.  Lots of people complain of feeling soooo tired (me included) when they start on a BB.  Fortunatley, the tiredness usually fades as you adjust to the medication.  The amount of time it takes to adjust varies.  

Who diagnosed the RVOT?  Have you had a recent echocardiogram?  I don't think I'd rely on the A&E or on my GP to come up with a game plan for what seems to be fairly serious.  I think I'd try to get copies of my ER reports and have them sent to my cardio.  The "dangerously high" comment is concerning.  Was there something in the reports that warrants sooner follow up?

For me, hormonal fluctuations definitely play a role with triggering pvcs "storms."  My EP agrees that hormones can be triggers for females who are dealing with ectopic beats.

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Avatar_n_tn
I was in hospital on Cardiac care for almost a week and saw my cardio there, The betta blockers seem to keep my runs of vt at an acceptable level since my bad episode and being rushed in.

I had an echocardiogram, MRI scan and an angiogram before RVOT was diagnosed. Im sure my hormones are a trigger so maybe thats something to look into further.

Thanks for replying nice to know im not the only one with this.
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Avatar_n_tn
I am also having a 24 hour tape fitted tomorrow so will see what these reults are... has anyone else been prevented from driving? if so for how long? driving is part of my job so a little concerned.
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21064_tn?1309312333
I'm glad to read that you had a good cardiac workup.  And, very glad to see that the BB's are helping to control the VT.  

I did not have any driving restrictions.

If the 24 hour holter monitor does not pick up the VT, you may want to ask your doctor for an "event" monitor or an implantable loop recorder.  That way, if you have an episode outside of the 24-hour window, you will be able to capture your cardiac activity.
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Avatar_n_tn
Hi to everyone. Interesting reading all the experiences you've all had. I had Paroxsymial Atrial Tachycardia with WPW and pvc's for 16 years before open heart procedure to ablate the pathways. I was on Inderal the entire time, just kept taking more and more of it to try and control the long episodes when they kicked in, usually 300 plus for 6-8 hours, totally exhausting me.

Docs here in Michigan flew me to Duke Univ. for EP eval in 1986. After 5 days of caths and repeated studies they convinced me to go the open heart route, supposedy they couldn't reach the place in the heart to ablate it with the catheter. Stayed in hospital 3 weeks post op. Came home and within 2 days was back in ER via ambulance in full blown tachycardia again...docs were confused and I was pissed. Went back on meds, tried several over next several years, none eliminated the atrial fib or pvc's. Now I'm have 20 to 25 thousand pvc's a day with bigimeny. Docs at U of M aren't sure they want to ablate as they are not sure I will benefit from it. I may go to Cleveland Clinic for referral and let them decide how I should handle this. Is very frustrating as I'm sure you all know to have this many irrregular heart beats a day. I feel them all and that raises my anxiety and makes me feel like their is some pending doom over me everyday. Anyone else feel that sense of ill fate hanging over them?

Glad to hear from anyone with any ideas or If I can help in anyway, let me know...

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21064_tn?1309312333
Hello TMG!

WOW!  You are a pioneer for ablations!!  I can imagine how frustrated you must be given what you've already endured with the crazy beats. Has your doctor suggested an echocardiogram b/c of the number of pvcs you are having?  I used to get the gloom and doom feeling much more often, but I always thought it was the panic attacks that accompanied the arrythmia???
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Avatar_n_tn
Can anyone explain exactly what a couplet is?  I've had a few episodes where I feel a premature beat and one immediately follows it.  There's no pause, just two quick beats.  Then my heart rate drops for a few beats, then I had a few more quick ones.  Are those couplets/triplets, or is it afib?  Someone please help.
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21064_tn?1309312333
That's what it feels like when I am having couplets.  It is like your heartbeat is caught, kinda stuck for a couple beats.  Triplets are the same, just a bit longer.  Not sure about afib.
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Avatar_f_tn
A related discussion, all kinds of geminys was started.
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