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pvc ablation? your input please?
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pvc ablation? your input please?

Here is my story. im a 35 y/o female 5'2 110 pounds. dont smoke, drink, have caffeine, take stimulants, or hardly eat chocolate, i excerise 3 days a week walking on the treadmill 2 miles at a time. i eat pretty good and have NO other heath issues. no high blood pressure, no high colesterol, no diabetes, ALL my blood work always come normal. i started noticing skipped beats when i was 19 y/o where i went to my first cardiologist and was diagnosed with benign annoying PVC's (premature ventricular contractions) told me anxiety brings them on and not to worry go on with my life. I started developing anxiety from that day forward. they skipped beats got worse and started getting fast heart beats so went to see a ep dr (electrophysiologist) who is specific for rhythm disorders of the heart. i had a ablation in 2002 for atrial tackys and then symptoms became worse then had my second ablation in 2004 for fast rhythms again. nothing could really be found but a few spots which they said they got. over the years i have been on my beta blocker Atenolol 25mg 3x daily and 2 months ago i took out the middle dose and now take 25mg 2x daily. back in october of 2012 my life changed and i have become impared from my constant pvc which turned into bigeminy and fast small ventricular runs only about 4-5 beat runs, also i have developed a rhythm called Afib (atrial fibrillation) i had a episode in march, april, and one in may. all were caught on a monitor because i have been wearing a monitor for 5 months trying to catch all the symptoms i could so my ep dr had proof. all the afib episodes converted back on its own and only lasted under 5 minutes each time of a heart rate of 180 bpm. dr's have no clue whats going on. i have had stress test, echo's, blood work and every test you can think of. everything says NORMAL!! so ep dr was asking me which rhythm i wanted to treat and he, my cardio, and myself all sat down and decided anothe ablation for the pvc's first since its the most harboring one. and they said a afib ablation is VERY extensive and hard on the heart and for my age ALLOT of scarring for the upper right atrium so want to hold off on that also the episodes are not lasting long and also they are converting themselfs back into normal sinus rhythm without cardioversion. SO.... my scheduled ablation is for june 13th at 6:30am at the university of washington in seattle washington with dr viswanathan. they will try to get the pvc's to flare up and see if it can be fixed. i forgot to mention i started a antiarrhythmic drug called rythmol (propafanone) a month ago because my symptoms were just to bad. has anyone had a pvc ablation and was it successfull? how did it go? and how do you feel today? im very nervous about having a 3rd ablation and the added scarring on my poor heart.my pvc's were up into the 5-15 thousand a day with chest pain and shortness of breath. just wondering others experiences with pvc and why mine went from a few here and there to thousands and also afib. also on my last ekg it said juctional rhythm. what the heckkkkk?? my electrical system is allll out of wack. i am a mother of 4 kids and simply CANT keep up. i feel disabled and am scared to go anywhere these days that i may just fall over dead :.(... please give me your thoughts, imputs, ideas, concerns. it all will mean so much to me. love your heart friendly friend ~K
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3885607_tn?1348512326
i also wanted to note that im having a cardiac MRI next friday because they have never done one before. will a mri show EVERYTHING that maybe a echo has missed in the past?
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1124887_tn?1313758491
Hi! Sorry to hear about your trouble.

First, you are talking about two different issues here. The A-fib and the PVCs don't have ANYTHING to do with each other. They may share the same cause (for example excess catecholamines) but a PVC can never trigger A-fib and A-fib can not make PVCs more frequent. They happen in two different parts of the heart and the parts are sealed.

In rare cases, PVCs can be treated with ablation, yes. In my country they never do so, unless you have runs of ventricular tachycardia along with the PVCs. Some people notice them and some don't. In some people stimulants may be a major trigger and other people can drink 10 cups of coffee or similar without having a single PVC (PVCs are by the way rarely triggered by caffeine, as caffeine is blocking adenosine receptors and the ventricles, different from atrias, are less sensitive for adenosine).

