PVCs and additional ablations

I had an ablation of two areas on the outside of my heart about 6 weeks ago due to very frequent episodes of V-Tach(300beats per minute). The EP doctor stated I had 6 different areas but only ablated 2 of them. The following day I went into V-tach twice. They started me on Solalol twice a day and then put in an ICD the following week. The first week was rough, with alot of activity, but then it was next to perfect... no V-tach and not one PVC. Then a week ago, the PVCs started again..just like I was having before the ablation. My questions are: What would cause the PVCs to  re-appear all of a sudden and is there anything that can be done to control these? It seemed like when the PVCs got more closer together, V-tach usually happened. I have tried to express my concerns with them(over the phone), but they don't seem to think the PVCs are anything to worry about.

[Michael J. McWilliams, M.D.]

What would cause the PVCs to  re-appear all of a sudden and is there anything that can be done to control these?

It is common for PVCs to go away and come back at random times in some people.  There is not a good explanation why this happens and there is not a great treatment for it either.  Sometimes medications like sotalol help, but not always.  

It seemed like when the PVCs got more closer together, V-tach usually happened. I have tried to express my concerns with them(over the phone), but they don't seem to think the PVCs are anything to worry about.

PVCs alone are not usually a reason for aggressive medical or ablation therapies.  If the VT is recurring, conservative treatment is probably better and has fewer risks. The suggested treatment for PVCs is reassurance and it sounds like that is what your doctors are doing. If you aren't sure that they are doing the right treatment, consider a second opinion.  

I hope this helps.

[kim62]

Thank you for your response. It seems that prior to the ablation, the more they tried to control the VT with meds, the more PVCs I would have... to the point where it would make me nauseous. I do have a problem with controlling my potassium level and I am wondering if that could be a factor since they took me off of my supplements 6 weeks ago. A second opinion? Hmmm... maybe a fourth? I have seen 1 cardiologist(who fdiagnosed me with SVT) and 2 EPs..who say it was not SVT...one said ablation should do the trick, the second one said ablate 2 spots and throw in an ICD to control the rest.... See any frustration building here?

[Brnvc]

The potassium is critical so I would go back on it. Also magnsium. Get your electrolytes checked and read up on Sotolol. It often makes PVCs worse and isn't a good drug for them. I'm having the same problem with PVCs post open heart surgery and also have an ICD. They say "you're safe" and that's pretty much all there is to it. Your drs shouldn't have had you on Sotolol. Find a good dr and EP but work on the electrolytes, stay away from caffeine, MSG... all kinds of food stuff can set them off. You're triggering it so keep a log. You can help yourself a lot -- and you ARE safe.

[kim62]

I agree about the potassium & magnesium. I was taking potassium for the last 5 years. I have been on so many different meds to control the VT. I just started the Sotolol a couple days after my ablation.... which was on 02/12/08. They took me off of everything else and now I take just the Sotolol. I feel the only thing that was accomplished by the ablation & the ICD... is the ICD converts me instead of me having to go to the ER once a week to have them stop it. I have my device checked on the 9th and I am anxious to see what all they have to say about the amount of activity.  On the low end,they had to set me at 40 bpm because the Sotolol make my heart beat too slow and the ICD was pacing me about 21% of the time when it was set at 60bpm. On the high end to convert me is set at 135 bpm because "I have a high tolerance" so they say. Average VT for me is right around 250-300..so, I guess it really didn't matter what they set it at because 135 is no big deal. As for finding a good docotr and EP... I had a team of 5 of them at one of the country's best heart hospitals...so... if you know anyone better... let me know.