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Treatment for frequent asymptomatic PVCs?
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Treatment for frequent asymptomatic PVCs?

Hi,

I am a 38 yo male in relatively good cardiovascular shape, but have recently been diagnosed with very frequent PVCs.  Test results to date show the following:
** echocardigram --> normal
** 24-hr holter monitor --> 14,800 PVCs/day, otherwise "normal"
** exercise stress test --> no evindence of CHD, PVCs predominiant before and after exercise, diappear during exercise.
** Blood pressure 130/80 on average.
** PVCs are completely asymptomatic.

In reading through posts on this site and elsewhere, it might seem that a course of action for this is NO treatment.  However, this concerns me in a few regards:
** Very frequent PVC (like the number I am haveing and more) are associated with increased risk of cardiomyopathy.
**  PVCs associated with increased risk of AF and possibly stroke.
** PVCs associated with increased overall cardiovascular risk.

Given these risks, even with the PVCs being asymptomatic, should treatment be considered?   In my mind, options are the following:
**  No treatment but follow closely for signs of cardiomyopathy or other CV abnormalities. In this case how often should I be evaluated with echocardiogram or other tests?
**  Low dose beta-blockers to attempt to decrease risk for cardiomyopathy and potential other risks listed above in the long term
**  RFA ablation.  Is this too risky for someone with a currently "normal" heart at least according to these tests?

Any suggestions would be greatly appreciated.
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995271_tn?1408549100
You could always try the BB, there's not much risk to it.  If it helps, cool.  If it doesn't help you can  stop taking them.

Ablation for benign PVCs has the best outcome when your PVCs originate in the same spot.  This is called Unifocal.  The QRS pattern on the EKG will look the same from PVC to PVC.  That's how they can tell.  If they are multifocal this means they originate in different spots around the ventricles.  Multifocal are tougher to get rid of but you may have some reduction.

PVCs are also easier to ablate if they are located in the right ventricle.  If they are located in the left ventricle they have to poke through the heart's septum to get there with the cath, thus complicating the procedure.

My suggestion is that you ask your cardiologist what your options are.    As you can see from my paragraph above the decision is a bit complex and there are diagnostics on your EKG studies that can be used to help guides you/doc in the right direction.  

I think a conversation between your cardiologist and an EP is warranted given the load.  Clinically speaking they would probably advise you to ablate if they see any dysfunction develop in your left ventricle.  There was a study that shows reducing PVCs can reverse the dysfunction.
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187666_tn?1331176945
Doing the math that works out to about 10 PVC's a minute. Yep, that's quite a few. I'm not sure of how much risk there is with that. If it was me, I would probably avoid the meds simply because they tend to have side effects where right now you're asymptomatic. And over time a medication can lose its effectiveness and you'll have to switch to something else. Then again, I avoid doctors and medications as much as possible. But being checked to make sure your heart is still in good shape is easy enough. Frequency of check? I don't know. Your cardio should know that. Perhaps an annual echo.

I didn't know PVC's could trigger AF. I thought PAC's had that tendency. And A Fib can lead to blood clots and stroke.
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967168_tn?1343732745
I think the risk of developing pvc induced CM is a roll of the dice.  I've seen a few here who have developed it but not many; I can't remember what those numbers were, I think >20% of daily pvc's but I'll have to look back.

Take my case - had arrhythmia's since I was 9, dr's told me nothing was wrong until age 42 when I was quite shocked to find out I had roughly 50,000 daily. No structural heart problems and I had an ablation and got rid of the pvc's for a few days but had major complications during surgery so they did a cardiac cath - its the only test that showed I had developed CM.  

I still question if it was pvc induced? dr's say no but it's possible.  After ablation I started having pvc's again about 10,000+ daily for almost 2 years and my last echo says my heart is fine; no CM. The thing about me is, I've been very symptomatic since childhood, pvc's, VT, shortness of breath, fainting, low blood pressure etc.

My last cardiologist said he's treated a woman for many years who had 80,000 pvc's daily who is asymptomatic and he only treats her with beta blockers.  If someone does develop pvc induced CM, the majority of the time it will correct itself awhile after the pvc's are ablated....or so I've read.

I haven't heard a risk of AFib with pvc's either so I'm clueless about that...I thought they originate in different parts of the heart but I'm still learning after all this time and would be some interesting info to have if you have it.

not sure on meds, everyone is different - one person may be very successful with meds and treatment but someone else like me; even ablation and meds haven't helped
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363281_tn?1353103243
From all I have read, A-fib is not brought on by the PVC's or PAC's, it is more or less brought on by having high blood pressure, age and other heart disease.

I do not take meds if I can help it at all, I try to control mine with natural supplements and my chiropractor, naturopath and acupuncture. I have had an echo and worn a holter though, and would like to again since it has been over 2 years. The two times I wore the holter, it only caught 9 PAC's but when I am not wearing, I swear I have so much more.

I have also read that in a structurally healthy heart, a large amount of these horrid PVC's PAC's can be had and not hurt it.
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Avatar_m_tn
Thanks for yor response.

There are at least 2 studies that indicate that a possible correlation between PVCs and AF.  One is "Premature Ventricular Complexes and the Risk of Incident Stroke" and is published in the journal (Stroke 2010; 41:588-593).  In this paper, PVCs are an independent risk factor for stroke, and it is observed that the increase in stroke risk may be due to increased AF.  Another study "ST-segment abnormalities and premature complexes are predictors of new-onset atrial fibrilation: the Niigata Preventative Medicine Study" (Am Heart J 2006; 152:731-5) indicated ~3-fold increase in AF risk.  

In my opinion, it is difficult to say what the results of these studies mean in populations  that are not those evaluated in these studies (i.e. middle aged + individuals which may have some underlying heart disease that manifests as PVCs).
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995271_tn?1408549100
You could always try the BB, there's not much risk to it.  If it helps, cool.  If it doesn't help you can  stop taking them.

Ablation for benign PVCs has the best outcome when your PVCs originate in the same spot.  This is called Unifocal.  The QRS pattern on the EKG will look the same from PVC to PVC.  That's how they can tell.  If they are multifocal this means they originate in different spots around the ventricles.  Multifocal are tougher to get rid of but you may have some reduction.

PVCs are also easier to ablate if they are located in the right ventricle.  If they are located in the left ventricle they have to poke through the heart's septum to get there with the cath, thus complicating the procedure.

My suggestion is that you ask your cardiologist what your options are.    As you can see from my paragraph above the decision is a bit complex and there are diagnostics on your EKG studies that can be used to help guides you/doc in the right direction.  

I think a conversation between your cardiologist and an EP is warranted given the load.  Clinically speaking they would probably advise you to ablate if they see any dysfunction develop in your left ventricle.  There was a study that shows reducing PVCs can reverse the dysfunction.
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967168_tn?1343732745
thanks for the info; going to read it again over the wknd but wow that's worrisome with frequent pvc's if I'm reading correctly just on first glance
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