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Cardiac ablation or not
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Cardiac ablation or not

I am sitting on the fence as to whether to have cardiac ablation.  I'm 70 years old and have lived with an arrythmic heart since I was 15.  I have refused treatment thus far because I don't do drugs very well.  For the last few months, I have begun to feel this slightly, which I never did before--flutters, moments of weakness, somewhat like hyperventilation.  Holter moniter shows over 30,000 abnormal beats per day.  I am physically and mentally active, feel as good as I have ever felt and am wary of "messing" with my heart. Can you give me any advice?  What is likely to happen if I leave it alone???
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21064_tn?1309312333
Hi Myrna4!!!

Welcome to the Heart Forums!!  

Sorry to hear you're dealing with the pesky abnormal beats.  : (

I have had 2 successful ablations and after having PVCs in the tens of thousands/day for years, I am nearly PVC-free.  For me, the procedure was a little less of an option.  I actually developed PVC-induced cardiomyopathy.  My heart was not pumping very efficienctly, and my options were anti-arrythmics for the rest of my life or try ablation(s).  I tried a couple of the anti-arrythmics (YUK) for a few months each, but eventually inquired about trying an ablation.  

The procedures were not difficult at all.  I was completely comfortable (conscience sedation) during the procedure.  Afterwards, there was a little downtime, but not bad at all.  The first procedure was on a Friday and I was at work on Monday.  The second procedure was on a Friday and I decided to stay off work a week, mostly because I was very tired and my leg was a little sore from the catheters.

Have you had an echo?  Is your heart structurally normal?  If so, what does your doctor say about waiting?

Connie
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Avatar_f_tn
It's a hard decision to make.

I also have 30,000pvc/day and for the most part function at a very high capacity, although I am plagued with lightheadedness on a daily basis.

An E.P I just saw said he would refuse to do anti-arrhytmics and ablation because of the risk. Mind you, the risk is small, but he wonders why I would choose a potential life threatening procedure for a "benign" condition.

You asked "What would happen if I just leave it alone?" Well, from my understanding from several doctors, cardiologists and the recent E.P. --nothing. The chance of developing cardiomyopathy is rare, but as you can see above, Momto3 developed it. That made the decision for her.

Have you had all the necessary tests to ensure your heart is "structurally normal"?
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Avatar_f_tn
Thanks for your replies.  It surely helps to hear from someone who's "been there."  I have had a recent CT scan of the heart and all shows well.  I'm going to an EP Thursday to get all my questions answered.  I'm new to this forum...trying to get all the info I can so that I can ask the right questions.
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329449_tn?1285769002
For what it's worth my cardio said that recent studies have shown that medications work as well as ablation for many people, since ablations are not always 100% successful.  If the heart is normal and you are used to living with it, it was not highly recommended.  I am probably not quoting him properly here, but I gathered that ablation was no longer considered as useful a procedure as it used to be.

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Avatar_n_tn
I think a lot of it comes down to quality of life and the reason for the ablation.  I had one back in January for SVT.  This condition was very hard to live with - heart rate would go from 55 to 170 in a matter of seconds and since I'm athletic, the accompanying dizziness from any kind of exertion was almost intolerable.  Now, except for the odd racing, I am SVT free. Still have lots of PVC's though.

According to my EP, PVC's are harder to treat with ablation than SVT.  It is harder to create the symptoms of PVC's and you need to be symptomatic during the procedure.  Another reason is many people have them in more than one spot, making them even more difficult to find.  Momto3 obviously had an exceptional team of doctors working to get rid of the pesky things.  When it comes down to it, that is the most important thing.

Drugs do work well for some but they sometimes lose their effectiveness.  I could not tolerate beta blockers and the calcium channel blocker I was on stopped working.

You have lived with these for 55 years. See what your doctor says and ask him/her the success rate.  The procedure itself isn't all that bad and, relatively speaking, is low risk (although low risk is still a risk).
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21064_tn?1309312333
Please let us know what you find out from the doctor on Thursday.  

You have come to a great place to gather information : )

Up until my heart stopped pumping correctly, my EPs said exactly what Upbeat's said - no anti-arrythmics, no ablation (unnecessary risk).  If you have a structurally normal heart and you are find living with the extra beats, I'm not sure why the doctor would insist on an ablation.

