Cath and PVCs

[pumpbumps]

I am writing on behalf of my 68 yo mother, who has a hx of PACs/PVCs for years controlled with medication (B-blockers). Approx. 4 mos ago, she began having more frequent palps (from a few/wk to several/hr to to several/min.) She has worn a 30d Holter which confirmed PVCs. She is very active--walks 1 hr/day, good diet, good wt--very healthy. She denies chest pain or SOB, but states that she feels some mild, localized pressure during the dysrhythmias occasionally. Her PMH is insignif. really--hysterectomy 15 yrs ago (no HRT), mild/mod OA. She has had elevated cholesterol but has taken Lipitor for years and it is well-controlled. Her cardiologist increased her Toprol XL fr/25 mg/d to 25 mg BID, which had some transient positive effect that lasted ~2d b/f degrading back to pre-increase frequency. She asked her cardio about an EP study, but he's opted to cath her instead. Would a less invasive procedure such as a stress test or cardiac CT be reasonable b/f cath? She just doesn't seem like a candidate for occluded arteries based on her S/S--Would an EP study be a reasonable place to start b/f a cath? Any thoughts would be greatly appreciated.

[Michael J. McWilliams, M.D.]

If she has a normal EKG and normal heart function on a echo, an EP study would not be very useful.  The only time I would do an EP study in that situation is if the PVCs all came from one location and she couldn't tolerate the symtpoms -- otherwise, the least invasive approach is best.

I usually do not opt to cath someone unless they have hight risk features or a positive non invasive stress test.  There are many ways to approach a problem.  Doing a left heart cath is not "wrong," but I would opt for a non invasive stress test first to try and avoid an invasive procedure.  It might be worth asking her doctor why he prefers the more invasive study over a non invasive stress test.  They may have a very good, logical reason.

I hope this helps.

[Cowgirl37]

I'm not a doctor and I know you are waiting for his answer.  

In the meantime, just a thought, did she happen to start taking generic TOPROL 4 months ago or did she switch from the extended release to an immediate release?  The generic I'm talking about is called Metoprolol Succinate ER (generic for the brand TOPROL XL) and doesn't work as well in some people.  A switch back to brand might do the trick.

[pumpbumps]

Thanks for your post--it's certainly a good thought. I'm going to check with her right away! That would be great if the solution was a simple as that!

[pumpbumps]

Thank you so much for your input. I'm so pleased that I'm not completely out in left field by thinking that going straight to cath is kind of a big leap. I agree that we do need to sit down with him and discuss it further. Unfortunately, I wasn't with her during that visit and she was so blown away when he scheduled the cath, she didn't really ask many questions.

You mentioned the degree to which her "quality" of life is effected--she's pretty disturbed by them and I hate to see her begin to limit her activity due to her fear of the dysrhythmias--although I can certainly understand as I've been through a similar situation myself with SVNRT.

Thanks again for your time and advice.