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Are Premature Ventricular Contractions are chronic condition?
I am a 24 yo male. I was diagnosed with PVC in August of 2010. They appeared after a bad flue, which lasted a week. The infection went away, but the PVCs remained. Some days I don't feel any and some day After running basic tests: ECG, Stress Test, Holter, and Echo, I was told that my heart is healthy. I did have 230 PVC in a 48 hour period, which my cardio told me was above average (he said average for a person my age is about 15-30 PVC per day). He told me that my PVC were likely caused by an imbalance in the Autonomic Nervous System, and he said that sometimes viral or bacterial infections can be neroutoxic and serve as a trigger arrythmias. I asked him if he thought that PVCs were a chronic condition and would stay with me for the rest of my life. His answer was that there's no way to tell, but that they can go away or substantially subside over time.
I've been reading posts on this forum for a while and the general tendency with most PVC sufferers here seems to be that the ectopics tend to come in cycles, but overall do increase as the person ages. I don't recall reading about anyone who used to experienced PVCs for some time, to have them completely disappear later on in life. So it seems to me that PVC are a chronic, progressive condition of neurocardiological origin. It also seems plausible to me that in a subset of PVC sufferers (a group to which I might belong myself), the ectopics are caused by mild, but chronic, form of localized myocarditis. The infection probably effects a small area of the myocardum, thus being undetectable by a standard blood test, echo or an ecg. The localized myocarditis theory, would in my opinion explain the cyclical nature ectopic activity, as some people can experience frequent PVCs for as long as several years, to have them suddenly vanish, for months or even years, only to reaper with a vengeance at a later time. So far, I have not encountered a SINGLE theory explaining the cyclical nature of PVCs. Chronic myocardal infection, which only effects a small portion of the heart or cardial branch of the sympathetic nerveous system, which can flare up and subside at seemingly random times, can explain this pattern. The tendency to flare up and subside, is highly typical in other chronic infectious diseases.
I recently came across an Italian study, which examined the prognostic significance of frequent monomorphic ventricular contractions. The study is titled "Long-term follow-up of right ventricular monomorphic extrasystoles" and was published in 2001. Full version can be found online and is free. I advice every PVC suffer to read it.
Basically, the study monitored 61 patients, of various ages, who had idiopathic right ventricular monomorphic ectopic beats for an average of 15 years. All patients had more than 1000 PVC per day and the mean number of PVC/hour in the group was 526, at the time of the first exam. Each surviving patient was followed up in the duration of the next 12-20 years. During the follow up PVCs were absent (defined as less then 100 PVC a day) during the Holter monitoring in 51% of all patients. Futhermore, only 32 % percent of all patients remained symptomatic (compared to 90% being symptomatic at the first test). The rest of the patients who still had PVC, no longer expirienced palpitations; their ectopics became completely asymptomatic. Furthermore, the mean PVC burden of the group decreased to 68 PVC/hour (an 87% reduction). In fact, all surviving patients, with one exception, experienced significantly less PVCs during the follow up. Many went from having several thousands of PVCs per day to zero. However, many of these patients had minor abnormalities in their ventricles, which probably served as an anatomical substrate for their arrythmias. Nevertheless, some patients had severe abnormalities, but had zero PVCs during their follow-up Holter.
So my questions to visitors of this forum and M.D.s monitoring the discussion:
1) Are there any people here who used to have PVC's, only to have them permanently disappear or become completely asymptomatic?
2) Can PVC's be considered a chronic condition or is there hope that they will one day vanish, never to appear again?
Looking forward to discussing the results of this study and any personal experiences members of this forum wish to share with me!
I've been reading posts on this forum for a while and the general tendency with most PVC sufferers here seems to be that the ectopics tend to come in cycles, but overall do increase as the person ages. I don't recall reading about anyone who used to experienced PVCs for some time, to have them completely disappear later on in life. So it seems to me that PVC are a chronic, progressive condition of neurocardiological origin. It also seems plausible to me that in a subset of PVC sufferers (a group to which I might belong myself), the ectopics are caused by mild, but chronic, form of localized myocarditis. The infection probably effects a small area of the myocardum, thus being undetectable by a standard blood test, echo or an ecg. The localized myocarditis theory, would in my opinion explain the cyclical nature ectopic activity, as some people can experience frequent PVCs for as long as several years, to have them suddenly vanish, for months or even years, only to reaper with a vengeance at a later time. So far, I have not encountered a SINGLE theory explaining the cyclical nature of PVCs. Chronic myocardal infection, which only effects a small portion of the heart or cardial branch of the sympathetic nerveous system, which can flare up and subside at seemingly random times, can explain this pattern. The tendency to flare up and subside, is highly typical in other chronic infectious diseases.
