PVC count rising after ablation

[jrizzuto]

Hello all, had a cryo-ablation 2 years ago for AVNRT, accelerated Junctional rythmn, some strange beats overall. The ablation was a success in that all the SVT's are gone. I had lots of odd episodes during 6 months after ablation but they seemed to calm down after that. I am not on any drugs at all, low cholesteral, normal to low BP. The low BP prevents me from using betablockers. I'll use .25 Xanax when my anxiety gets rough, but not on a consistant basis.

But now....since the six month mark (it's now 2 years later), the PVCs (which I got occasionally before the ablation)  seem to be rising as time goes on. I have a hand-held EKG that I use to check and I'm getting "missing beat" and "PVC" way too much. Mornngs seem to be the worst part of the day, after lunch it calms down, and evenings are good. But those mornings are driving me nuts. I will get trigeminal beats very often, but the norm is every 4th beat is a skip. This goes on for hours - driving me nuts. Then like magic - it goes away. No rhymn or reason.

My cardio says PVCs are harmless and not to be alarmed, and since I cannot tolerate drugs...well what can I expect from a doctor if I cannot tolerate drugs? I agree with that.

My concern: are these JUST PVCs? Could the ablation have upset something and now I have a new problem that could be more dangerous...perhaps throw me into a v-fib and sudden death?

Additional info: Smoking vs. no smoking doesn't seem to make a difference, I still get the PVCs...perhaps worse when I don't smoke since my anxiety goes way up. Same with red wine, I like 1-2 glasses in the evening, wine or no wine... PVCs are the same.

[jrizzuto]

Well you may have a point, since the EP said he did a lot of work immediately around the AVnode, that was the spot. So close in fact that he chose cryo rather than RF.

[itdood]

in late, but here are my thoughts.

I'm wondering if the source of your PVCs is any where near the ablation spots?

You probably don't know the answer to this questions without a proper EKG study of the PVCs.

*usually* PVCs come from an area of the heart called the Right Ventricular Outflow Tract (RVOT).   The RVOT is sorta close the AV node, but I'm thinking the ablation spots won't be near the source of the PVC impulses.  So the two wouldn't be related.

Anways, more ideas for you to investigate.

[jrizzuto]

Opps - posted a typo on the numbers....should be:

Red blood count - 4.18 (L)       range 4.20 - 5.80
MCV                 - 104.4 (H)      range 80.0 - 100.0
MCH                 - 37.2 (H)       range 27.0 - 33.0

I know these numbers are practically borderline but I was always in the center of the range.

[jrizzuto]

Yes I think you are right. I'm wearing the event monitor this week, let's see what happens. Fortunately my doc is attached to the same "Heart Place" as the EP so she can send him the results too.
In the meantime she gave me a blood test. They forgot to include magnesium (damn) but got mostly everything else. all is good except for the CBC stuff, not terrible but a little odd:

Red blood count - 4.18 (L)       range 4.20 - 5.80
MCV                 - 1.4.4 (H)      range 80.0 - 100.0
MCH                 - 37.2 (H)       range 27.0 - 33.0

I know 100% these values were ALWAYS in the center of the range. This points to anemia of some sort, the MCV-MCH relates to the size of the red cell itself, points to anemia, either B12 and/or Folic acid deficiency or too much alcohol. I drink 1-2 glasses red wine every night for probably 15 years. OK maybe a little more on weekends when we sit by the pool, but I don't overdo it. So I bought centrum silver multis and will start today. I don't want to go overboard with a bunch of vitamins that you essentially **** away since you can only absorb so much - waste of money and taxes your kidneys for nothing.

Amazingly enough I read that some forms of anemia can give you massive fatigue and irregular heartbeats. Mmmm, funny !

