Help!! I'm a new poster and need advice on my PVC's

I was diagnosed with having PVC's in September by a cardiologist. I had an EKG which showed nothing but he spent considerable time listening to my heart with the stethescope and he heard them. He scheduled me for an echo and told me it's nothing to worry about. I went and had an echo and it was normal. He told me my heart was beautiful and that they did see some PVC's on it, but it was nothing to worry about as my heart was structurally normal. I started taking magnesium which helped, but around Thanksgiving it seemed to have stopped working as great. Also, I had a couple of near faints so I went back in for another appointment. He diagnosed my near faints as panic attack since I was presenting with a surge of high blood pressure instead of low. He set me up for a stress test just to be safe and of course I heart beat like clockwork that day. Not a single pvc and he said my heart is in great shape other than me personally being out of shape.

Fast forward a week and a half and my pvc's have been off the charts. Most days non stop with anywhere from 2-8 per minute from the time I wake up to the time I go to sleep. Yesterday I notice a tightness in my throat and a wierd fast beat before the skipped beat. Today I had a run of biginimy right out of the shower and now a handful of minutess later it's every 3rd beat....UGH!!! it's driving me crazy. I was never put on a holter monitor, I'm assuming becuase I don't have insurance or maybe becuase he was able to catch them while listening to my heart. My question is even though I was in less than two weeks ago, do I make another appt as my rythm has really changed? I am feeling a huge increase in PVC's, biginimy, triginimy and couplets. Is this all fine becuase I have a structurally normal heart? I'm worried.

[itdood]

I've been in this spot before and I elected to go back for more testing.    It certainly doesn't hurt.  

I can say that there is no quick fix medical treatment.  You could try medications but you have to balance those with their side effects and also accept that you may need to take it for the rest of your life.  Surgery for benign PVCs has about a 50/50 shot of helping and a chance it could make them worse.  This is my own guess based on what I've seen and heard people go through.  Perhaps I'm wrong.

I doubt they'll find any new developments since you last check but again, it doesn't hurt to error on the side of caution.

[hulahoney]

Anyone else have any experience or insight with this. For a couple days it seemed to improve but now it seems even worse. The biginimy and triginimy has increased. I can't get into the cardiologist until next week and I am uninsured so the ER is off the list. I feel scared and alone.

[michellepetkus]

I am sorry to hear things are so bad for you.  Unfortunately itdood was right in the fact there isn't much the medical community can offer us with pvcs beyond beta blockers.  And the so called fix isn't always a good bet and is very expensive.  So there just isn't a lot of good answers for suffers.  The best advice I can offer you is to see what you can discover that may be making them worse.  Get your hormone and electrolyte levels checked to see if you have an imbalance.  Also do you have any stomach ailments that could be making the situation worse.  As strange as this sounds I had some fairly bad gas that I am not sure where it came from but I got as sick as you with the pvcs in October so much so I didn't eat much of anything but a banana and granola for a couple of days, I would try to eat and just gag or worse and surprising after my stomach ailment cleared up the pvcs quieted down as well.  So if your pvcs seem to ramp up after meals check for stomach problems that may be making things worse for you.  If you smoke try to quit because breathing issues can also worsen the problem.  Finally a very big trigger is stress.  The adrenaline from stress will definitely make the situation worse.  I know it can be really hard not to obsess about all the oddness going on in your chest but do your best to try and relax as much as you can.  It should help alleviate some of your problems.  The most important thing to keep in mind is the pvcs, even runs of ventricular tachycardia is generally not life threatening in a healthy heart.  That isn't always the best consolation for those who suffer from them badly but try to do your best to take charge of the situation and fight letting the pvcs control you.  Take care and if you can't get a handle on possible triggers you may want to consider trying the beta blockers.  They may not totally rid you of the pvcs but they may be able to help you cope.  Good luck at the cardiologist and keep us posted on how you are doing.  (((Hugs)))

[john2live]

I also had ultra sound of the heart and found nothing. I have been dealing with these thumps in my chest for 2 half years now, which ***** cause iam only 29. Right now i started taking co Q10 and magnesium pills to see if it will help. I usually get these scarry episodes that can last for days then be gone and come back week or two later. I cant see myself able to live like this forever as i will find something to rid of this. Good thing is all the times i have episodes they do pass by.

