RF-Abaltion OR MEDS

Oddly, my arrhythmias started out with episodes of PSVT  lasting several hours before reverting back to a normal rate, in the ER " of course".now when I do get the occasional breakthrough of PSVT or even IST, it subsides within 15-30 minutes, unlike the dreadful hours they lasted before I learned the ingestion of alcohol was a trigger for my SVT which would revert back to normal in 3-4hours, at which point the ER would release me. As luck would have it, I would go on to develop  PVC's 2-years after the SVT started.  I didn't know what felt worse the PVC's or the SVT!  Then in 2000 the couplets, triplets, bigeminy, trigeminy etc, was born. The event and cellular monitors I wore shortly after the onset of the Multi-focal/Multiform PVC's, all of this and even 5 beats of IVR.These NEW multi-form PVC's would last 2-3 weeks. Nvertheless, I would get remissions for days, weeks and even months, since they began. That is WHY I am on the fence and reluctant with RF-ablation. I understand  SVT is highly amenable to RF ablation  BUT for PVC's    even today, is less successful, especially if the focus/ foci are located on the left-side of the heart.  I "almost" got the nerve up for the EP study a few years ago, but, after reading "many" posts about repeat and unsuccessful RF-ablation outcomes, I backed out.  Otherwise, I would do it and get it over in hopes it will eliminate SOME if not the majority of my arrhythmias. That's why I wonder if I am truly a candidate for ablation at all? or should I (in my case) just tolerate the intermittant episodes, even when they roar in like a lion?? They haven't killed me yet but I will say they have effected the quality of my life over the 14 years I have been plaqued with these two rhythm disturbances. Lets NOT forget the side-effects of the MEDS! An EP study "if all goes well" maybe will at least tell me definatively whether I do in fact have any lesions..Focus/Foci, and a bypass tract or accessory pathway (for the PSVT) causing "my" Arrhythmias!  Even if they successfully ablated the PSVT portion of my atrial Arrhythmia , I would still be stuck with Ventricular PVC's, thus, still having to take MEDS! It's a catch 22! What does one do? Take the meds, or keep getting my annual Echos/ECG's, Thallium Stress tests, and the occassional wearing of a 24-holter monitor when I get a long run of PVC's as to ascertain and ensure they haven't progressed from the harmless ones to what could be a life threatning Arrhythmias.
Thank So Much!

[mabebesc]

Hi,

I had a succesful ablation on Aug. 4th for SVT, specifically AVNRT. I started episodes of SVT at the age of 16 and at the age of 52, I decided to do something about it.  I thought the EP study/ ablation was no big deal to go through and I'm the biggest chicken!!  My quality of life is so much better now.  I was getting to the point that I was scared everyday of getting an episode . It was the best thing I could have done for myself.  
I realize our situations aren't quite the same but I would think getting rid of at least one of your arrythmias would still be so beneficial .  Good luck and keep us posted.
Betty

[notahypo]

Thanks Betty it makes me feel better about "finally" doing it myself when I hear MORE success stories, like yours. Let me ask you, did you have a single ablation or multiple before you were cured?? Also, if you don't mind me asking where did you get your's done and who the Doc was. Lastly, was it an RF or CYRO ablation that you had done?? I agree, It makes sense to rid myself of at least the PSVT..of course, getting rid of some of Ventricular Arrhythmias would be nice too!  I am just so afraid that I will NOT remain on that table when they shoot me up with epinephrine, which I understand they do prior to Pacing and Mapping. I also worry about them accidently ablating my sinus OR more commonly, my AV node if I choose to try and have the PSVT eliminated. I may NOT be as fortunate as you and be the one who gets the pacemaker, or worse yet the stroke during the procedure. I know... I  always think the worst, it's hard not too when your luck in life in general is not the greatest..I have had a sudden rare reoccurance of bigemminy, Trigeminy, on and off for the last 4-days now. I thought it was the result of taking effexor ER for the first time, which I haven't ruled out but there is a chance that it was coincidental? So I am having a BAD week even though they are NOT exactly continuous they return and are still frequent. This is why I may have to finally do something about it, even though they probably will subside soon. I am tired of worrying when the next STORM of PVC's will be. It's not the few that bother me, it's the complex PVC's that are hard to cope with OR runs as they say. The SVT is udnder control with a occassional breakthorughs but the PVC's are almost always there until they too go into remission. My stomach has been so upset and burning during this last flair-up of multi-form PVC's, I am taking Nexium now but it seems to do NO good, at least yet!
Thanks
Eddie

