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Ablation vs Fleicanide
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Ablation vs Fleicanide

I am 33 years old and have dealt with PVC's for 5 years since my 1st pregnancy.  I have recently felt more fatigued, periods or lightheadedness, and intolerance of exercise, and I could feel my pvc's worsening.  Last week I had a holter monitor and it showed 40,000 plus PVC's in a 24 hr period.  The EP immediately prescribed felcainide and said if it didn't work, then we would go forth with the ablation.  After discussing this w/ several physicians, I have decided not to take the flecainide b/c I have read case studies and I feel the risks far outweigh the benefits, especially since it is not curative.  My quality of life with my family has been affected the last 5 years.  I have had every test to rule out defects and other causes.  The dr. knows it is coming from 1 area on my heart.  I am ready to take the risk to possibly get rid of this once and for all with an ablation.  I have not spoken to my Dr. as this just happened on Friday and it is Saturday.  Am I making a wrong decision?  Why would I risk the Fleicanide when I know it is not curative and only a mask?  My PVC's have gotten worse year to year, going from 1500 last year to 40000 this year.  I am at my wits end.  
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8 Comments Post a Comment
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612551_tn?1247839157
At your young age Ablation seems the best choice.. but I say that not knowing what the odds of success are.  You say only one area, so that should mean good odds.  Ask you specialist what the odds of a cure verses problems are.  I think in most cases the odds are the best decision driver and are usually in favor of having an Ablation.

Let us know what you decide, and how it works out.  We all benefit from the experience of others.

For me I wanted to do an Ablation to cure my atrial fibrillation, even at my advanced age.  As my symptoms are mild and Ablation for AFib is among the most risky/difficult we decided not go with the ablation - I have also rejected Flecainide.
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995271_tn?1312416925
40,000 a day should be addressed.

Having other information may help in your decision.  For instance

You know they're unifocal and this favors ablation.

What is the source of the PVCs?  I'm guessing probably RVOT, but it could be anywhere. Certain sites are easier to ablate than others.  Rarely certain focii are risky to ablate.

At what point are they occurring in the cycle?  this means, are they early, middle or late PVCs.  Also known as R o T phenomenon, post T-wave, or fused beats respectively.  These categories can help fire up a discussion with the doctor as to which is most ablatable.  This will also help corroborate other test results.

I don't think Flec is a good long term option.  My reasoning is that in people with structurally normal hearts it can create malignant arrhythmias where none existed before.  The risk of not treating benign PVCs is lower than the risk of taking Flec, although @ 40,000 per day one could make the argument that the PVCs are no longer benign.  the threshold when PVCs start to get attention is about 6,000 to 10,0000 per day.  Some docs go by >10% of your total daily beats, some go by >20% of your total beats.

Good luck, let us know how you make out.
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1217309_tn?1267053777
Hi! I would go for the abaltion personally...but that is my opinion only. I have been put on a beta blocker and it has reduced mine from 20,000+ to 1000-2000. I realize that I am lucky for now. My EP suggested if the BB doesn't work or quits working, he will try to bring out the "the big guns" and I am assuming that means anti-arrythimics....which scares the crap outta me! I agree that the risk is too great with these. If you look up frequent PVCs or abaltion for PVCs in the forum archives you can read some of the others experiences and maybe that will help give you some insight from those who have been through it. Also talk with Lisa...she is one of my friends on my profile.....she has been through the PVCs and a couple abaltions...she was very comforting for me! And please let me know what happens...as this may be in my future too! Good Luck!
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Avatar_m_tn
I would jump at the chance of an ablation. I have been on 300mgs of Flecainide a day for fifteen years and Beta-Blockers even longer.  I have been seen by countless EP`s and cardios know one will consider surgery. If you have the chance to live without taking meds or needing implantable devices go for it.
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1244042_tn?1269984089
So frustrated!!!!  Back to square one.  I talked to my EP today, and he said I am not a good candidate for ablation at this point b/c the PVC's originate from the bottom part of my Left Ventricle.  He said it is a very risky ablation, w/ higher risk for cardiac effusion and stroke.  He suggested I try the fleicanide, but I am just terrified.  He doesn't feel I am more at risk to not take it, but my symptoms of feeling the pvc's, the anxiety it causes, lightheadedness, and intolerace of exercise make me and him think I should take it.  So it's more of a wait and see.  I have cried and felt so helpless tonight and trying to pick myself off of the floor.  I am so thankful for these forums.  I am going to get a second opinion just for piece of mind, although my EP is fabulous.  So now, my own journey will begin to decrese my pvc's from 40,000/day to much much less...on my own....I will try.  Any suggestions on how to do this...please...I will try massage, back to beta blocker (atenolol), biofeedback, moderate exercise, relaxation, chamomile tea, and whatever else seems practical.  At a low tonight.
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Avatar_m_tn
I have just had an ablation at Barts whcih has the highest success rate in the country.It didn't work first time but my second has been successful. It's really not that bad and a lot better than the suffering caused by your condition. I wouldn't hesitate!
caroline
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503607_tn?1275675179
Have you tried other beta blockers?  I tried a few before  I started Atenolol.  I was having pvc's ever moment of the day and now I am getting none and I only take 25 mg.

I was not able to have my pvc's ablated either when I had my svt ablated 2 months ago.

Good Luck!
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996946_tn?1385991151
I have a history of taking flecainide. My Dr.s always told me as long as I 'DIDN'T" have a structurally abnormal heart , it was safe to take. I just wanted to clarify that with you.  Is that what you meant to say?
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