I recently came across an Italian study, which examined the prognostic significance of frequent monomorphic ventricular contractions. The study is titled "Long-term follow-up of right ventricular monomorphic extrasystoles" and was published in 2001. Full version can be found online and is free. I advice every PVC suffer to read it.
Basically, the study monitored 61 patients, of various ages, who had idiopathic right ventricular monomorphic ectopic beats for an average of 15 years. All patients had more than 1000 PVC per day and the mean number of PVC/hour in the group was 526, at the time of the first exam. Each surviving patient was followed up in the duration of the next 12-20 years. During the follow up PVCs were absent (defined as less then 100 PVC a day) during the Holter monitoring in 51% of all patients. Futhermore, only 32 % percent of all patients remained symptomatic (compared to 90% being symptomatic at the first test). The rest of the patients who still had PVC, no longer expirienced palpitations; their ectopics became completely asymptomatic. Furthermore, the mean PVC burden of the group decreased to 68 PVC/hour (an 87% reduction). In fact, all surviving patients, with one exception, experienced significantly less PVCs during the follow up. Many went from having several thousands of PVCs per day to zero. However, many of these patients had minor abnormalities in their ventricles, which probably served as an anatomical substrate for their arrythmias. Nevertheless, some patients had severe abnormalities, but had zero PVCs during their follow-up Holter.
So my questions to visitors of this forum and M.D.s monitoring the discussion:
1) Are there any people here who used to have PVC's, only to have them permanently disappear or become completely asymptomatic?
2) Can PVC's be considered a chronic condition or is there hope that they will one day vanish, never to appear again?
Looking forward to discussing the results of this study and any personal experiences members of this forum wish to share with me!
From what I can recall, the first experience I had with PVCs only lasted a few days. The second experience was about the same. This time they are hanging around. I wish that they would resolve themselves like the previous two times.
Frankly I am really frustrated with them. They are taking over my life and my moods. I actually think about everything I do now and whether it will cause PVCs. It's pathetic.
Frankly I am really frustrated with them. They are taking over my life and my moods. I actually think about everything I do now and whether it will cause PVCs. It's pathetic.
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Hi, I know you posted here a long time ago regarding PVCs but I was wondering if you still continued having them or are they something that eventually subsided over time ?
I took my blood pressure when my heart was pounding, and it was normal. So much for that idea. But I'll keep trying to figure out what this pounding heart thing is. You may be right about it being an adrenaline issue. I sometimes feel kind of shaky and weak...could be anxiety or adrenaline.
I have never read National Dysautonomia Research Foundation's site. But, I definitely will whenever I have some free time!
Our knowledge of the Autonomic Nervous System is comparable to our knowledge of the universe, meager and largely theoretical. The interaction between ANS and the heart is sophisticated and we do not posses medical equipment sensitive enough to study it in greater detail. Neurocardiology is still in its infancy, and our understanding arrhythmias is far from complete.
It is important to remember that scientists were able to induce arrhythmia's in several animal models just by electrically stimulating their cardiac nerves. It is also common for somebody who suffered a severe blunt force trauma of the back of the head (the location of ANS), to die from ventricular arrhythmia.
In regards to Dysautonomia, I believe that a vast majority of arrhythmia sufferers do in fact have a very mild form of this condition. In the mighty and glorious Soviet medicine they used to have a condition called Autonomic-Circulatory Dystonia (ACD). This condition was described as a dysfunction and dysregulation of the ANS, causing a wide variety of symptoms, ranging from generalized anxiety to migraine headaches. In fact, ACD was a common diagnosis given to people suffering from anxiety, panic attacks, sudden and unexplained blood pressure spikes, ectopic arrhythmias, orthostatic hypotension and a wide variety of other symptoms which were believed to be caused by dysfunction of the Autonomic Nervous System. If a patient would be hospitalized, complaining of tachycardia or palpitations, and no cardiological causes of his/her symptoms would be identified, a diagnosis of ACD would surely be made and the patient would be referred to a neurologist, not a cardiologist!