[JonHart]

Betty:

Be aware of the probabilities of ablation succeeding before you take the big step.  I had a combo heart valve replacement/Maze RF ablation in June 2007 (at age 70).  The ablation was to assist in "curing" A-Fib that I believe followed a severe dental procedure using Novacane/Epinephrine.   The perceived success rate was 85% with random A-fib and 50% with chronic A-fib.  Ten days after the surgery the irregular heartbeat returned, though not quite as bad as the original.  I was told let the heart heal before we take further steps.  After nine months of Amioderone, Digoxin and Warfarin my heart began sinus rythym.  My lifestyle was fairly normal (biking, golf, etc.) Six months later, the irregularity is back. Also back is Warfarin and a new beta-blocker, Bystolic.
The message is: get a good electrophysiologist to map your heart properly and get the least invasive procedure possible to minimize your discomfort.  Then give your heart time to heal properly.

Here's hoping for your success,

John S.

[notahypo]

Thanks for that tid bit of info.  That is obviously why I am reluctant to do it and instead choose to "suffer" and endure" the BAD episodes, like the trigeminy, quadrigeminy, and interpolated pvc's (but those I get often and can handle, if the runs are not too long) until they pass. I too have MVP w/trace regurgitation and "I'm told" over and over I have a structurally normal heart, since the last 15 years and the onset of these arrhythmia. My Ejection Fraction is 55%. My baseline ECG is always normal for the most part. These Arrhythmias would have never been discovered OR seen by the doctors had I not repeatedly wore an event AND 30 day-cellular heart monitor twice in a year! Now they BELIEVE! However, I am still left with enduring the breakthrough and sometimes longer lasting episodes, despite BB's and anti-anxiety meds. of course. This is why I am seriously contemplating on taking option "B", in this case, an EP study followed by ablation, if they even find anything. In my case, they would be "attempting" to rid me both of PSVT "and" Venrticular Ectopics/PVC's. So , it's really a no brainer that I "probably" have multiple areas to ablate. Yes, I am worried that I will come out no better than when I went in, and possibly even worse, with a life-threatning Arrhythmia I never had. OH.. and a pacemaker, if the operator and the EP doctor I choose aren't the experts I had hoped they would be. It's a rough decision and I concur with you John on doing ones homework to ensure we are in the BEST possible hands of the "true" PROS in this field of Electrophisiology"!.

Eddie
NotAHypo

[Momto3]

NotAHypo,

Is your EP willing to ablate for PVCs?  I wasn't able to find a doctor who would ablate until I was diagnosed with cardiomopathy.  I have at least moderate mitral regurgitation, but have had that for at least 30 years.  

Are you thinking of ablation because you are worried?  annoyed by the long strings of PVCs?  I can understand why you'd want to dump the PSVT!  I've heard that's pretty scary, not dangerous, but nonetheless, YUK!

[mabebesc]

Hi,
I had a single radiofrequency ablation done at Boston Medical Center on Aug.4th.   I have had no SVT since, thank goodness. The ablation was done by Dr. Kevin Monahan and he was excellent.  I felt exactly like you.  I was sure I was going to be the statistic who would get the stroke, the pacemaker, etc. etc. etc...........  I think we all feel that way.  But look at  all the successful stories out there -there are tons of them.  I was absolutely terrified -I think I drove everyone here on the forum nuts because I was constantly writng how scared how I was!!  I'm here as well as the rest of the forum to help you in any way we can. If you have any more questions,  I'll be happy to answer them.
Betty

[upbeat633]

Like momto3, I can not find a doctor how would consider doing an ablation for pvcs (in Connie's case, it wasn't until she developed a cardiomyopathy from the frequent pvcs--but that is a somewhat rare occurance--that they decided to ablate).

