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Avatar universal

continued arrhythmia treatment any other options?

I am a 52 year old male with lifelong history of palpitations and pvc's. Four years ago pvc's increased in frequency and I had some other arrhythmia symptoms (flip-flop thuds long pauses etc.)including near syncope. Had echo, signal avg. ekg.,  stress echo, all normal. Wore event monitor 1 month revealed pvc's w/ bigeminy, trigeminy, multiform, uniform etc. and a few episodes of nsvt and 1 of unidentified type probably 8 beat nsvt. Consequentially I had a spiral CAT scan and cardiac MRI (CCF) to rule out ARVD. All tests normal. For the past year symptoms increased PVC's of 100-400/24 hours. Occaisionally with 3 or 4 second pauses after (no pulse felt).
Sought treatment at Deborah(local) and had thallium stress and tilt table. Thallium normal, tilt positive (passed out). Frequency of symptoms has created extreme hardship both at work and home. Cant wear event monitors as I developed severe allergy to pads. Latest option given is Norpace or pacemaker. EP here does not think EP study will help doc says heart normal with conduction or nervous system problem. Scared of the Norpace because of toxicity and don't know if I can wear pacemaker as my job involves inspecting food processing plants where there are alot of large electric motors etc. I am really getting to the point where I just don't care anymore but still hope for some workable acceptable alternative. Any suggestions or direction wouild be appreciated.
11 Responses
Avatar universal
Bill D,

Thanks for the post.

If I read your post right, it sounds as if you began to experience significant symptoms from PVCs approximately 4 years ago, and these symptoms increased approximately 1 year ago.  Because of the increase in symptoms, you underwent a thallium and tilt table test.  The tilt table test was notable for you passing out.

I have several thoughts:
(1) As an aside, the "pauses" you experience after the PVCs are likely not really pauses at all.  The heart incompletely fills after a PVC, thus ejecting a low volume pulse which frequently cannot be felt.

(2) 100 - 400 PVC per 24 hours is at most 15 - 20 PVC per hour, or 1 every 3-4 minutes.  You can be reassured that this number of PVCs is not dangerous.  However, some people find them very distressing.  Som people find benefit from coping techniques, such as Tai Chi, yoga, anxiety management therapy or biofeedback techniques.  Beta-blockers, such as metoprolol or atenolol are also helpful for some.

(3) Many patients pass out with tilt table testing who are perfectly normal.  So an isolated "positive" tilt table test is not too concerning.  I didn't read in your post that passing out was a major part of the problem -- if it is then it is likely unrelated to the PVCs unless VT was seen during the tilt, which is unlikely given the fact that you did not mention anything about having a defibrillator.

(4) Finally, if your EP thinks that you indeed have pauses and need a pacemaker, then discuss your work environment with him/her.  Most people can work around electric motors without difficulty.

Hope that helps.
Avatar universal
Really sorry to hear of your troubles Bill, and sorry to hear an EP study has been advised against as in my case it did show up the problem - every other non-invastive test I had showed up normal which whilst I suppose good news really leaves you wondering what on earth to do when your symptoms are intolerable as mine are.  Have you been examined at one of the big Heart centres - maybe the Cleveland could help you.  Go for a second opinion.
Good luck.
Best Wishes, Linda
Avatar universal
Hi Bill, This doesn't address any of the big issues, but I also had a terrible reaction to the pads used for a one-month event monitor. The company then sent me pads that are used for infants (I'm only 49, after all), and I started the test over. This time it went great, no allergic reaction at all. Presyncope is scary -I had that too, due to SV tachy, but no longer, thanks to Toprol. Good luck!
Avatar universal
Thanks for the input. Believe me I would not post im this forum if I had not run the gamut of tests and beta blockers etc. etc. I can't take the betas because of an already slow heart rate and asthma. I don't think most people can appreciate the frustration and anxiety of living with significant symptoms and I can't believe that four second pauses in pulse with near syncope are considered "normal". If it was just the pvc's I could deal with it. After a life time of dealing with this thing I am totally frustrated.
Avatar universal
Hi Bill,
-
Yes, I know, I have the same problem.
Not that often.
But the 4 to 5 sec. pauses are HORRIBLE.
And there are NO BEATS in between.
Just one fluttery one and then the pause...
I hate them too. Feels like you are going to die...
...Anxiety...
And they can start out of nowhere, just when you feel ok.
So that's frustrating too.
-
My doc says the heart is one moment out of rhythm and will not stop completely (lucky us), it will ALWAYS start again.
But then you know that of course, as I do, cause we both still are here....;-)
-
Stay well - *Ria* -     >and the beat goes on<
Avatar universal
Thanks for the positive thoughts. Along with every description of pvc I have had some brief vt tracings and every once in a great while some 15 or 20 second runs of something that I have yet to record. These are the scary things. PVC's alone I can take but the rest is really getting to me. But you are right, so far I am still here. thanks for listening.

Bill D
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