I think that most of us here do suffer from ACD, a primarily neurological condition, which however has a dramatic effect on the functioning of our cardiovascular systems. Dysautonomia, in my humble opinion, is a VERY severe form of ACD.
Our knowledge of the Autonomic Nervous System is comparable to our knowledge of the universe, meager and largely theoretical. The interaction between ANS and the heart is sophisticated and we do not posses medical equipment sensitive enough to study it in greater detail. Neurocardiology is still in its infancy, and our understanding arrhythmias is far from complete.
It is important to remember that scientists were able to induce arrhythmia's in several animal models just by electrically stimulating their cardiac nerves. It is also common for somebody who suffered a severe blunt force trauma of the back of the head (the location of ANS), to die from ventricular arrhythmia.
In regards to Dysautonomia, I believe that a vast majority of arrhythmia sufferers do in fact have a very mild form of this condition. In the mighty and glorious Soviet medicine they used to have a condition called Autonomic-Circulatory Dystonia (ACD). This condition was described as a dysfunction and dysregulation of the ANS, causing a wide variety of symptoms, ranging from generalized anxiety to migraine headaches. In fact, ACD was a common diagnosis given to people suffering from anxiety, panic attacks, sudden and unexplained blood pressure spikes, ectopic arrhythmias, orthostatic hypotension and a wide variety of other symptoms which were believed to be caused by dysfunction of the Autonomic Nervous System. If a patient would be hospitalized, complaining of tachycardia or palpitations, and no cardiological causes of his/her symptoms would be identified, a diagnosis of ACD would surely be made and the patient would be referred to a neurologist, not a cardiologist!
I think that most of us here do suffer from ACD, a primarily neurological condition, which however has a dramatic effect on the functioning of our cardiovascular systems. Dysautonomia, in my humble opinion, is a VERY severe form of ACD.
if you haven't you should read on the National Dysautonomia Research Foundation's site... much of what you've put is what Dr. Blair Grubb's research and team have said also...the ANS is a much misunderstood system even by drs.
I've only found 1 dr who really understands what we dysautonomia patients go through. I'm 3/3 so I struck out lol wait or am I 4/3 since I'm the 1 in 10million or whatever the stats are with malignant arrhythmia's...and if my EP was right I've had this all my life. I've been trying to understand this for the past 2 years; learning as i go and making sure I keep a notebook of all my q&a and info my dr's give me.
thanks for the links and info; I can't wait to read it and see what new info I can garner
I've only found 1 dr who really understands what we dysautonomia patients go through. I'm 3/3 so I struck out lol wait or am I 4/3 since I'm the 1 in 10million or whatever the stats are with malignant arrhythmia's...and if my EP was right I've had this all my life. I've been trying to understand this for the past 2 years; learning as i go and making sure I keep a notebook of all my q&a and info my dr's give me.
thanks for the links and info; I can't wait to read it and see what new info I can garner
Darn, I was hoping you were a doctor or something. I figured you must know something about the subject, since you used all the technical lingo.
I hope you are right about the PVCs subsiding over time. I would hate to continue to live with these forever.
I hope you are right about the PVCs subsiding over time. I would hate to continue to live with these forever.
I am not a scientist or a doctor. I assemble stages for concerts and sporting events. I also do some carpentry, mostly decks and fences.
My elaborate PVC theories were conceived by my overactive imagination, after I read several scientific articles on Ventricular Arrhythmias. Therefore, they should be taken with a grain of salt. LOL.
My elaborate PVC theories were conceived by my overactive imagination, after I read several scientific articles on Ventricular Arrhythmias. Therefore, they should be taken with a grain of salt. LOL.
