pvcs are killin me!!!!

about 6 weeks ago my heart started throwing pvcs....on and off until now....there here all the time. i got an echo....normal but when i wore a 24hr holter moniter....6,800 pvc's not couplets but my cardio said no big deal!!!!
i got a second opinion ...this cardiologist says ....you need an ablation....i have an appointment sched..may 2nd...p.s. i also have major agoraphobia and the ablation people are an hour away. my questions are this abblations...are they necessary...i am a lil dizzy.also my cardio took me off inderal la120 and wants me to take acebutrol 400mg i haven't started it yet i am scared is this a drug that helps. well i am sorry to rattle on but any info you have i would greatly appreciate!!!!! ty  so much hyperr in lima ohio

[Michael J. McWilliams, M.D.]

That is a pretty radical difference in treatment approaches, one recommending conservative measures and the other a procedure.  The key question that needs asked to the doctor that wants to do the ablation is -- do you think the PVCs are dangerous for my health or are you treating a symptom.  The question you need to ask yourself is -- is the risk of major complications from the procedure worth treating symptoms.  Can you ignore the symptoms.

There are many things that I see in clinic that I "could" take to the lab and try to ablate.  As a rule, I try conservative measures and medications for a significant time and if it persists, I will offer the ablation.  PVCs will often come and go, sometimes going away for your years before coming back.  It is really a personal decision about whether the risks are worth it, but in general, the standard of care is conservative treatment, reserving ablation for medically refractory patients that cannot tolerate the symptoms.  I am conservative, so for similar patients with PVCs that are not indicative of other heart problems, I recommend conservative treatment.  but again, this is a personal decision.  Ask your first doctor what they think about doing the ablation.

acebutrol is a good beta blocker.  if you doctor wants you to try it, it might be a reasonable choice.  I try not to recommend specific medications or dosages  on the forum since I am not your real physician.

I hope this helps and wish you well.

[johncat]

Why does the second opinion recommend an ablation?  I have heard of people with 3 times as many PVC in 24 hours than you are having without having an ablation recommended.  Is the recomendation for medical reasons or because they have affected your quality of life to a great extent.

[hyperr]

thanks so much for your information!!!!!!! the radical opions on my condition is because one dr deals with pvc's and the other looked at my chart and said he dosen't handle these problems go to columbus get an ablation..........the conservative dr does handle pvcs and he says the same thing you do!!!!!!! thanks so much i will sleep better tonight!!!

[LukeL]

Also some of your older cardiologist/GPs  might still be of the mindset that PVCs can be dangerous in the general popualtion. (hate to say it but some doctors don't keep up on the latest trends in medicine)  I have had some older doctors still be of a mindset of treatment from decades ago, this is why multiple opinions are a good thing to get. I had 3 major operatons when conservative treatment could  have achieved the same results (not heart realted)

[upbeat633]

My last holter recorded 24,000pvcs/hr. The cardiologist then and recently an electrophysiologist say the same thing as Dr. McWilliams: they do not recommend abalation unless the symptoms from the pvcs are significantly reducing the quality of life.

(and the EP said he absolutely did not recommend an anti-arrhythmic drug because that might begin a dangerous arrhytmia).

The EP suggested acebutolol also. But I'm taking just half the recommended 200mg dose because most other beta-blockers I've tried give me more symptoms than the PVCs! so I didn't see the point in that. So far it seems to be working to reduce the multiple strings of pvcs I've been having. But not always.

Once I know I'm not terribly bothered by the acebutolol (dizziness or fatigue), I'll try a higher dose and see if that gives further improvement in reducing the pvcs.

I hope you get some answers from your doctors and enough information to make a good decision.

[hyperr]

thanks so much for your input upbeat....i am so scared to take that dang acebutolol!!!! hopefully i will soon ....im on inderal la 120 a day i dunno why he wants me to switch any how thanks for all your stories i am so hopeful now because of you all!!!!lots of love hyper