More questions about PVC's!

I am so curious about what kind of problem could cause sustained PVC's and PAC's and whether and ablation would be considered in someone 62 with a structurally sound heart. I did have an ablation for an extra pathway in '93 but what do EP's ablate when there are PAC's and PVC's? What could be the cause of these types of arrhythmias? Would it have to do w/the SA node? I  hope to have an appt w/an EP as soon as I can get in, and I am trying to do my homework so that I can ask intelligent questions about my elec prob!!
(I am knew to Charlotte and would love to have a recommendation from you if you know of an EP here.)
As I see it, I have 3 options:

Do nothing and live w/the daily arrhythmias which can cause much anxiety. I have tried Toprol XL 25mg (almost a year) and then Varapmil 180 mg and I have a question about that...would it take longer than one week to see good results, b/c I only stayed on it for that length of time. Someone told me yesterday that it takes a month or so to see a difference.

Try more BB's or Calcium Blockers to see if there is one that would help.

Or an ablation but would that be a risk for someone my age since my arrhythmias are not that serious, more of a nuisance, perhaps, altho to me, they seem serious! I guess b/c they are so frequent and esp when they are sustained.

I do not drink alcohol or anything w/caffeine, do not smoke, and try to eat healthfully.

Thank you for shedding more light on this for me. I value your opinions so much as we all do.

[Michael J. McWilliams, M.D.]

what do EP's ablate when there are PAC's and PVC's?

We map the where the extra beat is coming from (if it is one morphology) and ablate at that location.  If your PACs and PVCs have many different shapes (morphologies), it would be near impossible to ablate.


What could be the cause of these types of arrhythmias? Would it have to do w/the SA node?

The electrophysiologic explanation for what causes a PAC or PVCs is too difficult to explain here and does not really help clinically.  It does not usually involve the SA node.  PACs can come from anywhere but more often from from veins like the pulmonary veins, coronary sinus and superior vena cava.  They can come from many other places as well.


I  hope to have an appt w/an EP as soon as I can get in, and I am trying to do my homework so that I can ask intelligent questions about my elec prob!!
(I am knew to Charlotte and would love to have a recommendation from you if you know of an EP here.)

I do not know any EPs in the Charlotte area.  I know there is a good EP in Asheville, NC.

http://www.asheville.cardiologydomain.com/handler.cfm?event=practice,physicians,detail&physicianID=24A7AC65-2208-11D5-8BB200D0B7B0B8FC

If the medications do not work in the first few weeks to months, they probably will not decrease the numbers of PVC/PACs.

Conservation treatment is the standard of care.  The use of medications or no medications is preferred, rarely are ablations done for PVCs or PACs.  There are certain types of PVCs that are easy to ablate from the right ventricular outflow tract, but these are not the most common location.

I hope this answers your questions.  Good luck..

[deedle1976]

How many PVCs /PACs per day are you having? My understanding is that you have to be having them pretty much constantly (like minimum 8,000) in order to be a candidate for ablation. Also I think it depends on whether they are unifocal or multifocal.

[Barbmag]

No, even tho I get sustained events most every day, some lasting for hours and isolated PVC's each day as well, I don't think that they run into the range of 8,000. I am sure there have been days when they are in the thousands but not every day, thank Goodness!!
What does unifocal or multifocal mean? I guess I could google it but perhaps you could tell me!!
Thanks for you post to me!!
PS,...I love London and your country!!! :)

[deedle1976]

Unifocal means they all come from the same area or focus in your heart. Multifocal means they come from different area in your heart.
8,000 is just a number I picked out of the air. There's no exact figure as far as I know. People on here who've had PVCs ablated have generally been having near 20,000 per day.The ablation has risks whereas the PVCs don't (apart from driving you crazy!) I think you have to have alot to justify this risk and also so that they occur during the ablation procedure.  I don't really know much about ablations to be honest. This is just stuff I've picked up from reading this forum.
Thanks for the comment about London. Actually I'm from Ireland but have been in London for the last 5 years. It's a pretty cool place.

[Barbmag]

Thank you for clearing that up. My brain was going in the right direction but just wanted to make sure!!
I can certainly understand about the ablation and do not want to have one unless it is necessary. I just wish there was a safe drug that would take care of all of our PVC's and PAC's once and for all!!! I tell myself all the time that they are nothing to worry about, but then sometimes I do not listen to those words, esp if I am having a bad day!
I have not been to Ireland but we want to do that one of these days. It is just gorgeous! You are v lucky!

[Barbmag]

Thank you for answering my many questions and just to make sure I understand a little more about these meds~~~it would take longer than one week to see any improvements or reduced no of palps if there were going to be any, right? I perhaps did not give the verapamil long enough to do it's job. Plus, in your experience, does it take more than 25 mg of Toprol XL or 180 mg of Varapamil to see a difference in the no of PVC's or PAC's? I think b/c of my reluctance to take meds in the first place, each time I was taking these meds, I did not give them a chance. Would you agree and have your patient try an increased dose before stopping them all tog? I know it must depend on many factors but in general does it take a higher dose?

Is there one BB or Calcium Blocker that is your first choice over all the others for this type of arrhythmia or does it just depend on the person's cardiac condition, etc?

I appreciate your patience so much and thank you again!

[Michael J. McWilliams, M.D.]

There isn't one beta blocker better than the others for suppressing PVCs.  I would increase the dose to a moderate to high range before trying another medication.  I would arrange follow up in about 2-3 months to assess for improvement, a few weeks is not long enough.

[bichl]

I am 61 and also have many symptomatic PVCs and a resting heart rate usually in the 50s.  A 24 hour holter monitor registered 20% of my beats to be etopic.  I have seen 2 cardiologists and an EP.  I first was prescribed 25 mg Toprol  which did not help the PVCs and slowed my heart rate down and made me tired.  I next was prescribed flecainide 50 mg bid.  I have read may scary things about this med but my stress echo revealed I had a structurally normal heart and both cardiologists and the EP said I was a good candidate for this.  I must admit that it has helped a lot with the PVCs the one week I have been on it.  However, I had terrible abdominal pain and related digestive issues this past weekend which I suspect (but am not sure) may be related to the flecainide.  I am tempted to reduce my dosage and see if my PVCs remain suppressed.  I have touchy digestion anyway.  A quandry to be sure.  I am terrified of the ablation which was discussed by the EP.  He seemed to think the flecainide was the best course of action.  Anyway, you may want to discuss this med with your doctor.

[LukeL]

for what its worth I have found Toprol XL to be a gift from heaven. it blocks out 99% of all palps. I know I still have them I just don't feel them.

[Barbmag]

I will be seeing an EP on Feb7 to re-evaluate my situation. I have not seen this doctor yet so I look forward to getting another op. I just hate taking meds of any kind and thought that I could figure out what my triggers were, not do those things and also find some natural supplements that would help suppress the number of skips that I get daily. That has not worked and continues to be a source of frustration for me.
Thanks for your post and I will certainly ask my doctor about the med you are on. I hope you stay healthy and have found something that works for you!

[Barbmag]

I only took 25mg of Toprol XL so that was not enough to see any difference, perhaps. It did cause a certain amount of fatigue and so I am not sure if the increased dose would make me feel like a zombie!! But, I would love to find something that would help!!! Thanks for you post! I really appreciate everyone who has something to say on here!!!

[LukeL]

I also had severe fatigue and the zombie like feeling for the first 1-2 months, but that soon went away. You may need to give it some time, or try a different beta blocker, or go to a different class of drugs. I know some doctors like to use calcium channel blockers first.