Based on my knowledge, (which is limited to say the least), three 'basic ingredients' must be present for an arrhythmia to exist:
1) Anatomical substrate (ectopic focus, extra pathway, re-entry circuit, etc)
2) Dysfunction of the of the ANS (Overactive sympathetic drive, strong parasympathetic dominance, uneven distribution of catecholamines across the myocardium, etc)
3) Environmental Trigger (stress, caffeine, alcohol, heat, dehydration, etc)
In my opinion, the ANS is by far the biggest contributor to the genesis of ectopic arrythmias. That is why ablation is not very effective at eliminating PVCs, it does not address the underlying cause. You can burn several ectopic foci, but new ones will likely appear in the future, as overactive ANS will continue irritating the heart. Furthermore, the ablation procedure can adversely affect the patient, as catheters can damage the cardiac nervous fibers, leading to an increased ectopic burden and post-ablation tachycardia.
The solution to the problem lies in restoring the proper function of the ANS. In people with catecholamines-induced arrythmias, selective cardiac denervation can be attempted, in order to increase the threshold of arrhythmia. By selectively removing the sympathetic nervous fibers with neurotoxic agents, we can reduce the the release of arrhythmogenic neurotransmitters to the myocardium.
I think there's a study of the procedure conducted by University of California: "Cardiac Denervation Surgery for Prevention of Ventricular Tachycardia (PREVENT VT)"
http://clinicaltrials.gov/ct2/show/NCT01013714
Source: "Left Cardiac Sympathetic Denervation for Catecholaminergic Polymorphic Ventricular Tachycardia (N Engl J Med 2008; 358:2024-2029May 8, 2008)"
There's also a new anti-arrhythmic agent being developed in China, called Sulcardine Sulfate, (I think it is in Phase III of clinical trials). Supposedly, it is as effective as Flecainide in suppressing PVCs, but has a safety profile comparable to a better blocker. Only time and more trials will tell if its true.
All the best!
RVVq
1) Anatomical substrate (ectopic focus, extra pathway, re-entry circuit, etc)
2) Dysfunction of the of the ANS (Overactive sympathetic drive, strong parasympathetic dominance, uneven distribution of catecholamines across the myocardium, etc)
3) Environmental Trigger (stress, caffeine, alcohol, heat, dehydration, etc)
In my opinion, the ANS is by far the biggest contributor to the genesis of ectopic arrythmias. That is why ablation is not very effective at eliminating PVCs, it does not address the underlying cause. You can burn several ectopic foci, but new ones will likely appear in the future, as overactive ANS will continue irritating the heart. Furthermore, the ablation procedure can adversely affect the patient, as catheters can damage the cardiac nervous fibers, leading to an increased ectopic burden and post-ablation tachycardia.
The solution to the problem lies in restoring the proper function of the ANS. In people with catecholamines-induced arrythmias, selective cardiac denervation can be attempted, in order to increase the threshold of arrhythmia. By selectively removing the sympathetic nervous fibers with neurotoxic agents, we can reduce the the release of arrhythmogenic neurotransmitters to the myocardium.
I think there's a study of the procedure conducted by University of California: "Cardiac Denervation Surgery for Prevention of Ventricular Tachycardia (PREVENT VT)"
http://clinicaltrials.gov/ct2/show/NCT01013714
Source: "Left Cardiac Sympathetic Denervation for Catecholaminergic Polymorphic Ventricular Tachycardia (N Engl J Med 2008; 358:2024-2029May 8, 2008)"
There's also a new anti-arrhythmic agent being developed in China, called Sulcardine Sulfate, (I think it is in Phase III of clinical trials). Supposedly, it is as effective as Flecainide in suppressing PVCs, but has a safety profile comparable to a better blocker. Only time and more trials will tell if its true.
All the best!
RVVq
Thanks for the analysis, I hope you are correct.
By the way, are you a dr or a scientist? That was the most detailed description of PVCs I have seen.
Where did you learn this? I'm sure you didn't pull that out of the air, LOL.
By the way, are you a dr or a scientist? That was the most detailed description of PVCs I have seen.
Where did you learn this? I'm sure you didn't pull that out of the air, LOL.
I think the ANS has alot to do with arrhythmia's also. I've gone through quite a few EP's who think so also and have said mine are directly related to my ANS failure.
