Episodes of disabling aberrant heartbeat

[Sjakie]

40-year old male, 6'1'' 145lb. 2005 successful ablation AVNRT. From that time experiencing new problems. The severely disabling problem that bothers me most:

Episodes start with PVC/PAC.
Instantly my heart starts beating different: unlike my normal, unnoticeable heartbeat an extremely noticeable and forceful heartbeat (some resemblance with slow-motion (50-70BPM) version of prior AVNRT).
Drains physical energylevel with SEVERE fatigue as a result and exercise tolerance zero.
Eventually chest pain, need to sit upright in bed (SOB).
Then a PVC/PAC and heart restores to normal function and I regain normal physical energylevels within an hour.
Episodes last for several days (when lucky only minutes) up to a week.
Sometimes, the start/stop occurs during the night: going to bed no problem, waking up with problem or vice versa.

EKG's made have only revealed IVCD and borderline abnormalities.
An echocardiogram made during an episode showed diastolic dysfunction and hyperkinesia?
Not all PVCs/PACs I have induce or terminate an episode.
No eliciting factors are known.
Holter-regs: unusual high RR-variation (way beyond normal sinus-arrhythmia from breathing), PAC's, multifocal PVC's and ns-VT's (5 seconds to 1 minute, between 160bpm-200bpm, once/twice a month).
The ns-VT's cause: near-syncope immediately following and chest pain for hours after the event.

My new EP just started another round of 'standard' investigations.

My most important questions are:
1) Could a PVC/PAC originating from a specific focus initiate and terminate some kind of alternative conduction path causing my heart to beat differently?
2) Is comparison of several echocardiograms (recorded during severe episode and when having no problems) useful?
3) Apparently symptoms are not represented on EKG. Is it possible that the above mentioned suspected conduction disturbance is hiding in a 12-lead EKG?
4) Would an experienced EP be able to find out what the mechanism is of my symptoms?

[Michael J. McWilliams, M.D.]

That sounds like a very complicated situation.

1. PAC/PVCs are common initiators of arrhythmia's.  You doctor should have a decent idea whether the arrhythmia are triggered by pac/pvc if they can capture the arrhythmia on a monitor.

2. Probably not.  It is more dependent on what the rhythm is.

3.  12 lead EKGs are a general why to screen the conduction system of the heart.  The conduction system, be it normal or abnormal, is much more complicated than can be see on a 12 lead EKG.  EP studies are often necessary to determine exact causes for arrhythmia's.

4. Not always.  There is a lot we don't know about arrhythmia's.  Some hearts are more prone to abnormal heart beats and sustained fast heart rhythms.  It is not always as simple as ablating a pathway.  There are genetic causes of arrhythmia's that are not understood and it will likely be a long time before we can test for them.

[friendinneed]

My husband had a cardiac arrest in 96 at the age of 44.  He has cardio myopathy and atrial fribrillation.   He was put on anapril, amiodorane and tara coated aspirin.  He has lately been experiencing a shortness of breath.  His heart doctor feels he should consider coming off of the amiodorane as the later in age the worse the side effects can be.  He is to be seen to see if he is a candidate to have a defribulator installed in his shoulder.  He still is relatively young.  His father died of heart failure last year as did his 2 uncles when they were only 35.  It appears that this problem is in the male side of his family.   How long can a person last with a defribulator installed.  What are the complications if any.  He is presently working at a physical job in a warehouse.  Will this hinder how much he lifes, can he continue to golf and bowl? What will the quality of life be for him.  