[cindy707]

Yep it does make sense to me...Inderal was one of the meds i was on too before i had the ablation but had to be taken off of it because of the side effects of just feeling like i wanted to sleep all of the time.  Just food for thought Jrissuto i ended up on Antenolol with no side effects after trying four different meds.  I guess my main question is ....is the doc you saw the one who did the procedure or your diagnostic heart doc?  My feeling was that the diagnostic heart doc looks at the bigger picture ie:  PVC's, Atrial Fib., etc. and the ablation doc is the one to me that would know what the residuals of the ablation would be for you because of what they saw and what they did during the ablation.  There may be a fairly simple explanation for this happening and to me i always go straight to the horses mouth...and that would be the doc that heard, saw and conquered depending on how and where they ablated...just a thought.......:)

[jrizzuto]

Well I had to make a little adjustment to my plans. I didn't take the Inderal this weekend, this is why:
1- I was expecting the event monitor to arrive, so why bother measuring with an event monitor if the pill fixes it? Let me do the event monitor and THEN try the inderal. Make sense? As it turns out, the event monitor never arrived on Saturday like they claimed. I guess it will come Monday.

2- I'm also chicken and prolonging taking meds. It is what it is.

[jrizzuto]

Hey Cindy, glad you found me....again.

I went my cardio today, explained the situation. She took an EKG, sure enough 3 PVCs in 10 seconds. SO I asked for a blood test (for thyroid, electrolytes) and an event monitor. She agreed. When I get the event monitor, the object is to identify 1) how many PVCs I'm  getting and 2) is it JUST PVCs or did I developed some new issue.

She also gave me Inderal 10 mg. I explained that I have LOW BP and a pretty slow heart rate already, sometimes 58-62 at rest. I don't need a pill to make these lower than they already are and I won't be able to function. But she said go small, 1/2 to one pill once a day. See how I feel, see if I can tolerate it. If it helps the PVCs...great. If not we will explore another ablation.

I guess I should give it a try over the weekend when I am not working. If I know myself, I will probably have all sorts of side effects, most in my head, maybe a few real ones. I can imagine extreme fatigue, SLOOOOW heartrate, low BP, feeling like death LOL. Then I will do what I did with all the other meds I tried...throw them away. What a waste of time and money. But, I am what I am. I'm actually trying to psyc myself up, high hopes, telling myself "this is it, this will work, give it a try stupid!!!!"

Wish me luck.

[cindy707]

Aw man i am sorry that you are going thru this jrizzuto...i was so happy when you had your ablation for you.  The thing is that i always try to put it into perspective altho i don't know if it helps much....the heart beats for all of us on an average of over 100,000 beats in a 24 hour period...so that kind of puts things into perspective a little.   As far as V Fib, etc. this is one of the times where you need to step away from the computer and not even look at those things...i mean that's crazy my friend....sudden death is pretty darn hard to come by and as far as the ablation causing something new to pop up....well i guess it depends on what type of ablation you had...its a pretty well known fact if a doc "burns" the pathways that scar tissue can build up and over time the electrical conduction has to re route itself once again to go up over and around the new scar tissue...that is why burning is pretty much an antiquated way of doing ablations...most doc prefer to either using freezing or cryo or RF waves because you don't have things like that happen.  With ablations all they are trying to do is basically re route the electrical firing patterns back the way that they are supposed to be along the correct pathway...so to do that they have to close off any errant pathways, ridges, dips, etc. or zap the weird areas .  I don't know what your final situation was but i do know its possible for new areas to pop up and a tune up is sometimes necessary.  If it were my body i would call the ablation doc that did the procedure and throw it past them because they are the ones that basically had their hands in your heart with the wire and correcting everything.  My heart doc said that with some people you will get random runs and then they suddenly disappear and are never to be seen again...and now i can attest to that one because it happened to me 2 times in the past 5 years...once again thought i was dying LOL it lasted a nite or two and now its been a couple of years and hopefully they will stay in PVC-derdam or whatever country those buggers are from.....hopefully yours will do the same but if in doubt call the ablator they have first hand knowledge of physically  working with your heart...good luck my friend and i hope that they take off and never return like they did with me....................

[jrizzuto]

The original reason I had the ablation was soemthing called "accelerated Junctional Rythmn" which was spotted on the holter measurement. When the EP went in he found the real root cause - AVNRT. I had a few fibers going back up to the Atria from the Ventricle, causing both to beat together. Very strange. He said I had a lot of echo beats in there too. So all his work was very close to the AVNODE, so he chose to freeze (cryo) rather than burn. The rythmn after he was done is GONE.