The only thing that's worked for me is Inderal; which I just switched to the extended release and it's working like a charm for my daily episodes. I think Is_something_wrong explained why but for the life of me I can't remember - maybe he'll add to this...
The only thing that's worked for me is Inderal; which I just switched to the extended release and it's working like a charm for my daily episodes. I think Is_something_wrong explained why but for the life of me I can't remember - maybe he'll add to this...
How long did your outbreaks last? Where you completely PVC free between the outbreaks?
Here's my theory of the etiology of your arrhythmia:
I think that in your case, the PVC's are triggered by the activation of your parasympathetic nervous system. Your ventricular ectopic foci are sensitive to rapid release of acetylcholine, which occurs after a physical exertion and after sunset, following the circadian rhythm. Beta-blockers would probably make your PVCs worse. Trying to keep your heart rate more or less even through out the day might lessen your ectopic burden. It helps me keep my PVCs at bay!
The fact that your PVC first occurred when you were 17, points to a fact that there is a hormonal connection. Late teens, and early twenties are a time of male testosterone peak. Rapid change in hormonal levels when you were 17 caused an imbalance in your Autonomic Nervous System, which temporarily activated the ectopic foci in your ventricle(s).
Around 32, you probably were undergoing another hormonal transformation, possibly stabilization of your testosterone levels, which caused your PVCs to flare up again.
Most likely, the same forces are at play now, causing you to experience another outbreak of PVCs. Most likely, your PVCs will subside after some time, hopefully to never bother you for the rest of your life!
Good luck!
Here's my theory of the etiology of your arrhythmia:
I think that in your case, the PVC's are triggered by the activation of your parasympathetic nervous system. Your ventricular ectopic foci are sensitive to rapid release of acetylcholine, which occurs after a physical exertion and after sunset, following the circadian rhythm. Beta-blockers would probably make your PVCs worse. Trying to keep your heart rate more or less even through out the day might lessen your ectopic burden. It helps me keep my PVCs at bay!
The fact that your PVC first occurred when you were 17, points to a fact that there is a hormonal connection. Late teens, and early twenties are a time of male testosterone peak. Rapid change in hormonal levels when you were 17 caused an imbalance in your Autonomic Nervous System, which temporarily activated the ectopic foci in your ventricle(s).
Around 32, you probably were undergoing another hormonal transformation, possibly stabilization of your testosterone levels, which caused your PVCs to flare up again.
Most likely, the same forces are at play now, causing you to experience another outbreak of PVCs. Most likely, your PVCs will subside after some time, hopefully to never bother you for the rest of your life!
Good luck!
The first 2 outbreaks (when I was 17 and 32) came out of nowhere. This last outbreak (at age 41) started after I was on a treadmill for an extended period. Now, if I exert myself through intense physical exercise or sex, I notice an increase in PVCs soon afterwards.
I've also noticed that most of my PVCs come in the evening, as I am trying to relax. The days aren't too bad, but the nights can be bothersome, especially if I did something physically demanding. I'm hopeful that this episode will soon pass (please God!).
I've also noticed that most of my PVCs come in the evening, as I am trying to relax. The days aren't too bad, but the nights can be bothersome, especially if I did something physically demanding. I'm hopeful that this episode will soon pass (please God!).
So your PVC episodes only lasted for several months and then were gone for many, many years?
Did you notice what triggered your PVC outbreaks?
I hope my PVC would take a vacation for a decade or so....
Did you notice what triggered your PVC outbreaks?
I hope my PVC would take a vacation for a decade or so....
I had the same sensation of a strong heart beat you are describing. I talked about it with my doctor and he said that it could be either excess adrenaline or elevated blood pressure. Try measuring your blood pressure when you have this sensation of pounding heart.
Good luck!
Good luck!
I started having PVCs two years ago. A 48-hour Holter monitor showed that I was having about 8500 PVCs a day. My cardiologist said I didn't need a beta blocker because it would slow my heart rate, and the slower my pulse was, the more PVCs I had. For the last year, I've had very few PVCs. Most days I have none. And that's wonderful.