I understand how you feel, I too get multi-form pvcs, drives me crazy, I've had days and days, even weeks of bigeminy, so much so that going into trigeminy and quadgeminy made me feel a little hopeful :-). I've had several strings of pvcs, at highest count 62, but EP still not concerned, and still won't consider ablation because it was never intended for pvcs and carries a small risk of stroke or other complications when pvcs are supposed to be benign and when I have a structurally normal heart.

If your decision is to have the ablation because of the pvcs, keep on doing research and asking questions. I've heard a lot of good stories of people who had an ablation for SVT or other reasons, but some of them end up having pvcs after!!!

I am a bad pill taker, but a little acebutolol has stopped the long strings and I've had long stretches now with no pvcs at all, some days better than others. It has made me feel like the EP's advice was in my best interest after all, but I didn't think it at the time he was saying no, no, no to ablation.

[notahypo]

Yes there are Doctors I've been too that will attempt PVC ablation both here in NJ and NY. Dr. Zimmerman @ Hackensack University Medical Center and Dr. John Fisher @ Montifore Hospital in NY. However, they BOTH tell me that although they will probably rid me of the PSVT they say there is NO guarantee that they can "Successfully" ablate mutliple "foci", especially if they are located in the left side of the heart, since it's too close to the Pulmonary Vein/Artery. However, Dr. Fisher told me, and I quote, " Ed, we probably could get rid of "some" of the foci causing the ectopics, which in turn, "may" reduce the majority, or at least some of the more bothersome episodes/ PVC's. "We may NOT get them all but if we can reduce them to a "tolerable level" by ablating some of the foci, "provided they are multi focal PVC's, this will REDUCE some of the Type, Frequency, Intensity/Run, if you will, to infrequent episodes, you can live with. It's funny the one doctor says I can be totally under during the procedure and the other says I have to be slightly awake to tell them when they duplicate what I actually experience during the various episodes. Also, I was told that PVC's probably won't occur if I am "totally" asleep during the procedure. A little confusing because if it's a "Focus or Foci" causing them why couldn't they initiate them just as they would an SVT or any other Arrhythmia? when they are Mapping and Pacing?? It doesn't make sense. Then Again, I am NO doctor. Anyway, to make a long story short, apparently there are EP specialists that will go after "benign" but problematic/bothersome (at least to many of us) PVC's?

Thanks to ALL for your input, especially Betty for sharing her doctor's info. and location. I wonder what "his take" on  PVC's and  ablation is?

[Momto3]

Hi Eddie,

I was/am multi-focal, but the majority of the shortcircuits could be attributed to two predominant foci; one was right side and one was left...got 'em!!

I was in a "twilight" sleep.  I'm told I followed directions, did arm exercises, etc. I don't remember any of that.  They did say the versed tends to suppress the PVCs so they would ease up when they were ready to ablate and the PVCs would recur.  Mine were pretty pervasive so getting them to occur was not too difficult.

What have you decided, or have you?  Tough call, but could be worth it just to get rid of the PSVT.

[notahypo]

I was just called by my"cardiologist" who's EP staff doctor read my holter and "as usual"  they say they are NOT concerned with anything they see, even now, BUT if I want to have a consultation with the EP doctor Dr. Jima?? who is now on staff at my regular cardiologist's office.  I am contemplating on JUST the consultation for now. I am at a standstill once again, also because they have mostly subsided after over a week of the onset Bigeminy and Trigeminy, Quadrigeminy... etc,, So I am so confused as I know they will return with a vengeance and I will once again be in the "want to do something now" mode!

[upbeat633]

Funny isn't it, pvcs can come and go as they please like bad house guests.