Now I also had PVCs but he did not address those since I only had a few hundred per day. I can't say for sure but I feel as though I have 10 times that now, getting more frequent every day. So my question is did the ablation disturb something? My next move will be another holter for a few days to examine what is going on.

Your description of skipping / hesitation sounds like PVCs to me.

[donna4140]

Im worried about the ablation damaging something just like you said. I dont want any more palps,or something worse. I guess I can live with what I have now . Not sure if I want to chance it.Maybe it depends on where they have to ablate and for what .And to answer the question about the effect atenolol has on pvcs, Im not sure if thats what  I have (pvcs-pacs) Those only happen once in awhile. Sometimes not for weeks and weeks.My heart will beat a couple of beats and then feel like it skips a beat or hesitates. Sometimes it does that for days or a week or more. The atenolol for me has no effect at all for those.It doesnt stop them. I have no clue what those are. Ive never had those diagonosed. Im assuming their pvcs.I dont know how you can say it was a success if your problems have come back?

[jrizzuto]

Donna - If you search on my earlier posts I describe the post ablation experience. I can tell you that after it all I am very happy I did it despite these other issues. My SVT was killing me. You do have odd sensations even up to six months, where the heart tries to use the old pathway that is gone. Hard to describe, but you will know when it does it.

See I always had PVCs, just not so many. My concern is that the ablation damaged something or is causing the increase of PVCs. But the ablation itself was a success.

[jrizzuto]

What effect has the atenolol had on your PVCs?

[donna4140]

I take atenolol also .Im on 50 mg a day. I take 1/2 in the morning 1/2 at night.It seems to work out ok that way.That way Im not wanting to fall asleep so much.

[DeltaDawn23]

I, too, tend toward low bp.  I ended up taking Atenolol 25 mg. (beta blocker) and breaking into 1/4's and keeping track of bp and delaying a dose if my bp or hr is down.  I go between 1 to 2 25 mg. tablets per day.  When I took a whole tablet, it hit me like a ton of bricks.  I'm wondering if you could tolerate the Atenolol taken in this fashion?

[donna4140]

Hi,  I was wondering where you had your cryoablation done? I have a appointment for one in august at brighams & womens hospital in boston. I have atrial tach,and afib.I worry about the aftermath of having it done.So at this point I am still debating whether or not I even want to go through with it.Part of me wants it done so I dont have to deal with atrial tach anymore,but Im wondering if it will stop other palps from happening or cause more.I have heard that cryoablation sometimes does not last,and then the problems will return. How long did it take for you to start feeling better after you had it done?How soon were you able to get back to doing normal things? Are you on any meds? Im worried that I'll have more palpitations after its done.For the most part my heart beats pretty normal. On occasion I'll get palps that can last for days or weeks,and then theyll just stop .I have no clue what those are.Pvcs/pacs?? Ive also heard to avoid wine,because it can make palps worse. Ive also found that hot or spicy foods can give me palps. So I avoid those.Also what were your odd episodes you said you were having?

[jrizzuto]

Hi Jerry - yes I know these bad habits have a role, but believe it or not if I stop either one for a while it has no impact on the PVCs - they are there no matter what. Since no one wants to be on the same planet as me if I don't smoke, and my anxiety levels go sky high, even my GP reluctantly said "go back if it makes you that crazy". He is not happy about it but some folks are just hard core. I cut down bigtime, just enough to keep me sane.

My only reason for writing was to explore the possibility that the ablation may have did something unexpected and is making the PVCs much more frequent. If anyone has a similar story, please jump in.

Jim

PS - Missing NY/NJ, here in Dallas.

[Jerry_NJ]

As you know the smoking and alcohol are not helping.  

I too drink a beer or glass of wine many times at dinner, and shouldn't.  It doesn't seem to cause me any problems.  I quit smoking about 25 years ago.. it was hard but I don't miss it at all and haven't for many years.

You have been checked by a heart specialist and think it best to try to put the AFib and sudden death thoughts out of your mind.  It may be hard, for be I simply decide to think about something else or get busy doing something.  I have the most trouble putting upsetting thoughts out of mine when trying to get to sleep, especially in the dark.  My problems are mostly nostalgic/age driven, I'm a "senior".  I suffer from permanent AFib and thankfully have few symptoms when not physically pushing, so I just don't think about AFib or sudden death.