But something is different. Each day, I now have episodes of a very strong heartbeat. Very regular (no PVCs), but strong. I I feel them when I'm more active and also when I first wake up in the morning. I have no idea why I have this. I can check the number of beats per minute without having to feel my wrist or neck when this happens, and it's annoying. I can also hear the heart pounding in my right ear. (Had an MRI with contrast dye of my head for that and it checked out okay.) But I don't have the pounding heart all the time. I have no idea whether I need to see my doctor about this or not. And I can't seem to figure out what might be causing this.
I also know that many people have their PVCs come back. Keeping my fingers crossed that mine won't and that the pounding heart episodes aren't anything serious and will diminish too.
Anyone else have this?
But something is different. Each day, I now have episodes of a very strong heartbeat. Very regular (no PVCs), but strong. I I feel them when I'm more active and also when I first wake up in the morning. I have no idea why I have this. I can check the number of beats per minute without having to feel my wrist or neck when this happens, and it's annoying. I can also hear the heart pounding in my right ear. (Had an MRI with contrast dye of my head for that and it checked out okay.) But I don't have the pounding heart all the time. I have no idea whether I need to see my doctor about this or not. And I can't seem to figure out what might be causing this.
I also know that many people have their PVCs come back. Keeping my fingers crossed that mine won't and that the pounding heart episodes aren't anything serious and will diminish too.
Anyone else have this?
[wishes I had an edit button lol] now I have about 10k pvc's/vt runs and 2500 pac's psvt episodes
After my ablation I had to have a pacemaker/icd implant due to complications during the procedure.
After my ablation I had to have a pacemaker/icd implant due to complications during the procedure.
I've had arrhythmia's of some sort since I was age 9; along with fainting episodes....which progressively worsened over 30ish years to over 50,000 pvc's/vt runs daily.
I had an RF ablation got rid of them for a few days but developed pac's and psvt daily; then my pvc's and VT returned and progressively worsened again in the past 2 years.
I had an RF ablation got rid of them for a few days but developed pac's and psvt daily; then my pvc's and VT returned and progressively worsened again in the past 2 years.
Wow, looks like you've done your homework on this. My history is as follows...
Back when I was about 17, I experienced a bout of PVCs and wore a Holter. They told me they were benign and they went away. About 10 yrs ago I had another episode with PVCs and went through the same process. This time had all the tests (echo, stress, etc). Same result, benign. They went away, and about 6 months ago recurred. I just went through all the same tests, and they are benign once again.
Right now I am taking all types of supplements and hoping for the best.
Back when I was about 17, I experienced a bout of PVCs and wore a Holter. They told me they were benign and they went away. About 10 yrs ago I had another episode with PVCs and went through the same process. This time had all the tests (echo, stress, etc). Same result, benign. They went away, and about 6 months ago recurred. I just went through all the same tests, and they are benign once again.
Right now I am taking all types of supplements and hoping for the best.
You are completely right, the ones who stop being bothered by palpitations are busy living their lives. They would have no reason to be here.
Did you experience more PVCs when you were younger, or did they become more frequent with age, or did they remained more or less constant throughout your life, with occasional flare-ups here and there?
It will be interesting to see more studies, like the one I mentioned, published in the future. I wonder if the results of the this study would be replicated, proving that in most people PVCs tend to become less symptomatic and less frequent with age/
Did you experience more PVCs when you were younger, or did they become more frequent with age, or did they remained more or less constant throughout your life, with occasional flare-ups here and there?
It will be interesting to see more studies, like the one I mentioned, published in the future. I wonder if the results of the this study would be replicated, proving that in most people PVCs tend to become less symptomatic and less frequent with age/
1) I don't think you'll get an answer to question 1. Those folks aren't haning around BBs looking for support. You tend to read only bad news on the BBs because there are people looking for help.
2) I agree with your doc on this one, completely. Especially the part about the viral issues being a cause.
I had a nasty bout back in 2009, and it followed a viral infection. It's been getting a lot better, and I'm in my mid 40s. Though I know I could flare up at any time. I hope I don't!
2) I agree with your doc on this one, completely. Especially the part about the viral issues being a cause.
I had a nasty bout back in 2009, and it followed a viral infection. It's been getting a lot better, and I'm in my mid 40s. Though I know I could flare up at any time. I hope I don't!
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