right ventricular outflow tachycardia

[lazymedic42]

risk factors of rf ablation, mortality rates, success rates and is ablation first line treatment or last. Is this arrythmia truly benign ? 61 y/o f with 3 yr hx of intermitant symptoms of "palpitations". No chest pn, difff breathing, sob, loc,or cardiac hx.  24 hr monitor showed unifocal pvc in excess 20k. Ejection fraction 43. Rx of 50 mg q 12 hrs toprol shows great reduction in frequency. recent echo shows lv function returning to normal. To ablate or not to ablate. That is the question.    

[lazymedic42]

many thanks for your support. In researching papers on Pubmed I ran across a condition caused by ablation with the wonderful name of "gas pops". Can't make this stuff up. With rf ablation, heat is produced and causes gas to form which can lead to a blowout of the heart wall. Have to immediately go in and sew up the hole. Getting past that bit of fun news, I gather one should make sure that an ablation is done at a major cardiac center with ORs ready to go.  My decision for my wife - and I think we will eventually go the ablation route - is what hospital to use. Living in NYC area, my first venture with St. Francis Hospital was a disaster. Finally- against my cardiologists wishes ( read that as my previous cardiologist) wound up at wonderful Columbia Pres uptown and got it done the right way.  4 years out without issues.  I will drive her to the moon if that is the best way.
be well and best of luck.

[lazymedic42]

thanks for the reply; wife made the decision today to postpone the ablation for another 6 months and see what evolves. Ectopy from the ventricles can have more issues than afid or other atrial focal points, sudden cardiac death being one of them. RVOT and ARVD are two of the more common ventricular arrythmias, the latter being the more serious. Fortunately we have ruled out the rarer ARVD. That said in my cardiac rehab class we have several patients who have had the ablation for afib and several who have followed the med route. Each is happy with their decision so i gather it becomes a matter of personal choice and research, research, research !!!!  I cannot stress that enough. Read about your disease or condition until you cannot read anymore - and then read again.  Medicine is like the weather in Maine - wait 24 hours and it changes. Keep up with the changes. .
As for losing weight, it's gotta be done. Period. Shed the pounds and your heart will love ya. Took an MI, pacemaker and two stents to get the picture so i lost 35 pounds.down to 150.  Feel great. Became an "near" vegan and got my cholesterol down to 88. Not sure hydrating will convert afib to sinus  but it will keep your blood thinner and  make your kidney's really happy.. Diet and exercise - ain't rocket science.
be well.
    

[MichelleP_3811]

I really can't tell you if you should or shouldn't but what I do know is pvc ablation has mixed results.  Any ventricle ablation has mixed results and can sometimes lead to other rhythm problems.  I kind of liken it to chasing your tail.  You fix one problem only to have another crop up.  If I were you I would first try to eliminate any and all triggers that I think could possibly be contributing to the problem.  Stomach issues even as simple as gas is a big trigger for me.  Stress is another big trigger.  I have pvcs and pacs.  I had a bout of them in October that made me really sick where I could barely function but right now I have maybe 100 a day tops so they are tolerable.  So I guess what I am saying is, for me personally, I would only do the ablation if I was in a situation where I could no longer function without doing it.  Otherwise I personally think it is too big a risk but that is my opinion.  It sounds like you feel good despite the quantity of pvcs so you should simply ask yourself will doing it improve the quality of your life?  The good news is they are unifocal so that is a plus to fixing them.  Good luck deciding and keep us posted on how you are doing.

[DeltaDawn23]

I think a lot of us are pondering that very question.  I have Afib.  My EP doctors have given me rate reducers (beta blockers), which worked for about 7 years.  In the last 2 years I've had 2 episodes which converted on their own, and 2 that I had to have electro-converted.  I now have been on Norpace XR for 8 months and no new episodes, but a few pvc's, pac's and occasional tachycardia.  One EP says to stay on meds and look into ablation in 3 years as it is evolving.  My main doc says I can go off the Norpace (some side effects) and see what happens.  Then if it comes back, I can go to another anti-arrythmia med or ablate.  There are lots of success stories and some not so much on this board.  I just read on StopAfib.org blog that one fellow got rid of his problems by losing weight.  I'm working on that.  Also staying hydrated is important.  Not going to hurt to try.  Keep us posted on your decision.