PVC's and Hemochromatosis

[Celeste77]

I'm a 43 year old women diagnosed with Hemochromatosis and I have multi-focal PVC's (3 noted foci's), mild MVP and runs of NSVT.  I also have problems with chronic low to low normal potassium (2.9 to 3.6) and magnesium.  August 2006, my annual EKG, stress-echo showed an EF of 65%, mild MVP w/o regurg, no signs of blockages, thickening etc. 2 weeks ago I came out of a year long cycle of horrible PVC's. At it's worst, I was having as many as 10 to 40 per minute every day almost the entire day, with periodic runs of 6 to 8. I also had weeks on end of bigeminy.
My current ferritin level is 721, serum is 257. I will begin phlebotomy again on July31st. In the last few months it's come to my attention that Hemochromatosis in itself can cause arrhythmia's, including PVC's, and of course Heart Failure or CAD.

In your opinion, could my increased PVC's be a result of iron-overload? How will I know if subtle heart damage has already occurred due to Hemochromatosis? Could having Hemochromatosis increase my risks for serious arrhythmia's or SCD?

Concerning multi-focal PVC's: With having multiple foci's, all foci's producing PVC's close together, is there increased risk of having one of them fire off during the middle of a T wave and inducing VF?
Are multiple foci ablations less successful then single foci ablations? If so, why?

Thank you. I appreciate your time.
Celeste

[Michael J. McWilliams, M.D.]

Hi Celeste, I am not sure if the cardiomyopathy regresses after it develops (I treat arrhythmias in everyday life).  The key is make sure that you don't develop the cardiomyopathy.  Women are relatively protected up to menopause because the menstual cycle acts as a monthly phlebotomy. The key to hemochromatosis is keeping the cardiomyopathy from occuring.

[Celeste77]

Thank you, your assurance is priceless!

If you have time, I have one more question: I know that many Cardiomyopathies can be alleviated through treatment of the underlying disorder so to speak....would Hemochromatosis be included in that group? Would the extra iron stores in my heart actually go away with the Phlebotomy if ever I developed a Cardiomyopathy from the Hemo?

I will try not to worry, although hard to do at times, I've really tried to to accept these darn things as benign and to go about my life as normal.  

Thank you again.

[Michael J. McWilliams, M.D.]

Hi Celeste,

Those are very difficult questions.  I am not sure that there is good data to answer them.

In your opinion, could my increased PVC's be a result of iron-overload?

It is possible that a cardiomyopathy from hemachromatosis could cause increased PVCs.  I believe an MRI is the best test to look at iron infiltrates into the heart but I am not sure that it is that helpful in guiding treatment, you should be treated the same way regardless of the results.  It is important to keep your iron stores low and you are doing that by participating in phlebotomy.

How will I know if subtle heart damage has already occurred due to Hemochromatosis?

I think an MRI is the best approach, but again, I wouldn’t order it.  I would just treat you to prevent it.

Could having Hemochromatosis increase my risks for serious arrhythmia's or SCD?

There is almost nothing in the literature on this topic.  The best I can say is that with advanced cardiomyopathy, yes there is increased risk.  Your stress echo shows no evidence of cardiomyopathy. Try not to worry about this one, you could make yourself sick with stress.  There aren’t even case reports suggesting this is the case.

With having multiple foci's, all foci's producing PVC's close together, is there increased risk of having one of them fire off during the middle of a T wave and inducing VF?

Again, there are no cases reports suggesting this.  Usually when something like this is suspected, case reports are published followed by retrospective studies.  

Are multiple foci ablations less successful then single foci ablations? If so, why?

A single PVC focus is usually relatively easy to locate and ablate.  Multiple foci is very difficult and once one or two foci are ablated, it is common to have a new foci or different morphology start.  Some people are prone to PVCs and we don’t understand why yet.  That is why you will find most EPs shying away from ablating multiple PVC foci.

I hope this answers your questions and decreases your concerns.  Thanks for posting.