The atrial fibrillation on the other hand, is not common in a young female. In my opinion (but as you know I'm not a doctor), THIS is what may cause risk for you. I'm not sure I understand what you said about the right atrium, atrial fibrillation rarely origin from the right atrium, it's usually the left atrium in general, and pulmonary veins especially, that is the focus of the arrhythmia. Treatment is usually isolating the pulmonary veins with ablation and it has nothing to do with right atrium.

You may have PVCs, ventricular tachycardia, atrial fibrillation, all sorts of atrial arrhythmias, PACs, you name it; in a healthy heart. Ultrasounds and MRIs are rarely of any use in young people except to rule out obvious heart diseases, your problem seems to be somewhere in the electrical system and that can't be seen on any of those tests. It may also be that you suffer some kind of non-cardiac cause of your palpitations/arrhythmias.

Are your thyroids checked? Plasma adrenaline/noradrenaline/cortisol? I can't help thinking you may have some sort of excess stress hormones triggering all those arrhythmias. Junctional rhythm means that your AV node is stimulated and taking over the pacemaker function. It's OK as long as the rate isn't too low, but again, something must be stressing your body and I think a cause must be found.
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3885607_tn?1348512326
Thank you for responding.  You are right I meant the left atrium, not right,  I meant they would need to cross over the right atrium to get to pulmonary vein and left atrium.  Sorry for the confusion.  And yes I know they are 2 separate areas.  That's why I don't understand what's going on. I'm just so sad having to live with this everyday.  My heart feel like a waiting time bomb. Everything I do irritates it. Today I cleaned the horse pasture/stall and did some light  barn work and boom here comes pvc's full force.  Then tonight I'm watching the news and I feel that same dang quick run again ......... then normal beating again.  I just know the last 8 months my heart has been sooo out of wack.  If I don't take my  rythmol I'm in bigeminy and not stop pvcs. I totally agree something in my body isn't right.  But WHATTT could it be?? Uhggg my ep dr said they are finally thinking these electrical issues in normal hearts are something people were born with.  I was considering flying to boston to see one of the best ep dr's in United states as he has many success stories and years under him but not sure if it will make a difference.  I just want to feel normal for one day every now and then,  I even forgot what that's like. Hopefully this coming Friday the mri will show something and maybe after all these years ill be able to say OH THAT'S WHY!! Wouldn't that be nice.  Also I'm fearful that maybe the ablation won't work,  either they couldn't get them to flare up to ablate anything OR they ablated to much and did damage.  Guess its the risk we people take out of being miserable and desperate.  I love your knowledge by the way.  How do you know so much?
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Avatar_m_tn
The connection between atrial fibrillation and premature ventricular contractions is highly complex and not very well studied in my opinion. However, there's some evidence that the same mechanism that can cause frequent idiopathic premature ventricular contractions can also lead to development of idiopathic atrial fibrillation in the same individual. For example, the ARIC Study (1) found that incidence of AFIB was 1.56 times (multivariable hazards ratio adjusted for numerous established risk factors) higher in people with frequent PVCs than in people with no PVCs. The niigata preventive medicine study also found that PVCs present during a 10-second ECG recording were a significant risk factor for development of Afib over the period of 10 years (2). The fact that PVCs and AFIB might share a common mechanism in a large subset of patients is evident from countless anecdotal data you can gather from any Atrial Fibrillation internet forum.

The mechanism that promote both arrhythmias in a healthy heart could be related to the dysfunction of the autonomic nervous system. It is evident from many studies that hyperactivity of ganglionated plexi is major contributing factor to idiopathic atrial fibrillation. There were some recent studies that demonstrated the role of autonomic hyperactivity in the pathogenisis of idiopathic RVOT PVCs that are commonly encountered in clinical practice. Hyperactive state of one, or several, cardiac nerves can create a discrete arrhythmogenic focus at the point of the greatest concentration of nervous fibers. In AFIB patients the triggered activity that jump-starts the arrhythmia usually originates from the PVs, as they are richly innervated with both parasympathetic and sympathetic nervous fibers. If your cardiac autonomic system is in a highly hyperactive state that you can get both AFIB and PVCs without any structural substrate to support the arrhythmia. Remember, that many people with Permanent Afib have no fibrosis detectable on their MRI. The hyperactive state of the intrinsic cardiac autonomic nervous system, in some cases, can be more arrhythmogenic then fibrosis and cell nercosis causes by a major heart attack!