If I had to deal with SVT, like sueinns, I think I would have been more fearful.  I can't imagine my heartrate skyrocketing....UGH!!  I don't know how you guys manage with SVT, even if it is only once in awhile.  With the PVCs, I was so used to them, I wasn't afraid...If I ever have an episode of SVT, I'll be running over here with a LOT of questions!!  

Here's to a great day!

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431362_tn?1211654781
trouble is though my SVT wasn't just once in a while, it was happening up to 10 times a day and that's why i went for the ablation.
flecainide worked to a certain extent but I could tell it's effectiveness was wearing off after about 2 months.  I'd had absolutely no heart issues at all until January of this year - all came completely out of the blue and was VERY scarey!!
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21064_tn?1309312333
So here you are going along life and SLAM!!  No wonder you were scared!!  Ten times a day is crazy!!  Like you don't already know that!!  I'm just amazed at how you guys manage the fast beats...

I tried flecainide for about 4 months and rythmol for about 3.  I honestly did not realize I would be on them forever!  When I asked the doctor and she answered "for the rest of your life" I started thinking about an ablation.  I was so nervous, but I'm SO glad I went that route.  For me, it was absolutely the right thing to do.

I hope you continue to have great SVT-free days!
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Avatar_n_tn
Same for me.  My SVT came on suddenly just before a bout with the flu. I sometimes wonder if the virus somehow caused the condition. The episodes would last for weeks before giving me a reprieve.  Thankfully, ablation is a good treatment option for SVT due to it's high success rate.
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431362_tn?1211654781
my ep dr told me that I would have been born with the extra pathway.  he said a lot of people have these extra pathways and it doesn't cause them any problems till they're in their 70's but is most common in females in their 20's and 30's.
I believe I was born with it but had a lot of stress late last year (nan passed away - was very close to her, father fell out with me big time, found christmas to be extremely stressful and had a virus) so I think all the stress bought it on.  
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Avatar_f_tn
To you who have responded to my dilemma...thanks.  The EP apointment yesterday was productive and I think we came up with a plan.  There is no damage to my heart at this point, I've lived well with the arrhythmic heart for 55 years...unclear at this point if the abnormal beats have increased over the last few months but now over 31,000 per day. This still does not affect my quality of life.  What little I feel from it is not bothersome and an occasional "sinking feeling" I cannot link directly to my heart.  I feel as good as I have ever felt, better than 20 years ago. He said if cardiomyopathy develops, ablation is still a choice with possible good results.  Therefore, we're going to monitor my heart with an echocardiogram every 6 months starting in September, with ablation an option should any enlargement appear.  He is not pushing me to do the ablation at this point because he says he's never known anyone to have this condition for so long without treatment and (kind of tongue in cheek) wants to see what will eventually happen to me. I feel informed and pleased with this plan.  Now I have to sell it to my family doctor!
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21064_tn?1309312333
I like this doctor!!!  Wonderful news!  It sounds like he has a reasonable plan, one that you are very happy with : )

I'll bet the family doctor will be OK with it since it's under the guidance of an EP!

Keep us posted!  We love to know how everyone is doing.
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Avatar_f_tn
I hate to ask a dumb question but do you know if what happened to you happens very often to people who have PVCs (that they develop cardiomypathy)?  And also if you don't mind me asking, what exactly is that?  My doctors have always told me that nothing dangerous can happen from PVCs and that they are completely benign.  I am so worried about these that it is affecting my life so bad.  I am not the same person and I have found myself starting to not go out and do the things that I used to because of them.  I am only 27 and I guess you can say that I have really just given up on life which is really sad because I have 2 small children.
I refuse to be on beta blockers for the rest of my life and I don't know that I would chance getting an ablation done as I have read that there is a very small chance of death.  I just cannot accept that these are not dangerous.  It cannot be normal that your heart is not beating properly.  My mom has developed A Fib and because I have had these skipped beats for 3 years now I am convinced that I too will develop the arrythmia.  I will not go out of my comfort zone like on vacations because of my fears.  I would really appreciate it if you could give me some insight on your condition.

