FREQUENT PVC's

Brief hx:  I am 43 years old.  I had a holter a few days ago which showed 51,000 PVC's in 24 hours (stated 42% of beats were abnormal).  PVCs have been going on for years but only recently have I felt frequent palpitations but no other sx.  The holter summary said I had Ventricular run beats and the technician comment said probable accelerated idioventricular actvity versus ventricular tachycardia, the longest run 53 beats.  I had 3500 PAC's (according to the summary).  The doctor who ordered it is on vacation but a cardiologist (was on call - not at CCF) said it was concerning and would recommend ablation/ ? meds.   However, another cardiologist that I know said don't listen to summary and technician comments - not accurate and they were runs of SVT.  My question:  Is this anything to be concerned of (1st appt when I called CCF was mid-Oct) and am I a canditate for ablation?  Also are the summaries of Holter's usually correct or do all the rhythm strips that showed an abnormality need to be read by an electrophysiologist?  

[julesluvsdrew]

I would deff see an electrophysiologist to get his oppinion on things.You wrote 53 beats,and to me that deff doesnt sound like  V Tach but maybe SVT!I have V Tach and if I had a run of 53 beats theres a good chance I would of needed help shocking my heart back in to rhythm!I had an ablation years ago for my V tach and it did help for a long time.I feel for you with these pvcs,they are a pain in the neck.My point is I wouldnt worry about what the technician said,im actually quite surprised he or she said anything because I didnt think they were supposed to interpret anything.Let me know what happens when you talk to your norm cardio!

[kim62]

You mentioned you have VT. How long would your runs last before you would convert? Did you ever pass out from it? I have a complex VT. I have been thrown into VT many, many times(50+ times). I use to convert on my own, but as time went on I would have to go to the ER and have them use the lovely line of drugs like adenosine or ameoderone, etc. Then it got to the point where it was hit or miss with drugs and have to be cardioverted. The puzzling thing for my team of Cardiologists/Electrophyisologists is that even at 260-320 beats per minute... I have NEVER passed out. There have been times where I stayed at 260+ for a few hours and still pretty much functioned normally. They seemed surprised that I tolerated it. I have had 2 failed ablations, as they say that my VT does not originate in any one particular spot... mine floats...During the EP studies, they said that as they paced me out of VT... just before normal sinus rhythm, another one would start up somewhere else. I now have a dual chamber ICD which is now my best friend! Before the ICD and while on 3 anti-arrythmics, I was going into VT at least once per week. Do you or anyone else out there know of anyone who has had the similar problems?  

[Momto3]

That is a lot of PVCs!!  I used to have over 20,000/day, and eventually developed PVC-induced cardiomyopathy.  I had two successful ablations and am doing much better.  Prior to the ablations my EF was 40%, and today it is back to normal at 60%. I consider myself very fortunate to have had a doctor who recognized this rare phenomenon...You may not have the same experience, but it's worth asking about.  Do you know your ejection fraction?

I agree that seeing an EP is the way to go. CCF has highly skilled EPs, but I'm not sure about waiting until October. Maybe you could get a referral for a quicker appointment?  When my EP called CCF with a referral (valve problem), I had an appointment the following week.  Are you taking medication?  I have a cardio at the CCF, but my EP is at another Cleveland area hospital.  Good luck and please let us know how you're doing.

[julesluvsdrew]

I have never passed out from it..as crazy as it seems,I have been having an eppisode a day on average...Maybe every other day but my norm for the past 3 months has been a episode a day of V tach..Its making me crazy!The episode lasts less then a min but after it happens its pvc central!!!!!!!!!!!Plus my heart rate stays really high..im on a high dose of atenolol too,so that scares me to think its not really helping my heart rate...Im on the atenolol for high blood pressure though.Im not on anything right now for my irregular heartbeat..I am without insurance..and wont have it for months now(just found out).I think im going to have to go to our county hospital.Trying to go to work while having v tach is a task in it self...Each time I think..well this may be the big one,the one where i will have to be defribulated!Can you tell me about your ICD?Is it hard to live with it?

[kim62]

I have had my ICD since February 2008. The first few weeks were the roughest as I was nervous and unsure about having it or even wanting it. Prior to the ICD, my VT was out of control and meds were not much of a help. I have received the "big shock" only once since February, but have had smaller ones and paced out of VT more than a dozen times. I am now thankful for the the ICD and combination of new meds, as I would have had to be converted in the hospital many, many times if I didn't have it. If I had been given the choice of having one implanted 2 years ago when my condition worsened, and  knowing what I know now...I would have been thrilled at the idea.  It isn't hard to live with, other than a few changes like can't use the cell phone on my left ear, can't be an arch welder... damn, there goes my dream job!... and I have to stay clear of high magnetic fields or large magnets. Other than that...they implanted it deep enough that there isn't even a lump or bulge. They still are on a mission to find a drug that will keep the VT under control so I don't receive shocks.

[julesluvsdrew]

I like the fact you can have it implanted where you dont even have a bump!(how vain of me huh!)lol..What meds did you try taking before your relized it wasnt helping and the ICD was the way to go?

[upbeat633]

Sorry to hear that you are experiencing such high frequency pvcs. I am in the same situation. I have high frequency pvcs, and I had a pvc string of 62 beats. I was told the same thing--accelerated idopathic ventricular rhythm, because my heart beat is always between 75 to 90bpm when it happens therefore it isn't considered true tachycardia.

I'm told that with a structually normal heart with EF 55-60% (as interpreted from my last echo ((although it showed mild regurge in the aortic valve which I think is a concern)))--that even accelerated idiopathic ventricular rhythm is supposed to be ok because it is occurring in a "structually" normal heart with "adequate re-set mechanisms".  I was told that anti-arrhythmic drugs could change that to a worse rhythm, and that anti-arrhythmics aren't normally recommended for pvcs either.

By the way, my last holter showed on average 24,000pvcs per day. Recently I did a 30 day monitor, and over the several recordings the electrophysiologist estimated 30,000pvcs/day. I have good days an bad days, and have one or two days no pvcs or next to none. I'd like to know the reason for those!! I'd like to repeat them :-)

Mostly I'm symptom free except for feeling unwell a lot. I think it's the pvcs but all the doctors say there is no correlation.

I hope that you get in to see a specialist soon to get the answers you seek. I have been told by 3 cardiologists, and now 1 electrophysiologist, that abalation is not a consideration because it comes with much greater risk than "benign" pvcs , no matter the number, and no matter the pattern they say "structually normal heart = benign pvcs=no invasive treatment. I am not sure why ablation would be recommended if your heart is structurally normal, it may be symptom related, but you said in your post you are next to symptom free. I hope you get the answers you seek, but I'd suggest several professional opinions before you decide on a course of action. Just to let you know, I've tried three beta-blockers without much success, but acebutolol seems to have stopped the long strings and may reduce the high frequency to 15,000 or 20,000/day, it's still high, but it's something. Let us know how it goes for you, my best thoughts go out to you.