Mine were so bad at the begining of this year that I made up my mind to see an EP and ask for an ablation. I didn't care anymore, after  weeks of bigimeny they were going into long strings and I couldn't stand it.

Well, you can pretty well guess what happened. At the EP appointment, they all but stopped. He must have thought I was crazy.

However that was not what he based his advice and decision not to ablate upon.

While he was aware of my holter monitor the year previous that showed 30,000pvc/day, he also reviewed a recent echo that showed structurally normal heart. He said no to ablation because pvcs are "benign" (except to those of us who have them :-))) and he said no to anti-arrythmics.

I don't see any harm in you going to the EP appointment. You will get one more set of eyes to look over your condition, and you will get advice from a specialist in electrical problems of the heart to add to what you have already researched. This will help you in your decision as to treatment options.

Good luck. Let us know how it goes.

[Momto3]

I can totally relate to right where you guys are/have been!  There were times when I thought that someone just needed to get rid of the PVCs because I could not stand it anymore!

Armed with my Holters showing thousands per day, I was ready!  I was in bigeminy in the doctor's office, even some nsvt episodes.  You guessed it again....NO ablation, no anti-arrythmics!  GRRRRR!!!  For me, it was more that I didn't like the anxious feeling I got when I had the PVCs.  I was NOT worried, but it just felt so weird.  I felt like my nervous system (not me) was on edge......no ablation, no anti-arrythmics : (

Then the cardiomyopathy showed up....New plan!  Anti-arrythmics and 2 ablations.  Like I said I wasn't worried, but when this happened, the doctor became much more concerned.  Now, I was a little worried.....I had a short run just a little while ago, no worries, just weird...

[notahypo]

Your exactly right what harm can yet another EP consultation, 10 years later or so, do me? None! He will probably say, at the very least something I already heard... like "since" you have NO syncope associated with your PVC' runs and the various types you get and have a structurally "normal" heart, there is really "no need" to ablate"!?  Just stay on a BB to reduce the symptoms! "Oh and"Yes we can probably eliminate your intermittant episodes of PSVT, that appear to have taken a back-seat to your Ventricular Rhythm (essentially because of the Tenormin)  but you'd still be stuck with the more frequent episodes of the PVC's!" So... I am going to see if ANY "new" strides in ablation have been made and also just see  what "another" EP doctor suggests and advises at this stage. Maybe, I will just try to cope with those episodes that roar in like a Lion, and just keep repeating the mantra, as I have over the last 14 years, "This Too Shall Pass" and stay on the meds (Not Anti-Arrhythmics) that at least I know do "help" a little. Of course, If this doctor can convince me that he his 99% sure he can rid me of the PSVT, (without the need for a pacemaker) even though the PVC's are more common these days, I may just say to hell with it and just do it! At that point if something goes array during the study or they can't reproduce the PSVT, etc... My mind will be made up that getting it done, at least for me, was NOT meant to be, at least yet!

[upbeat633]

I think that once you have made your mind up to proceed in a certain direction you do so with more confidence. Interestingly, by doing so, you take back some of the control, it's not all PSVT or PVCs controlling you, it's the other way around. It sounds like you might be on the right path, or at least have a good attitude about going forward to investigate further.

In my own sitution I wonder if that's what settles the pvcs a bit, when I feel like a church mouse, wham thousands of pvcs, when I feel like a lion, they behave a little better. I'm somewhere inbetween today :-), hope they are better for you?

[notahypo]

Hey thanks Upbeat663.. you surely named yourself appropriately for the forum "upbeat" that is! As I sense you have a great "upbeat" attitude about this problem many of us share in these forums. Your definately on target about a connection with the "mindset" of the sufferer and the  incidence/intensity of these eposides. I too notice when (and excuse the pun) I am "upbeat" or have a positive frame of mind, they (the PVC's mainly) truly either subside or are much less pronounced? This is a fact! So I agree with your approach 100%. Thanks for reinforcing that.

Eddie