Ablation for PVC

[ab_gee]

I am 31 y/o and  I was diagnosed with MVP since 2001 but remained asymptomatic. Until april this year, I was hospitalized due to chest pain, palpitations and >30pvc/min. I was initially put on Flecainide 100mg bid which worked for me perfectly but the doctor switch my medication to magnesium when I got pregnant in May. Unfortunately, I had a miscarriage in July and my symptoms of chest pain, shortness of breath and palpitations are persistent so I was put on atenolol 25 mg once a day since I have a concurrent asthma too. My normal heart rate is 50-60 and bp 90/60 so this will further go down with atenolol which gives me dizziness.  I was in and out of the hospital so  my electrophysiologist decided then to put me again on flecainide but unlike before this time it didnt work, my pvcs increased and symptoms got worsed. With all these he suggested ablation of the arrhythmia since I also told him that we are planning to have a baby again.

Is ablation the best option for my age with these symptoms?
What is the success rate and chance of recurrence?
What future complications should I be aware of?

[Momto3]

Hi and welcome!!

When I was around 19, my GP said I had the heartbeat of "70 year old man."  He said it was fine, just beating differently.  I didn't pay too much attention, but always remembered the comment.  A few years later, at an early pregnancy checkup, my OB commented on my heart "sounds" and insisted on an EKG and cardio followup.  Although I don't really remember knowing about pvcs until my mid 20's, I definitely had lots of unexplained anxiety.  In hindsight, it was probably the palps!  From my mid-20's until late 30's, the Inderal generally worked well.  I had breakthroughs, but the doctor always reassured me that I was fine.  

In my early 40's, whammo!!  For the first time, I really couldn't get a handle on the pvcs.  By this time, I was very used to them and they didn't frighten me.  By this point, I was having thousands per day, but still not problematic UNTIL I developed "pvc-induced cardiomyopathy."  WHAT??  My doctor agreed that hormonal fluctations could be contributors to the fluctations.  Fast forward......

I had two very successful ablations in 2003.  It has been nearly 4 years since the second procedure, and I rarely notice pvcs now!  I do have occasional flips and runs of nsvt, but it dissipates quickly.  If I had to do it again...you bet!  This "stage" of life is tough enough : )

[Jslow]

I'm a 49 year grandma and loving it, but these pvcs along with tachyacardia are driving me crazy. I was diagnosed in my early 20's and meds worked pretty well until the early part of this year. I'm memopausal, so I've wondered if this has had something to do with me not responding to the meds. Anyway, I am a canidate for the ablation, but opted out when I was told that it could possibly not work. Question, when did you have the ablation and do you still "deem" it a success!

Jslow

[ab_gee]

Hi again. I went thru ablation this morning and i am still in the hospital. I was awake the whole time since the pvcs wouldnt come out and he induced the pvcs  with isoproterenol. I still feel dizzy and lightheaded, but the doctor said I can get up afetr 6 hours. He said that the procedure was successful and hopefully no more pvcs will come back. I will be discharge tomorrow. My doctor(electrophysiologist) referred me back to my cardiologist and said to follow-up with him.  The office of my cardio just called and told me that TEE or GEE will be scheduled for me at a later time. I am worried why I need to go thru another procedure, is it necessary?

What kind of procedure is this and why do I need it if he says that the procedure is successful?

[Momto3]

You're welcome.  I had two ablations for pvcs, the first was RVOT and the second was LVOT.  I had no complications and for each procedure, I was hospitalized overnight.  The EPS and RVOT ablation took about 7 hours.  When I arrived at the hospital, I was given an IV and just prior to being taken to the EP lab, I was given versed via the IV. I'm told it puts the patient in a "twilight" sleep, and also has an amnesiac effect. I have very little recollection of the procedure so I guess it worked really well : )

I remember getting the Versed and I also remember when the doctor was applying manual pressure to seal off the entry site (after the procedure).  As for the time in between, I'm told I followed the doctor's directions, but I don't remember any of it.  There were a few catheters, but only one point of entry. After the procedure, I had to lay flat for 6 hours with a 10# sandbag on the entry site (groin).  They did let me to sit up enough so I could eat and drink comfortably, but other than that, I was pretty much flat on my back.  

I had the ablation on a Friday and was back to work on Monday.  I wish I had waited a few days since I was pretty tired and a little sore (not a lot).  I took Tylenol for the discomfort, but other than that, I didn't need any medication.  

One thing that was really weird -- I had so many pvcs that, for me, they were "normal." It felt strange when I had a rhythmic heartbeat, but it didn't take long to get used to : )

Good luck with the procedure and with the baby plans!  Please keep us posted.  Feel free to ask any questions about the procedure, etc.  There are several people on the Forum who have had ablations and we will do our best to help you out.  

connie

[ab_gee]

Thank you. Your response helps a lot since I really need a second opinion because I am  scheduled for ablation and having second thoughts about it. Yes it is right ,my doctor told me that by the looks of my ekg that the pvcs are coming from right outflow tract of the right ventricle. My pvcs are bi and trigemeny and I would have palpitations and chest heaviness most of the time. My doctor explained a lot but its good to get second opinion and to hear from people who had really underwent the same procedure.
Thanks again.

[ab_gee]

Thanks for your response. I want to get pregnant and my family physician suggested ablation too since I am very symptomatic and I would end up taking the medicine for the rest of my life. That helps a lot, I will be opting to do that option.
How many days did it take for you to recover? How did it feel like after the procedure? Were you awake and did you feel anything during the ablation? Did you experience any complication?

[Michael J. McWilliams, M.D.]

These are all questions that I encourage you to discuss with our doctor.  Without knowing what type of PVCs they are, it is difficult to answer the question.  I am going to assume that you have the most common cause of frequent PVCs -- from the right ventricular outflow tract.

Is ablation the best option for my age with these symptoms?

If they are very symptomatic and not responding to medications or you are planning a pregnancy, ablation is a decent options -- assuming they are all coming from on location and you have a structurally normal heart.  If you are planning a pregnancy, I would probably make the same recommendation assuming the above.

What is the success rate and chance of recurrence?

The success rate for RVOT PVCs is over 90%. Without seeing your studies, I am not sure what to quote you for recurrence.  If they are all from the same location, one ablation should do it.

What future complications should I be aware of?

Most of complications that occur with this procedure happen at the time of procedure or within days.  The risk of death is usually less than 1%, there is risk of vascular injury, bleeding around the heart that could require drainage or rarely even open heart surgery, bleeding in or around the groin, rarely injury to the coronary arteries.

These are all rare events.  complication rates in good hands are low, the risk of procedures is never zero.

This is a relatively low risk procedure with a high success rate if the PVCs are from one focus.

I hope this helps.  thanks for posting.

[Momto3]

Hello.  

I have a bit of a different history, but wanted to let you know that, in 2003,I had two very successful ablations for frequent pvcs.  To date, I have not had a recurrence, except for "normal" pvcs.  Not sure about future complications, but the immediate complications from the procedure includes bleeding, needing a pacemaker and some other rare complications. Your doctor will be able to give you more information on the chance of any complication.

I ended up with an ablation because I acquired pvc-induced cardiomyopathy.  It was ablation or meds (rhythmol or some other antiarrythmic) for the rest of my life.  I tried the meds for awhile and ultimately, opted for the ablation(s).  Worked great for me...Be sure you go to someone who has a good track record for this type of procedure.  Good luck!