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MVP PVCs and a failed ablation

I've had mitral valve prolapse diagnosed since i was about 10 or 11. I am now 25. Back in August i went to my doctor because I'd been having really bad palpitations that felt like skipped beats for the last three days. Laying down, at work, no matter where i was, what i was doing they never eased up. I could feel my heart clear as day in my chest. Did an EKG found i was having begemi PVCs. Did an echo, blood test, thyroid everything came back normal. I have very little stress in my life and didnt drink a crap ton of coffee or eat a **** ton of chocolate. Plus by day 2 i had told myself no more caffeine.

Doctor gives me a beta blocker. It made me feel like ****. Sleeping constantly and made minimal difference on my heart.

Fast forward a month and i see an electrocardiologist. Even on the beta blocker my ekg basically looked the same. No change in the pvcs. Takes me off of the metropolol and suggests i do an ablation procedure. In the meantime he puts me on flecinide.

Man that flecinide is magical. Helped so much. Didnt feel a single pvc while i waited until early October for my ablation.

Five days beforebthe procedure they told me to stop my meds so they wpuld obviously see the pvcs happen. Well my heart rate is still going crazy at like 110-120 bpm resting but the pvcs are almost nonexistent.

I barely changed anything. No change in job. No dietary changes. I don't understand how i could go from constant pvcs to barely any with no changes on my end.

They were able to induce the pvcs before sedation with an iv drop of some medication that increased my heart rate to 140-150. But once they actually gave me the sedatives and put the catheters in my heart they couldnt induce the pvcs. Somewhere along the line my bp tanked and i lost consciousness and they stopped the procedure without doing any ablation.

Did he need to have my pvcs trigger in order to do the ep study or the fact that my resting heart was high before the meds enough for him to do the ablation?
2 Responses
20748650 tn?1521032211
You absolutely need to see the pvcs to do the ablation..

You dont even necessarily need alot of them, but you need to see them.

Basically, if youve ever looked at an ekg youll notice the pvcs tend to look similar... Each pvc had its own special 'shape'.

The reason the shape of the pvc is what it is has alot to do with the specific spot in which its located.

When they do pvc ablation they basically take a "picture" of each of your pvcs. The ablator is then used to pace (deliver a small electrical shock) to different parts of your heart.

Those electrical shocks produce a waveform with a special "shape" as well.

Basically the shape of the pvc or paced stimulation is like a google maps pin..

When the shape of the paced waveform matches the shape of your pvc, the operator knows that his ablation catheter is positioned directly above the part of the heart where the pvc is coming from.

Without any pvcs to take a picture of at the start of the procedure, they dont have that google maps or gps pin to let them know when they are in the right location to burn.

Additionally most labs use 3d mapping systems... These systems are basically really big fancy computers that are able to calculate the approximate location of your pvc's. With these systems the more data it had to work with the more accurate it can be.

In summary at least 1 pvc is needed to perform the ablation, and the more pvc's you have the quicker the procedure will be as the 3d mapping system can help narrow down the precise location.

Given your story its possible that either the staff couldnt get you to have any pvc's at all, or the amount of pvc's you were having was insufficient for them to complete the ablation before your condition deteriorated.
20748650 tn?1521032211
Reread what i posted and realize how hard this is to describe without pictures...

For an example that might help illustrate..

I look at an ekg and i see 4 pvcs.

2 pvc heartbeats are pointy on top
2 pvc heartbeats are round on top

Both of the pointy pvc's are identical
Both of the round pvcs are identical.

I go inside the heart and i shock the left side of the heart.

When i shock i see a pointy pvc show up on my ekg. I put a picture of the natural pointy pvc on top of a picture of the pointy pvc that appeared after i shocked.

They match! So i burn there.

Next i try shocking the right side.. And lo and behold! A round pvc appears.. And they match so i burn!

I had 2 pvc's when i started.. 1 pointy and 1 round.

Each of the 2 pvc's occured twice! So what i saw was 4 pvc heartbeats... 2 from each side of the heart.

I paced 2 places in the heart, and matched them up.

Now i have successfully burnt both pvc's i saw.
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