References:

1) Agarwal, Sunil K., et al. "Premature Ventricular Complexes and the Risk of Incident Stroke The Atherosclerosis Risk In Communities (ARIC) Study." Stroke 41.4 (2010): 588-593.

2) Watanabe H, Tanabe N, Makiyama Y, Chopra SS, Okura Y, Suzuki H, Matsui K, Watanabe T, Kurashina Y, Aizawa Y. St-segment abnormalities and premature complexes are predictors of new-onset atrial fibrillation: The niigata preventive medicine study. Am Heart J. 2006;152:731–735
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Avatar_m_tn
Have you ever strongly pursued the anxiety relationship to your heart rhythm issues?  I assume you have but you may want to try taking a strong prescribed anti-anxiety med that knocks you into 'no-worry land'.  If this lessens or alleviates your heart symptoms, this could lead you on a different path than another expensive, and potentially damaging, ablation procedure.
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1807132_tn?1318747197
Not making a blank statement about any person's stress as each of us are individuals but for me I was really quite oblivious to the fact that life really stressed me out.  I kind of held it all inside and suppressed a lot.  It wasn't until I reached my forties and started to slow down that I realized I was running at a frenetic pace and my stress was always up.  For some reason I got into the habit of everything being an emergency.  It takes a toll on your nerves after a while.  Anyways, stress can come in many forms and even be silent in the background only being noticed once we stop and look around.
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1807132_tn?1318747197
I would like to add if you are trying to decide on whether or not do do an ablation follow the path that gives you the most peace and you can't go wrong.  But whatever you decide to do I wish you the best of luck and if you do decide to go ahead with the ablation my thoughts and prayers are with you for a successful one.  Stay strong.  
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1569985_tn?1328251082
I have read that people suffering from afib have half the episodes if they practice meditation or yoga.  Of course, this is not the whole answer, but it does indicate that stress plays a part in these types of heart issues.  Michelle, I have some of the same issues.  My job was so stressful and I just couldn't see what it was doing to me.  I let a difficult situation take over my life and alter my health without thinking I could do something about it like leave or find another job.  If I had it to do over again, I would have left sooner than I did.  I tend to react to situations.  Now I am trying to ask myself if it is going to matter in 24 hours, or even an hour -- most times the answer is no.  At least 2 of my afib episodes have occurred when my husband was very ill -- I was even hospitalized just before he had a major surgery.  This is a very complex issue and has a lot to do with modern life in my opinion.
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Avatar_m_tn
Horseluver, let me tell you I understand exactly how you feel - PVC's are just horror! My situation is similar to yours except I didn't have an ablation yet, but I am very determined to have one since I'm having thousands of PVC's day in and day out. No other problems and the doctors say - healthy heart. Ah yes... but they don't care that this made my life so miserable I can't even begin to describe it... Right now I'm on Sotalol and had to increase the dosage recently. I'm 35 and don't want to be on medications for the rest of my life, I want to be able to live normally, get pregnant and have a child. So, question to you all my friends: would you rather risk the ablation, or be on meds for the rest of your life?
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171679_tn?1214856403
I was cranking out 40-50 thousand PVCs a day, basically entering bigeminy when I got out of bed and staying that way until sometime after falling asleep at night.  My PVC ablation at the Cleveland clinic was successful and that was almost seven years ago.  My dad had atrial fib but I've never has a sign or anyone comment about me possibly heading that direction.   I hope there is no common cause in my body.  idiopathic all the way.  I am 57 and play full court basketball occasionally.  I was not willing to accept being so medicated that I couldn't function.  I'd do it again it a heartbeat!  Electromagentics were used to hold the burning catheter in place from outside the body and I laid there drug free for seven hours I recall.  Drugs masked the PVCs as mentioned.  
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