1st EP Visit--Update

Well, I went to my very first EP visit ever. He was very nice, but immediately sat down and said, I'm trying to figure out why are you having all these tests. You have pvcs. ?!!!.  

First of all, I've only had two holter monitors in my 25 years of having them, the monitors were 12 years apart, one stress/echo two years ago and another echo last week because I've had 20,000+pvc/day for the last two years.

Didn't phase him. Pvcs are benign. I should just accept it. I am fine.

Yes I know they are benign, but I'm having increases, couplets, triplets, strings, it's now well over 20,000+/day. "Doesn't matter, pvcs are benign. Unless they cause VT, pvcs no matter the pattern, no matter the number are benign".

You know what the joke is? I didn't have a single pvc on their ECG at the office. He only heard two when he listened with steth. I wasn't sure whether to celebrate or cry. I'm almost constantly in bigeminy or trigeminy, or couplets. All day. So what gives. He recommended a stress test with imaging to make sure my heart was getting enough oxygen. I said I didn't get short of breath or have chest pains and that when I exercise on a treadmill the pvcs stop above 125bpm, he smiles, "I know" he says, "pvcs are benign". So I said no to the stress test. He smiles "I think you'll be fine".

He did say that anti-arrythmic drugs are absolutely not indicated for people with pvcs because they will increase the rate of mortality, they are pro-arrythmic in this population causing more serious rhytm issues. So I learned one thing, I won't take an anti-arrythmic.

He said that unless the pvcs were causing VT, then ablation isn't suggested because PVCs are BENIGN and ablation is invasive with higher risk than pvcs.

Because he couldn't record or verify my high frequency pvcs he suggested a 30 day event monitor. Why? To see if the pvcs were causing VT. I know they are not. Even with my most recent and highest string of 62pvcs, my heart rate was below 100bpm.  He suggested sectral because I've had such profound fatigue reactions to the other beta-blockers. This I accepted. Some people on this forum have said it helped.

Without any meds, this morning my heart was wonderful to listen too. No pvcs. As I write, ugghh, lots of them. But I'M FINE!!!! lol pvcs are benign.

Can anyone share information on their reaction with sectral?

[steph4501]

Sounds like a great appt!!  Sounds also without a doubt this electropjhysiologist was very comfortable with say, "These are benign."  And of course I know that was comforting to hear and for us on this board as well.  *grin*..  Great appt!  I hope the Sectral helps you and lessens the frequency of the pvc's..

Just a minute ago I came home and as soon as I stood up to get out of the van, but heart went immediately into bigimeny.  Skip, skip, beat, skip,skip beat and this lasted a good 10 minutes!  I was starting to get scared, but then I took a few deep breaths and came on here.

When you say your highest "string" was 62 pvc's --  Is that 62 pvc's in one minute??

I haven't really counted, but I think on average I must get 15-20 per minute on my bad days.  On my good days I think I get about 7-10 a minute.  ugh...

Anyway, thanks for the uplifting post.  helps to hear all these positives from the Dr's, but it still stinks going through al this...

Hugs!

Steph

[upbeat633]

It was a bit comical, given my history, not to have any pvcs recorded in office. He was very nice, but I also knew what he was thinking--benign, why doesn't she get it?

My string was 62 pvcs one right after the other, then a normal beat or two, then another long string, a normal beat or two, I got tired of counting. But my heart rate was low, and I didn't feel anything but anxious over it.

I did get some good information out of the visit though. No matter the pattern, no matter the frequency, still benign unless it causes VT.

But it seems unfair to live in a house that is "structurally fine" and have someone turn the lights on and off 15-20 times a minute. It's just that I am (we are) the only people who see the lights going on and off. Everyone else thinks, oh what a lovely home.

[steph4501]

That is a good way to put it!  With the lights in the house going on and off every 15-20 or so times EVERY minute!  Hmmm..  Gave me an idea.  My husband gets tired of me worrying about this, but he doesn't understand.  So tonight I will turn the light on an off every time I get these and he will see JUST WHAT I MEAN!  hahaha...   On the outside we seem fine, but on the inside we sure are feeling it.  

It's frustrating!  But all our Dr's have told us we will be fine and these are benign.  I don't think I have heard one bad comment about these pvc's being "dangerous," other than them being annoying and scary at times.

So when you get 62 strings, they are back to back, like:

Skip, skip, skip, skip, skip, beat, skip,skip, skip and on and on??

I have gotten 3 in a row with no normal beat in between, then a HARD thump.  Those are yucky!

take care!!

[cuttersma]

What s the difference between PVC's and VT.