Thank you :)
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Avatar_f_tn
I'm sorry to hear your fears.  I took the opposite path when my doctor became concerned with my PVCs about 40 or so years ago.  I decided I had too much living to do to worry about it...that I would live as well as I could as long as I could. I raised 3 sons, taught school, lost a husband who was never sick until cancer struck. I looked upon my condition as being my unique self.  But first, I examined life and death until I was confortable with death.  I now look upon the PVCs as a blessing...the examination allowed me to accept my husband's death with grace and do not fear my own.  My priority has always been quality of life rather than longevity.  I hope you will find your own peace with this.  

I have spent hours lately googling terms I didn't understand...enough that I was armed with questions for my appointment with the EP yesterday.  I now feel "informed."   Try it.  Knowledge is POWER!
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21064_tn?1309312333
Hey Kate9106,

There are NO dumb questions, so don't even think about that.  

PVC-induced cardiomyopathy is rare.  I think I was the first case my doctor came across and she has been in practice since late 80's, early 90's.  Since my diagnosis, she has had 2 additional patients with PVC-induced CM.

In general, the CM that I had caused my heart to lose some of its ability to pump blood effectively.  In the most severe cases, cardiomyopathy can lead to congestive heart failure so it's really important to try and treat the condition.  I had thousands of PVCs daily for years and it was always fine (annoying, but not dangerous).  On a Holter in January 01 or 02, my Holter recorded 22,000+ PVCs and my doctor was not at all concerned.  Not quite 12 months later, I was having a routine echo (for a leaky valve) and the CM was evident.  Lots of tests and opinions led to the diagnosis and ultimate ablations.  My heart function returned to normal and I hardly have the PVCs any more.

The anxiety from the PVCs is the hardest part for many people.  It just seems absolutely ludicrous that our hearts can be beating so weird and it can be normal.  But, it's true in the setting of a normal heart.  I'm so sorry to hear that the PVCs are altering the way you live your life.  Try not to let them frighten you. When they get to you, stop around here and talk with us : )

You are young and have a young family - it's time for fun and great times!!  There are so many exciting things in life and you don't want to miss them because of your quirky beats.  Are you taking a beta blocker now?  If so, is it helping?  Has your doctor mentioned ways to get past the anxiety?  I can't even imagine you would be a candidate for an ablaiton.  There are people on the forum with 30,000 PVCs a day, and doctors are not even considering ablaiton.  Same went for me until the risks associated with the CKM outweighed the risks of the procedure.  That made the decision a lot easier (still scary, but a little plainer to see).

As for the Afib, I sometimes wonder if I will develop that.  My Dad has it, and I've a long history of PVCs, but for now...all is well.  My Dad doesn't feel anything with the Afib!!

Please take that vacation.  There are so many fun things to do with your children; you don't want to miss out.  We're here whenever the PVCs get to you!!! Not to worry : )

Keep posting and let us know how you're doing.  Some day, you'll be on the other side of the fence and you will be helping others who are just beginning the journey.  Enjoy the day!

connie
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21064_tn?1309312333
GREAT words to live by!!

What a wonderful post!!
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Avatar_f_tn
Myrna 24, glad you had an informative visit with your E.P. and thank you for a beautiful post, it was very inspirational. Quality of life is the most important since none of us really knows for sure how long it will last.

Kate9106, don't give up on life, pvcs are just a small part of it, although they can seem to consume your every waking hour. I too refused beta-blockers when the pvcs got really bad because a cardiologist a long long time ago (when I had 10,000pvc/day) told me they probably wouldn't help much and I'd have to be on them the rest of my life. I was about your age.

Well, since that time I've tried 4, because my pvcs keep increasing in frequency, I'm in the 30,000pvc/day range now.

Three of the BB gave me terrible side effects of fatigue or dizziness, much worse symptoms than the pvcs. The 4th one, acebutolol seems to have reduced the pvcs on occassion, but not always. It's also caused me to gain weight. Gee whiz. So I've decided to go without a BB.  However, it's always there if the pvcs get the better of my minds ability to carry on and ignore them. My point is to encourage you to try something before you give up on living your life well. When you feel you have options, you feel more powerful, you feel more in control, and it DOES become easier to handle the pvcs. Don't let them rob you of enjoying your children or any vacations!
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