So EP said I can't do anything about it. I'm doomed ?

[IA64]

This is a 2nd thread , an update to an old one which I'm going to quote here :

" Hello everyone, I've been having heart palpitations since 10 years and now that I turned 31, I'm on a business trip since 45 days.

I've had dozens of ECG, Electrocardiography, MRI etc.. which ruled out any abnormal health structure. That was in 2008 . One doctor said that RVOT was the cause of my palpitations ( I get many everyday ). Another doc confirmed that I seem to have PVC/PACs RVOT randomly.

I went for a RF ablation ( cost $31,000 covered by insurance ) but unfortunately they were not detected so doctor advised to live with them as these are probably harmless and symptomatic only.
Since 3 days, I' ve been having terrible episodes of palpitations, stomach burning sensation, left chest pain ( stabbing that would come and go ) I feel like all my nerves or muscles are weak and cramped.
I feel nervous all the time. Sometimes palpitations ease when I sit down but if I go to bed I can't sleep as they start the minute I lay down and it comes and go as I change sleeping position. I also have this burning sensation moving in my back and left chest.

I feel like I'm about to die and it happened that when I think it's coming, I get an immense feeling of fear or adrenaline rush in my body which makes me feel like my heart is stopping and beating very slowly.
The last time I had them that bad was 7 years ago when I was on a business trip as long as this one ( longer than 3 weeks ). I do usually get palpitation episodes frenquently but not the terrifying one.
I was in perfect shape when I arrived 5 weeks ago as I could go out joggin, boxing etc.. but lately the minute I stand up and walk i get almost paralized from palpitations.

One last thing I noticed is that arousal/masturbation etc.. triggers palpitations immediately.
Also pressing on my stomach / end of my chest will trigger them
Am I having serious heart issues or it's anxiety? Can palpitations over time damage the heart structure ?  what do do ? I tried beta-blockers and Calcium chanel blockers in the past but nothing helped.
I'm returning to home country on Friday as this is affecting my work and life."



Now after 3 months here's the update :


I went to the US and now I'm back to home country. I did there many tests ( ECG/EKG 4 days holter + MRI + Echocardio + Stress test

Findings :

I have

- PVCs ( Bigeminy, Trigeminy ) and in couplets and triplets ~ 1200-1500 / day
- PACs ~ 400-600 / day
- Atrial Tach / SVT ~ 1000 / day

Doctor gave me Betablocker which did not help at all.

Echo result was excellent

Stress test is OK

I quit smoking 2 months ago and still cold turkey ~ that did change nothing.

MRI results turned to be a bit concerning but doctor wasn't : They found one micro-aneurysm in the Right Ventricular Outflow Tract but everything else is normal ( no ARVC/D )

He said this might be triggering the arrhythmia but it's not life threatening.

- Flecainide did not help. Isoptin did not help . Indreal/Nebilet did not help.


Now for the worst part... I am not a cather ablation cadidate. Why ? because doctor said that my PVCs and PCAs are multifocal. They are not from the same place and don't have a dominant pattern or morphology.

So what now ? I'm doomed ? seriously I'd rather die than live with this horrible nightmare that destroyed 4 relationships in my life and made me unable to travel to pursue my career

[IA64]

Actually on the internet it says that Nebivolol is used to treat high blood pressure but had great effect on arrhythmia.

Not sure what my EP is doing here but calcium chanel blockers did not help. Flecainide/Isoptin and Inderal were almost a placebo pill.

What's really strange is that my PVCs are multifocal or polymorphic. EPs were astonished. They literally said that they rarely see anything like that. It's coming from everywhere were and the only way to map it is to go for an ablation but it will probably do nothing more than reduce a bit the number of episodes.

Nothing can be done to control them.

Maybe a pacemaker ?  

[is_something_wrong]

Sounds like you have an exaggerated adrenaline response. My doctor prescribed Metoprolol 100 mg and told me to increase the dose to a point where I had effect but not unbearable side effects. At 100-200 mg I have good effect. I've even tried as high as 300 mg.

Nebivolol is not used to treat arrhythmias.

[IA64]

Doctor initially suggested Concor ( Bisoprolol ) but my Father who happens to be a surgeon ( urologist ) refused it due to many side effects and  erectile dysfunction symptoms.

I'm on Nebilet ( 5mg/day ) that doctor said that it should be very effective but it's doing literally nothing.

Also my blood pressure goes up to 160/100 when I stand up to take it at the check-up room. 1 minute later it's 130/88

[is_something_wrong]

It clearly sounds like your ectopics have some adrenergic cause, if they are worsened during stress and intercourse but not during running. Beta blockers should help, but often they are given in too low dose.

If you have tried Toprol or similar beta blockers in doses of 10-50 mg/day, you haven't tried beta blockers properly. Some people, but not everyone, get an effect from a dose this low. How high was your dose?

Also, Sotacor is a possibility. It is a beta blocker with additional antiarrhythmic properties.

If your average heart rate is 91, you probably tolerate a high dose. Ask your doctor?

[IA64]

Thanks guys. The problem is that I've been on Xanax and it did help a lot but only when I'm doing nothing. So when I'm idle or sitting or resting, there is no arrhythmia but imagine that... I can't have a proper sexual life. Anytime during intercourse I get those very nasty PVCs that push me to pause and take a minute break. They then stop, and come back if I resume.

I started exercising everyday and I can run for 20 mins non stop and I feel nothing. Only when I rest, they start and wont stop for few hours.

When I said i'd rather die, I meant that my life isn't about feeling some weird beats that are annoying no. I don't mind having PACs as I find them annoying a bit but controllable. SVT is also OK for me but the PVCs are really disturbing. I feel my head is about to explode, sometimes about to faint / chest discomfort / shortness of breath that comes and ago every couple of seconds.

here's a screenshot of the ECG report :

https://i.gyazo.com/c93b58d65a82e7f0e3c4bf219bbc9819.jpg

Also what's about that one micro-aneurysms in the Right Ventricular Outflow Tract ?  Doctor said it might be what's causing all my arrhythmia but can't do anything about it. He refused to say that my heart structure is completely normal but also said it's not abnormal.

Thanks again guys.

[Jerry_NJ]

Well said, my anxiety is minor but I take your pragmatism to "heart" - great advice.  My afib goes mostly unnoticed, lucky part of bad luck in my case.