Would appreciate any information you can provide.
friendinneed    

[notahypo]

I just happen to do a search on interpolated PVC's and a link lead me to your forum. Anyway, although I have a teo-fold problem which began with PSVT/IST in 1992  "followed a few years later by a "2nd curse" PVC's which were ONLY single-form uni-focal PVC's in roughly 2000 my 1st episode of both Multiform/complex PVC's started.  I have been getting interpolated PVC's pretty regular "when they start up" since about 2001. Now getting these pretty frequent "runs" if you will, of Interpolated PVC's, I am able to tolerate and endure single form and the occasionally garden variety PVC's alike, as they are "now" nothing compared to the feeling of ongoing runs and clusters I get.  I would like to post this at the forum, as I haven't posted recently since I am coincidentally going through with the EP study after being on the fence with abaltion for these arrhythmias for almost 16+ years now. I just can't deal with these interpolated PVC's and the "occasional breakthrough of SVT as well, ANYMORE. I have already seen a Dr. Frances Marchlinski at the University of Penn. who is supposedly one of the best at PVC ablation. According to my EKG's, he has a good idea where they me be coming from. The drawback, is I may have a focus on the left and right side of my heart. I was told by another EP doctor that you can have only a single focus causing these types of PVC's. I guess he was wrong? My understanding of Multi-Form PVC's is more than likely the result of Multi Foci (lesions) present. Where remains to be determined by the EP study itself, although as I stated he has a good idea of where they are emanating from. I just hope that the "majority" of these PVC's can be  successfully ablated and that the SVT, if sampled or induced during the study, can be as well. Killing to birds with one stone, in my case,  would be ideal. He primary goal is to go after the PVC's "first". Then if he can find a bypass tract that is rarely ( only less common because of the BB) still causing my PSVT while he's up there and can ablate that too, it will be the greatest gift and most ideal outcome one can expect. I go in April..Quite "scared" I will admit as a 53 year male, as it will be my 1st invasive procedure and ALL I dwell on, and I shouldn't so much, are the possible WORST complications such, as MI, Stroke, Artery Perforation, Valve Damage. After those, worrying about coming out with a worse life threatening arrhythmias that were termed "benign" but truly bothersome arrhythmia's that are affecting the quality of my life. Only thing I can say is that if the ablation is successful for even on of these arrhythmias, I will only wish that I would have done this sooner and maybe I could have avoided the 16 years I suffered from this problem. Conclusively, do you think I am expecting too much from this procedure or is it possible to get the "ideal" outcome? Just to point out Dr Marchlinksi, told me if he were to rid me of 95% of my problem, especially the PVC's, would I be happy with that.. I said of course! Are my expectations too high or is it possible to kill two birds with one stone during what I hope to be a "single" ablation.

[heart2]

Hi, I'm so sorry you have been suffering for 16+ years.  I waited only 5yrs to have my EP study done.  You don't mention meds...have you tried anything?  I would say that an ablation should be a last resort after all the standard meds are exhausted.  My EP study and ablation was successful for ST and I had many spots on the one side ablated.  However, I had a complication that could easily have killed me.  It is by the prayers of all my friends & family and the grace of God that I am able to share my opinion with you.  I can't disclose the particulars for legal reasons, but I will tell you that NO procedure is SIMPLE.  Especially when it's done to YOU.  Be sure you have tried every med they can throw at you, and keep in mind that the EP doc wants you to have this procedure.  I wish you well and I'll say a prayer for you.

[Runman]

I'm a 62 year old male, excellent health according to my cardiologist....avid runner - 40 miles a week...resting hr of 44bpm...low cholesterol, high hdl, low ldl, etc...have "suffered" from benign pvcs/pacs most of my life....had every cardio test known...all normal...recently, after lifting some heavy items, i noticed my normal slow hr will suddenly speed up (i can actually feel it coming on)...it's very quick beats and only lasts a few seconds (seems like longer because it scares me)....i respond by coughing and it seems to correct itself and go back to normal.....no shortness of breath, dizziness, etc., just very quick beats....I don't feel any "extra" beats but I guess they could be stringing together....it's only happened a couple of times....wonder what you thought....thanks

[IanCremona]

A related discussion, Stress ECG - Fast Heart Rhythm after workout was started.

[tracywifey]

A related discussion, Runs of Extrasystoles was started.