[RVVq]

I would disagree michellepetkus and itdood.  The success rate for PVC ablation is rather high at experienced centers that use 3D mapping and non-contact mapping and irrigated catheters.  One EP told me that at his lab the success rate for PVC ablation is above 90% (St. Paul's Hospital, Van, B.C.). A quick Google Scholar search will show that acute success rates of monomorphic PVC ablation at large centers across the world range from 75-97%, with most recent studies reporting a success rate above 85%.  However, reoccurrence rates are rather high as well, with approximately 5%-15% of patients having arrhythmia replaces within the first year.  For example here's a study done in Thailand in early 2000's, were ablations were preformed on 33 patients with mean of
over 20,000 PVC/day (1). Acute success rate of 97%, however, 24% of the patients had residual arrhythmia of over 1000 pvc/day at one month follow-up and 5 of them chose to undergo repeat ablation. At 12 month follow-up 63% had less than 20 PVC/day, and 27% had 0 PVC/day. However, only one patient remained symptomatic.

Another Japanese study reports an acute success rate of 89%(2). The mean PVC/day burden of the group decreased from 23,989 to 137.

My point is that if you are having frequent (over 1000 per day), monomorphic, and highly symptomatic PVCs, than I think ablation is a good option. However, you have to choose an experienced center with 3D or non-contact mapping (EnSite), irrigated catheters or remote magnetic navigation (Stereotaxis or Sensei).  You should expect a high success rate!

References:

1 - Krittayaphong et al, One-year outcome after radiofrequency catheter ablation of symptomatic ventricular arrhythmia from right ventricular outflow tract.(2002) American Journal of Cardiology, 89 (11), pp. 1269-1274.)

2 - Sekiguchi, Y, et al, Chronic hemodynamic effects after radiofrequency catheter ablation of frequent monomorphic ventricular premature beats. (2005). Journal of Cardiovascular Electrophysiology 16 (10), pp. 1057-1063.

[michellepetkus]

I wouldn't say only 27% being cured of the pvcs is true success.  My svt was cured, I have not had one episode since.  Granted having far less pvcs is not as taxing on a person as having thousands though my EP wouldn't even broach the subject unless a person is having over 20,000 symptomatic pvcs a day.  The point being it is a very expensive procedure and not as clear cut a cure as an ablation for svt but definitely worth mulling over if finding the triggers cannot be found and the pvcs are disrupting a person's life.  I'm not against the ablation I just think people need to take more into consideration if contemplating it.

[RVVq]

It is interesting that your EP would not consider ablating PVCs unless one's having more over 20,000. The EP I e-mailed told me that at his Hospital their threshold for PVC ablation is very low, as long as the person is highly symptomatic. They ablate people with around 1000 PVC/day. Its a quality of life thing, i guess, since their no medical studies which prove that PVC ablations improve survival.

I don't know how much ablations cost in USA. In Canada the government charges pays about $9000 for ablations, but its all covered by our health insurance, so a patient does not have to pay anything. And if you don't want to wait in line, you can always go to Cuba and get an ablation for $3000 (If you trust the local communist EP, of course!) They will ablate anything you want, or even make a custom tattoo on your heart, for a little Western currency!

I guess in USA the cost of the procedure would be an important factor to consider when deciding on whether or not to ablate PVCs.

For me, I think I will wait a little before going in for ablation. I hope that in 5 to 15 years they will perfect non-inavasive EP studies, (256 Electrodes + CT Scan to create an accurate 3D electroanatomical map of your heart), which should make ablations a lot more efficient, safe and less time consuming. In 25-30 years, I am sure the procedure will be a completely non-invasive, as they will use external ultrasound devices or a gamma knife to destroy heart tissue. So far they only tested that method on animals. Us, humans have to wait a little!

All the best!

[michellepetkus]

"They will ablate anything you want, or even make a custom tattoo on your heart, for a little Western currency!"

Hilarious.  Yes, in the states it is crazy expensive.  I had ful on surgery 10 years ago and it cost $14,000.  I had the ablation for the svt in Sept and it was $50,000.  I had to pay $4,000 for total out of year expenses.  The problem is once you start to use your insurance your rates go up.  So the health care system here is a little messed up.  But I agree that 20,000 seems high.  I had a bout of the pvcs in Oct that I averaged around 10,000-15,000 a day and I was super sick not able to eat, sleep or function for that matter.  But it stopped and now I only get a handful a day so not sure why my EP needs them to be so high.  I know when they were at their worst I was getting them every minute so I am sure he could have found the bad spot.  Maybe he just wanted me to not panic about the whole thing.  Well your comments about new procedures on the horizon do sound promising.   Science is fasinating.

[RVVq]

I think the reason why your EP mentioned the number 20000 is because clinical studies showed that people can develop cardiomyopathy as result of such a high PVC burden. I also think that your EP probably is not too experienced at ablating PVCs. Currently there are non-contact mapping systems (like LocaLisa, Ensite Array, etc) which don't require a high PVC burden in order to localize ectopic focus. In fact they are able to accurately  locate the ectopic focus based on a sing PVC. So, from a technical standpoint, a patient does not have to be in bigeminy in order to accurately map ectopic foci. There's no need for ventricular pacing or adrenalin infusion. However, not all centers have such mapping systems.