success rate for PVC ablation/ atenolol question

[hankstar]

Thanks for taking my questions.

(1) Could you please quote if possible the success rate for PVC ablations at the CCF, also the complication rate for this procedure?

(2) At what stage is a PVC ablation recommended or does it depends symptoms associated with frequency?


(3) Any new information on why one can go for months or years without any significant amount of PVC and then they flare up at the rate of thouasnds a day for weeks to months on end before subsiding. Could some autoimmune disorder or connective inflammatory disease be a trigger? I suffer from ankylosing spondylitis and this is the pattern with my PVCs flare up, just curious, I haven't had any in over 2 and half years.

(4) I take Cozaar 50mg daily and atenolol (atenolol) 100mg daily in divided doses, 25mg 4 times daily, I find it more  effective in helping the palpitations that way, my internist agrees with this approach. I read an article recently, can't site the article right now of some negative studies regarding atenolol and treating high blood pressure, would this apply to its effect on palpitations also, Have you all seen the article or information on this information or study? Any opinions if so?

Thanks for your valuable time and service.

[CCF-M.D.-MJM]

Hello,

1. (1) Could you please quote if possible the success rate for PVC ablations at the CCF, also the complication rate for this procedure?


Dr. Natale quotes first procedure success rates of 80% and second procedure of 90%, if the first procedure fails.  Failure is defined as atrial fibrillation 6 weeks following the procedure.  We quote a <2% incidence of pulmonary stenosis and <1% incidence of stroke.

(2) At what stage is a PVC ablation recommended or does it depends symptoms associated with frequency?

It is variable.  Many people know they want it because they are so bothered by the symptoms from AF.  We are a biased population because many people seek us out because they already want the procedure and have heard the success rates.

Rate control is certainly a reasonable approach, but some people would rather not take the medications and are willing to take the small but real risks.

(3) Any new information on why one can go for months or years without any significant amount of PVC and then they flare up at the rate of thouasnds a day for weeks to months on end before subsiding. Could some autoimmune disorder or connective inflammatory disease be a trigger? I suffer from ankylosing spondylitis and this is the pattern with my PVCs flare up, just curious, I haven't had any in over 2 and half years.

No new data that I know of.  It certainly could be an inflammatory process in a subset of patients.  Otherwise, it is unclear why PACs and PVCs come in cycles.

(4) I take Cozaar 50mg daily and atenolol (atenolol) 100mg daily in divided doses, 25mg 4 times daily, I find it more effective in helping the palpitations that way, my internist agrees with this approach. I read an article recently, can't site the article right now of some negative studies regarding atenolol and treating high blood pressure, would this apply to its effect on palpitations also, Have you all seen the article or information on this information or study? Any opinions if so?

For PACs/PVCs, if it works, keep doing it.  Beta blockers significantly decrease the strength of contraction and thereby make them less noticeable.  It may also decrease the frequency.

The ALLHAT study showed the diuretics should be first line therapy for most patients with hypertension, but beta blockers were ok for second line. I am not sure what study you are referring to.

I hope this helps.

[Gem123]

I think the study you're talking about may be a Swedish study which was in the news last week, which found that although atenolol lowered blood pressure, it isn't effective at preventing arrhythmias as it doesn't cross the blood brain barrier - the particular arrhythmia mentioned in the article I saw was ventricular fibrillation, but it may (?) apply to others also.

[Momto3]

Hank,

Got the following summary from www.cardiosource.  Hope it helps.

Background: Atenolol is one of the most widely used â blockers clinically, and has often been used as a reference drug in randomised controlled trials of hypertension. However, questions have been raised about atenolol as the best reference drug for comparisons with other antihypertensives. Thus, our aim was to systematically review the effect of atenolol on cardiovascular morbidity and mortality in hypertensive patients.
Methods Reports were identified through searches of The Cochrane Library, MEDLINE, relevant textbooks, and by personal communication with established researchers in hypertension. Randomised controlled trials that assessed the effect of atenolol on cardiovascular morbidity or mortality in patients with primary hypertension were included.

Findings: We identified four studies that compared atenolol with placebo or no treatment, and five that compared atenolol with other antihypertensive drugs. Despite major differences in blood pressure lowering, there were no outcome differences between atenolol and placebo in the four studies, comprising 6825 patients, who were followed up for a mean of 46 years on all-cause mortality (relative risk 101 [95% CI 089–115]), cardiovascular mortality (099 [083–118]), or myocardial infarction (099 [083–119]). The risk of stroke, however, tended to be lower in the atenolol than in the placebo group (085 [072–101]). When atenolol was compared with other antihypertensives, there were no major differences in blood pressure lowering between the treatment arms. Our meta-analysis showed a significantly higher mortality (113 [102–125]) with atenolol treatment than with other active treatment, in the five studies comprising 17671 patients who were followed up for a mean of 46 years. Moreover, cardiovascular mortality also tended to be higher with atenolol treatment than with other antihypertensive treatment. Stroke was also more frequent with atenolol treatment.

Interpretation: Our results cast doubts on atenolol as a suitable drug for hypertensive patients. Moreover, they challenge the use of atenolol as a reference drug in outcome trials in hypertension.

[hankstar]

Thanks, that is same article I read, interesting to know what CCF thinks of it.

