How fast are PVC's supposed to dissapear, after starting betablockers?

[mulder86]

My cardiologist has put me on a betablocker because I have 18% of PVC's and sometimes SVT (not so much),
He says there's a small risk of developing cardiomyopathy if they don't become less.

My 24h holter monitor showed that most of the PVC's were during the day.
When I'm sleeping I don't have as many.



So this is probably why he thinks that my heart will respond well to beta-blockers (i'm a rather anxious person)
How soon should my heart starting giving less PVC's,
after starting daily beta blocker therapy ?

[researcher09]

Sorry, don't know much about Belgium.   Erasmus has Tamas Szili-Torok who has stellar reputation in complex VT ablation.  Best of luck to you and that you get lucky with AADs.

[mulder86]

Thanks for the replies guys.
I live in Belgium,
so a good doctor should be easy to get.

I guess that ablation holds some risk....

so i will try betablockers first - and then see where i go from that.

In the mean time live life to the fullest ;)

[RNRita]

Hi. I've had them for 40 years....I started on Inderal.  It had not effect on them and I didn't like how I felt.  I have been taking atenolol for 38 years.  Started me on 75 mg daily. I cut my dose, over the years, to 12.5 daily. If I'm feeling like my heart is racing, I may take the other half.  

I still get PVCs like the rest. And PACs...and a lot of other weird things, but I do like my atenolol...

[tom_h]

Have tried any other beta blockers besides Propranolol?  Physicians sometimes have a go-to drug perhaps because they've been using it for so long and are not familiar with perhaps more modern drugs.  Propranolol, aka. Inderal has been around for a very long time.  Because of it's non-selectivity, it is used for a number of treatments other that cardiac issues.  This could be one reason why you don't feel "right" when taking it.  the half life of Propranlol is a little misleading for the layman.  The primary chemical has a half life of around 4 hours, rather short.  But there are a couple other chemicals that remain active for many hours.  This can lead to excessively high concentrations.

I use what I refer to as the Tic-Tac of beta blockers, Metoprolol.  I've been on it for nearly 10 years and continue to take following my ablation for mild hypertension.  It is very effective for that with me.  I take 75mg. per day.  Aside from the delay is getting my heart up to workout levels, I feel no other side effects.  No aches or pains, or odd sensations. Plus it doesn't affect my libido in any way. Metoprolol is a cardio-selective drug, and I mention it only as an example of a cardio-selective beta blocker.  As I said earlier, from my experience here on the forum beta blocker in general have mixed reviews for PVC's.  I took it for SVT, and it had very little to no effect in lowering the number of events while on it, at the levels I tried.

[itdood]

Propanelol is a non selective BB.  Your body will build tolerance to propanelol and you have to keep building the dose.  Because it's non selective there might be side effects.   The only way I think it might work is if the PVC are rate triggered which yours might be given they slow down at night.  A BB doesn't work on the root cause of PVCs, in my humble opinion.    Personally I think BBs suck for PVCs, it didn't work for me at all, I felt it made them worse.  I tried propanelol.   Study of 1 person so take it for what it's worth.  You have other options.   You could try a selective BB instead.     You could also try a stronger med called flecianide.  There are also other antiarrhytmics out there.  

RVOT PVCs are the most common source and have the highest success rate for ablation.  

[researcher09]

It's easy for specialists that do a lot of them, RVOT.  However, you probably want somebody that can carefully map out the both left and right sides to make sure you get all the PVC's.  Only the top centers will have the skills and equipment to do left sided VT right with low complications.  Where do you live?

[mulder86]

and if i develop cardiomyopathy,
and THEN have an ablation...

cardiomuopathy will reverse right?
how big are the risk for ablation in my case?

i'm 28 years old.

thanks guys! gotta try to stay healthy :)

[mulder86]

the thing is, i have a feeling the betablockers will make me feel bad,
because i have had bad experiences with them in the past and i feel really hypersensitiveto them so i want to take it slow and increase dosage slowly.

my pvc's are Monofoclae ventrcular pvc's from the RVOT.
with a bit of luck, these are easy to ablate right?

if i don't respond to Betablockers soon,
i guess i should push for Ablation?

[tom_h]

Are you taking 10mg. of Propranolol per DAY?.... Look..I'm certainly not a physician, but I'm pretty sure that's like a starting dose.  You have a lot of room to play with if you wanted to stay on that particular BB.  There's a myriad of drugs you can also try at different levels.

