premature ventricular contractions -possible ablation

[jonesy70]

I am 50 years old and a long sufferer of PVCs. While the PVCs have waxed and waned over the years, they have become more frequent in recent times-up from 4,500 to over 15,000 in a 24 hour period-record on a Holter Monitor.

I am one of those unfortunate people who feel just about every PVC. I have long periods of trigeminy, couplets, which can be quite distressing.   I have had just about every test imaginable include annual stress echos, chest xrays, EKG, Holter etc. The good thing is that other than being born with a bicuspid aortic valve (associated with mild regurgitation which has not deteriorated in recent years), my ejection fraction (70) and overall heart function are very good.  Importantly my cardiologist has determined that the pvcs are benign. I am currently on atenolol (50 ml), which doers not appear to work any more. I have tried natural therapies (hawthorn, magnesium, fish oil) but this has not helped either.

My cardiologist has now suggested the option of ablation, however he is not sure how successful it will be given  my pvcs are multifocal.  He said that while ablation might reduce the number of PVCs, it certainly won't get rid of them altogether. He also says that medically I don't need an ablation as the PVCs will not kill me. It is more about improving my quality of life. This has left me in a quandry i.e.balancing the risks of ablation and the fact that it is unlikely to be totally curative versus living with the pvcs and using cognitive therapy/stress relaxataion etc as a means of managing the pvcs from a psycholgical perspective.

Any advice on what I should do?. I am a little bit concerned about the latest research indicating that PVCs may actually contribute to cardiomyopathy.  My local GP and cardiologist say this is very remote.  

Jonesy

[jonesy70]

Better treatment options on the horizon?

I have now seen the electrophysiologist. While ultimately the decision rests with me, the specialist said that if he was in my shoes he would have an ablation. I am still not convinced that this is the right way to go. My instincts tell me to hang on a while as  there may be better treatment options on the horizon, particularly as the cardiology community now seem to be recommending more aggressive treatment options, particularly those who experience frequent PVCs. I am hoping that this includes better drug treatments.

Is there any one out there who has had PVcs successfully ablated?. While my doctor says there is a 85 percent success rate and 1 percent risk, I left his office even more confused. In this context, while having a cardiogram in his office, the specialist said I was having PACs and not PVCs. He said sometimes it is very difficult to tell the difference between the two. He said the 24 hour Holter did not give him enough information about where the ectopics were originating from. Has anyone else experienced this confusion?.

[tsco]

Flecainide is the medicine I take.It is very effecive at diminishing extra beats etc. Unfortunately it is the medicine that causes or aggrvates my left bundle block.  So if my heart rate gos very high at all I feel the weird bundle block and sometimes that triggers my SVT.  I guess im trying to determine the worse of two evils....*****

[jonesy70]

Thanks for your comforting words. I suspect there are a lot more people than we think who share a similar problem.

What medication did they put you on that decreased the pvcs?. was it a beta blocker?. Atenolol does not work for me any more and a doctor friend of mine as recently as today suggested I try flecanide before considereing an ablation. I might raise this when I see the EP.

Mark

[tsco]

I really feel for you. I have the same problem. I feel every PVC. I also have had several ablations for my tachacrdia. and... developed rate induced left bundle brach block in the past severa; years. It stinks aLL of it. But out of everything I find the pvcs and pacs the most nerve racking. My episodes of trigemny and couplets bring me to the brink of lossing it. I wish they could figure this mess out. The last time I had severe trigeminy I went to a specialist to inquire about ablating focal points. Fortunately with medication they subsided for now .  My opinion is I would do it because quite frankly I can not live with them in a constant state. I know that.

[Mom2four85]

thanks :)

[jonesy70]

Lisa

Here are two of the references:

Wikipedia reference:

en.wikipedia.org/wiki/Premature_Ventricular_Contraction

Medscape reference to 4,000 pvcs

http://emedicine.medscape.com/article/761148-overview

Hope you can find these articles. they are quite interesting.

I only had 24 hours access to the other article I referred to which cost $21.

regards

[Mom2four85]

I just wanted the info for my collection :)  I developed pvc induced cardiomyopathy and finding virturally no info on it, and was told nothing about it.

I find this interesting and contradictory to what I've been told by drs and read - "frequent pvcs more than 4,000 over a 24 hour period"  I would love that specific info so I can pin down where it came from; confirm it.

I cant find either of these articles - can you send me pm with the links from Wikipedia and the other one if you don't mind? especially the one with 4,000 pvcs being stated?

[jonesy70]

In addition to 'wikipedia' which highlights a couple of pieces of research on frequent pvcs (more than 4,000 over a 24 hour period) and the potential link to cardiomyopathy, I came across the following article in a journnal titled Medical Hypotheses- www.elsevier.com/locate/mehy
73(2009) 818-820

Title: Same ablation may be used for frequent premature ventricular contractions and supraventricular tachycardia.
It cost  $21 American dollars to download the article.

In short, the hypotheses behind PVC induced cardiomyopathy is based on the observation that a signficant improvement in left ventricular function occurs after the suppression of the ectopic focus, therefore suggesting that the cardiomyopathy actually resulted from the frequent PVCs.

I am not a doctor and don't profess to be an expert on the subject. However, you would hope that the growing body of evidence will result in better treatment options for people who suffer with this terrible affliction.


Jonesy

[Mom2four85]

"I am a little bit concerned about the latest research indicating that PVCs may actually contribute to cardiomyopathy"

what latest research is that? I would love the info, I'm still researching and compiling it

[itdood]

I know both sides of the issue really well but I don't have any clean-cut answers.  My suggestion is to schedule some EP consults and talk it out.