Other studies have shown it to be very effective in treating exercised induce PVCs and even RVOT (VT).

These studies leave patients confused in my opinion without real reliable data, as some other conflicting studies will pop up a few completely contridicting the previous studies.

Overall generally beta blockers (including atenolol) is the one line of drugs has shown to reduce the overall mortality rate in patients that have suffered a heart attack, has heart disease and even heart failure.

I have spoken with someone who knows a highly respected cardiologist concerning and apparently his opinion was to take it with a grain of salt, his opinion more studies needed to be done before reaching any conclusions.

Thanks again.

[hankstar]

I was speaking of ablation for premature ventricular contraction(PVCs), not PVI(pulmonary vein isolation) ablations as done for atrial fibrillation, unless the two ablations has the same success rates and complications, I am sorry if I confused you with PVI ablation and PVC ablation, it is easy to mistaken them as one of the same when written, sorry for not being more clear.

Regards andthanks for answering the questions.

[CCF-M.D.-MJM]

No, you clearly wrote PVC....I had just finished the PVI answer previous to your question.  I will talk to some other physicians about the risks and post again when I have the answer.

[hankstar]

  Thank you very much.

[dafan]

Hi Hank so good to see you back on the board.. been a long time since ive posted. As a pvc/pac sufferer I just want to say that mine have essentially dissappeared... Until this morning. My wife went in for a routine gall bladder surgery and I guess the stress got the best of me. This time tho I really think it was pac's, because there was hardly any pause and no hard beat just irregular. It went on for oh say about 45 minutes.It started subsiding when i took a Xanax and my anxiety went down. I know you arent a doc but does this sound like it is anxiety related to you? BTW had echo's holter and ekg and they all were normal when they started flaring up in Feb. thnx a million.ps I had HBP which was app.150/95 for 2 to 3 yrs before bringing it under control with diet and lost weight. And Have been extremely athletic for 30 yrs... Im 50 now.

[dafan]

One more quesiton Hank. Is stress considered a trigger for A-Fib? A couple of times this morning it felt like it could become that although the pac's ... or pvc's... never did occur simultaneously. thanks.

[hankstar]

Hi and thanks for the kinds words. My guess it is probably related to anxiety especially if they can be linked to a specific situation or trigger , such as anxiety over your wife's surgery. I myself had gallbladder back in 1993, conventional one , a 7 inch scar, nowadays it is usually done with just 4 little cuts, nevertheless the risks are still there.

PAcs and PVCs can feel exactly the same, sometime pvc feel milder, for example i had a few on stress and some i could hardly notice and others were very strong, yet they all appear to arise from the same focus and were pvcs. Interpolated PVCs don't cause a complete pause and can be mistaken for pacs, pacs can mimic pvcs also, sometimes with a full pause, the symptoms are basically the same and only a holter or ecg can confirm for certain which one it is. Whether PACs or PVCs, they in general are harmless if your heart is structurally normal and no coronary heart disease or congential abnormalities are present.

  Hope your wife surgery went well and you both continue to do just fine, if in doubt consult your doctor as only he/she can offer the best advice and guidance, also what other test maybe necessary if any at all.

Take care,
      Hank.

[hankstar]

From my understanding it common for stress and alcohol to be a common trigger of paroxysmal a-fib, sometimes freqent PVCs and PAcs are  indistinguishable from a-fib , just by pulse checking or symptoms, usually it takes an ecg tracing to confirm.

Also a-fib and PVCs can occur on the same ecg tracing, so it might be a combination, always check with your doc if in doubt.

Take care.

[dafan]

Thnx so much for your insight Hank. The surgery went fine. And the ectopics are gone... for now!ha...Ive been thinking of getting my PCP to give me a scrip of Inderal which he said he would do if they were worrisome. However the frequency has REALLY gone down since Feb. except for this episode and one other when we were landing in New Orleans. (Due to stress). Be talking with you later. Rocko.

[cuaco]

If anybody knows the answer to this question I would be interested and grateful to hear it.  I have just been reading a book by a cardiologist (not on a heart related topic) where he happens to mention that a pvc falling on a T wave causes cardiac arrest. He does not elaborate any further or place this statement in any context to the patient's existing health. I understood from this forum that pvcs in a healthy heart were harmless, is this still the case if they fall on T wave, whatever that is?

[hankstar]

Hi ,

What you are talking about is called a R on T PVC or R on T phenomenon, this occurs when the PVC occurs early in the cardiac cycle, The PVC occurs on the downstroke of the T wave sometimes triggering ventricular tachycardia or even V-fib.

Look back in the archives under Topic Area Arrhythmia Subject R on T phenomenon/PVCs as triggers for SVT (reply 12/13/03 by CCF-M.D. BKJ)

I asked this question almost a year ago look back in the archives and you will see the answer given by the doctor. In general it is benign phenomenon and no dangerous arrhythmia is triggered . I have since been made to undertand it is usually only dangerous in those that has just suffered a heart attack or have severe coronary heart disease.

Browse the archives and see the reply yourself, perhaps this will give you some reassurance, in general this is not something to be worried about with every day run of mil PVCs.

Take the doctors answers , not mine. I asked this question for the same concerns you probably have.

Take care.

[cuaco]

Thankyou for your response, I have been worried about this and feel much better now!