pvcs

I have had pvcs for 5 to 6 years my doctor said if there is no blockage there should be no problem is this true?

[Cleveland Clinic]

No it depends on the frequency and symptoms associated with the PVCs and also your heart function. Some people with thousands of PVCs daily can suffer from PVC induced cardiomyopathy, and this responds well to PVC ablation. Also, if you are very symptomatic from the PVCs ( dizziness, palpitations, lightheadedness, etc) you may be a candidate for anti-arrhythmic suppression and/or PVC ablation.

[101705]

I wouldnt be too quick to jump on ablation.  I had one on July 20/07.  Pre-ablation my holters ran between 18,900 to 32000 in 24 hours.  After what appeared to be some mixed review (i.e. some good and bad periods) I would say that for the past month steady (i.e. 30 days x 24/7) I am worse than pre-ablation with probably 35000 to 45000 per day now - almost all the time in either bigem or trigem - always bigem thru night from when I lay down to when I get up.  I have no CM to date and at 43 they tell me I'm in good health - but I suppose with my constant big #s CM may well be in the mail.  Hate the thought of all those toxic anti-arrhythmics - thats why I went the ablation route in the first place.  Now dont know what to do - another ablation? not so sure.  Anyway think long and hard before alowing either of your ventricals to be burned.  Mine was supposedly a cut & dried monomorphic RVOT job - what could be easier to ablate? VT I suppose but TG I dont have that (yet).

[scooter01]

Thanks for your information.Ihave talked to 2 doctors and have 2 different opinions.It really bothers me to even think of ablation because of what you said.I wore a holter several times and was not told my count I dont think they are very high because they come and go.My heart rate is in the mid 50s one doctor said he would go with a pacemaker first to get heart rate up and see what happens.Just terribly concerned not knowing what to do thanks for your thoughts.

[Gabby46]

Sorry to hear about your failed ablation.  I thought I would share my story with you.  I too was having around 25,000 pvcs per day and due to intolerance of beta blockers I had a RVOT ablation done in Nvv 06.  It did not work and my pvcs increased also to around 28,000 (not as bad as yours).  I then tried two antiarrithmics and could not tolerate the medications so I decided to try the ablation again as I was actually feeling worse.  My second ablation in August 07 at Cleveland Clinic was 100% successful. To date I still am not having "any" pvcs and I finally have my life back.  My advice to you is to try another ablation but make sure you have it done by a doctor that has "extensive" experience with them.  My first one was done in Nashville by a great doctor but he does only a few of them a year.  He referred me to Cleveland Clinic where they do several a day.   It made a big difference for me.  I think you are probably risking cardiomyopathy if you don't do something.  I am only 47 and didn't want to live the rest of my life feeling the way I did with the pvcs. I also had doubts about going through a second ablation but I am now back to my old self and totally satisfied with my decision to ablate a second time.  Good luck

[Gabby46]

Are you sure your actual heart rate is in the 50's.  Mine was registering in the high 30's to 50 most of the time but it was actually due to pvcs not a low heart rate.  I would suggest you have a workup by an electrophysiologist and he can tell you if your low heart rate is really low and a pacemaker is needed or is due to pvcs.  The reason I question the pacemaker is my pcp had told me I would need a pacemaker.   A lot of doctors don't understand pvcs and misdiagnose because of that.  The electrophysiologist can also install and monitor the pacemaker if that is what you need.  Good luck

[scooter01]

Thanks for information. Seems like the more I here the more confused I get.

[Momto3]

I agree that you may want to consider a second procedure in the hands of an expert EP.  I had a long-standing history of frequent pvcs and for years beta blockers helped (for the most part).  I developed CM and if I remember it all correctly, the doctors were concerned that my mitral valve regurgitation had worsened. Indications were that it was time for the valve to be repaired/replaced.  However, further tests indicated that was not the case.  My doctor researched my situation extensively, and believed that the CM had developed as a result of frequent pvcs.  It is rare for this to happen, and at that time, it had not really been documented.  I tried antiarrythmics for 7 months, but decided to try an ablation (scared outta my mind!).  I was very happy with the results (holter showed "only" 6000 pvcs - a drastic improvement for me), but the doctor thought I should consider a second procedure.  We knew ahead of time that I was multi-focal so there was always a good chance it would take multiple procedures.  I went ahead with the second procedure (2003) and I am nearly pvc free today.  My first procedure was for RVOT, and the second was for LVOT.  

If you don't mind, what major city are you near?  Any chance you could get a second opinion at one of the major centers?

[Momto3]

Ooops, I forgot to say that I agree 100% with Gabby46's comments about your heartrate.  I had a number of people (docs/nurses included) that thought my pulse was in the 40's. When, in fact, it was the pvcs.  The cardio docs would take a reading and it was in the 70's.  They said, the others were not picking up the "silent" (extra) beats.

[scooter01]

I live in the south Jackson Miss. is the nearest largest  city.Are you telling me these monitors we have at home are not correctly reading the heartrate?I am hearing so much about EP drs. that I am very reluctant to see one.

[101705]

Scooter, I dont mean to sound overly negative.  Just remember that like me, there is always the possibility that you may not get the result you desire, or it may be somewhat worse.  Its really hard to know what to do.  I think your body tells you and everyone has their own individual toterance for PVCs.  For me it was more than I could handle so I had the ablation.  Now I seem to be back to square one and thinking about ablation # 2.  I will wait a while to decide for sure and to let my heart heal 100% from the ablation of July 20 - although I suppose if it isnt already 100% there it is about 99%.  The problem is that the EP's cant really tell who will benefit from an abaltion and who will have a negative result.  Of course if you are monofocal PVCS you have a headstart (so did I) but I wrongly assumed that this meant that there was just one little area in my RVOT that needed to be burned.  The fact is they really cant say till they insert the cathaters that do the activation mapping and can see how much of your RVOT is activating (i.e. irritable) before the sinus beat.  In my case (I saw the activation map - white part earliest site, red next, and then other colors I dont remember) it was like a topographical map of north america (i.e. the part giving trouble) so the ablation is not a "surgical GPS guided precision strike" on a single point - they may as in my case have to bomb all around the target so to speak and still wind up missing a few of the buggers.  Anyhow I think the advice you are getting from Gabby and Momto3 is very good - they are speaking from experience as both have had two ablations.  I may go for a second and defacto join their club.  I only hope that my result is as good as theirs.  Good luck to you whichever way you go.  

[Momto3]

Good point 101705.....Ablation wasn't really "on the table" for me until I ran into a problem.  If I didn't develop CM, I'll bet I'd still be flip-flopping away.

However, I am glad I had the procedures and that the doctors worked their miracles.

Not sure if this means anything, or not, but my second ablation was supposed to be for another foci for RVOT.  Based on the holter and the telemetry monitors, that's where they were headed with the cathethers. But, when they got in there, they found that I was just the "other side" of an RVOT ablation, and turned out to be LVOT.  I can't remember the exact wording, but it was something like..."we started to concentrate on a late RVOT, but it turned out to be a very early LVOT..."  I think it's wise to take your time before jumping back in for another procedure.  Hopefully, if you go that route, you'll have a very successful procedure : )