Personally, I'd be more concerned about the high number of PVC's  than the runs of SVT.  I had 54 years of sustained SVT or literally hundreds, mayne over a thousand events with some lasting up to an hour.  Yet I was a nationally ranked sprint cyclist and speed skater at one time and even today at 64, still compete in an "grand master" division.  I suspect that if a heart would be adversely affected by SVT, it would be mine.  My feeling is, you need to get these PVC's addressed.  Cardiac Ablation could be used on both, but that procedure on PVC's is often met with mixed results.  Ablation therapy finally cured my SVT.

[researcher09]

I really don't understand how a cardiologist tell a patient that his risk of developing cardiomyopathy (heart failure) is small if PSVT and 18% PVC is allowed to continued.  If it continues, I think the end result is certain.  How well the drugs do in arresting progression is a matter of luck but the statistics are not encouraging.  Your cardiologist should be able to give you the odds from numerous published meta analysis.  He should also be straight with you and tell you what he means by "small risk" and under what assumptions he made that comment.  My opinion is that your cardiologist has reached the limit of his skills when it comes to your treatment.

[mulder86]

i had 22000 pvc's on the day of my 24h holter monitor.
and now i can't sleep due to what i think is "after effects" from that first dose of beta blocker.

maybe it's better to go on a long halflife betablocker in that case,
IF betablockers would reduce PVC's to begin with.

I know my pvc's are unifocal,
maybe i should just have it ablated lol.

Cardiologist says try betablocker first

[mulder86]

The first dose has stopped working,
and I feel an increase in PVC's now and a slight headache.

Withdrawal symptoms after the first dose?

[mulder86]

10mg propranolol.
i don't think the PVC's have lessened since the first dose,

maybe I need to wait a few days?



Thanks for your answer.

[is_something_wrong]

I used to take 25 mg Metoprolol and had OK effect, didn't notice any significant number of ectopics for a couple of years. So my doctor decides I didn't have to take them anymore. Big mistake. Three days later, the PACs were back with a vengeance, hundreds/thousands a day. The weird thing is, after that, it feels like I've developed some kind of immunity towards beta blockers. No dose completely eliminates the ectopics, like 25 mg used to do. My doctor let me experiment with dose, and I've been as high as 400 mg. Even more weird, I had no side effects. The heart rate still increase to 180 with heavy exercise (confirmed with Holter) and no bradycardia. Only slightly low blood pressure.

I have no idea why this happens

[tom_h]

Doing some figuring first, and I hope this is right:
So at an average of 72 bpm you have approximately 104,000 beats (QRS complexes) per day.  If you're awake for 18 hours a day, you're experiencing roughly 78,000 beats while awake.  If your physician says 18% of them are accompanied by a PVC, that would be roughly 14,000 PVC's per day or about 13 PVC per minute. Yes, that's a considerable amount.  I have to add that we've had forum members on here with a LOT more; double that (can you imagine!).

I'm not going to sugar coat it for you.  I will be surprised if a beta block puts a significant dent in the number of PVC's that you're experiencing.  That just seems to be the case with a lot of member who experiencing large numbers of PVC's.  

You didn't mention WHICH beta blocker or the strength.  I was on Metoprolol once at 200mg a day for about a month.  During that time, I was in zombie mode.  It was horrible.  It felt like I was walking around in concrete boots.  Even at that level, it didn't faze my PVC count...... which at the time was perhaps a few thousand per day.  PVC's are without a doubt the single most discussed topic on the forum, but remain the most mysterious.  The come, they go, they come back.  Some (like me) experience clusters that vanish for weeks on end only to return. While other unfortunate people have them continuously.  If this beta blocker doesn't work, try others.  Try different strengths of each in an attempt to nail something down that works for you.  But I'd say not to expect miracles to occur in taking any of them.

[is_something_wrong]

I forgot to say, sometimes beta blockers make the PVCs worse, if the heart rate gets to slow.

[is_something_wrong]

I think most beta blockers should have an effect within a few hours. However, the dose needed vary greatly. Some respond on low dose (25-50 mg of Atenolol or Metoprolol, 2,5-5 mg of Bisoprolol or 10-20 mg of Propranolol). Some need five to ten times that dose. Some do not respond at all. Which dose are you taking?