[artskip]

The thing is, after some period of time all of us, eventually get it, that  PVC's are benign. I know that there not going to kill me. They affect the way I live, the've taken a part of my soul, my freedom. Maybe it's because Dr's can't do anything for us. My Ep doesn't  think I should get an ablation, he said there are risks to the procedure and an 80% chance it will help. He didn't think they would get worse after an ablation but he couldn't be sure of that.
Yeah, PVC's are benign to the heart, but what do they do to your soul.

[Me_Just_Me]

I too suffer from PVC's and PAC's - so many that I can actually tell the difference when they occur.  I have a wonder EP that completely understands I want a quality and a quantity of life.  I won't settle for "they're benign" I want them to stop.  I've tried all kinds for meds - beta blockers, calcium channel blockers and anti-arrythmic.  The arrythmic meds (flecainide) worked wonders for me.   The weekly, then monthly, ekg's were a bit of a pain.  

[Me_Just_Me]

Also, I forgot to mention that my EP stated that PVC's and such can be ablated if they're focal - unfortunately my aren't.  I did have an ablation for Atrial Fib but that was 10 years ago and I've alway wondered if the issues I have now were brought on by the ablation.

[Momto3]

Great news from the EP.  I know EXACTLY how you feel.  It's definitely bittersweet.  When I was having those high numbers of PVCs, my EP said the same thing.  Benign.  I know, but........Benign.  I LOVE the correlation of the lights going on and off, it's brilliant!!

You know my history...I still think it's a good idea to have a periodic echo given the slight risk of CM when the PVCs are so frequent.  I still think it's best to check things out when we notice a significant change in frequency and/or patterns.  Had I not gone for a routine check on my valve, I would not have known about the CM.  For me, the echo was a blessing.  

I agree on not taking the anti-arrythmic.  You have accepted and learned to live with PVCs and know they will not hurt you, so why add an unnecessary medication to the mix?  At one point, my EP was going to try Sectral, but I can't remember why we never did.  That could have been when the CM showed up and she decided on flecainide..not sure.  I see a notation on my paperwork that mentions Sectral, but I didn't take it.  Hope it works well for you!!

Have a fabulous Easter!

connie

[Momto3]

PVC's are premature ventricular contractions.  They are extra beats originating in the ventricles.  They can occur as an isolated extra beat, two in a row (couplet), three or more in a row (run) and tend to feel like "skips" as opposed to extra beats.  They can occur every other beat (bigeminy), every third beat (trigeminy) or every fourth beat (quadrigeminy) or in pretty much any pattern.

VT is ventricular tachycardia is when the heart beats rapidly, over 100 bpm.  Sustained VT is when this occurs for at least 30 seconds.  Non-sustained VT is less than 30 seconds.

[SillyHeart]

Wouldn't 62 back to back PVCs in a row be considered non sustained VT?  Or no?

[Momto3]

Actually, I think if we had 62 PVCs with no regular beats in between, it could be sustained VT (more than 30 seconds).  

Upbeat, why isn't that considered SVT?

[upbeat633]

I think that the rate has to be above 100 bpm doesn't it?

Even with the 62 beats in a row, when I counted my pulse per minute it was 80 to 90. Very, very regular and relatively slow, even with the pvcs.

And of course I did get one or two normal beats, a string of 10pvcs, one or two regular beats, a string of 40pvcs, one or two regular beats, another string, and on and on. The longest was 62 in a row before I got tired of listening and counting. I didn't feel like my heart was beating fast, and I really didn't feel any symptoms other than being anxious that I had such an increase in pvcs.

I tried to research this, and came up with something called accelerated idiopathic ventricular rythm. I don't know if its correct or not, but it seemed to described what I was experiencing.

I'm not really sure though. The EP wouldn't comment because it wasn't recorded on anything that he could look at. This has never happened to me before and hasn't happened since. As a matter of fact, I seem to have a few minutes without pvcs at all since the EP visit. This is new for me too.

I was back into couplets and triplets this morning so I tried 100mg of sectral. (divided the powder in the capsule). It's not recommended, but I'm so sensitive to BB I didn't want to get that profound fatigue feeling again. It may be coincidence, but I'm getting several minutes of no pvcs again. I'll take sectral for another couple of days and see if it gives the same result.

If anyone can comment on whether it was SVT or not, I'd appreciate it.

[Momto3]

I've heard of that Idiopathic ventricular rhythm, but I'm not familiar with it.  

I know when I get more than 3 PVCs in a row, it feels really weird.  I've probably had as many as 8-10, but nothing more without a regular beat in between.

I'm not sure about the 100 bpm either....I'll try and remember to ask my regular cardio next month.  He's not my EP, but he's really nice and great about answering questions.  Now, I've just got to remember to ask the question : )

Have a great weekend.

Take care
connie