20,00 pac's per 24 hour

[Woon82]

I have had Av-node reentry ablation 7 years ago with success.  However, I have always had occasional PAC's which would usually set off the Tachycardia. I have also been diagnosed with Dysautonomia/mitral valve prolapse syndrome after the ablation. The mitral valve prolapse is very mild.  I was told a 3/10 in severity.

I was told the PAC's about 3-4 times in the 24 hour period gave a rhythm that resembled heart block type II but after the EP looked at it he said it was the PAC not letting the heart re-polarize.  I was also told the PAC was coming from somewhere close to the center of the heart.

I did not see the EP I wanted to for the PAC's.  I am set to see Dr. Kay at UAB who is I feel is one of the best in the world.  He performed my first ablation.

Is ablation for this many PAC's an option?

The first EP said it could be done theoretically but why perform a dangerous procedure to cure a benign rhythm. They released me and said to talk to Dr. Kay.

I also need surgery for a cervical disc bulge.  I am a little worried about the anesthesia and the effect it may have on my heart.

Any advice would be greatly appreciated.
Thanks in advance.

[Arizona Jim]

I have almost the same number of PACs you do.  Somewhere between 20,000 to 25,000 per day.  On good days, maybe 15,000, on bad days I've averaged over 20 per minute.  I had an ablation for them 18 months ago and they were nearly non-existant for a year.  My EP found that I had Dual AV node physiology and ablated one of them.  She also noted that there was a pathway further up into the heart that she couldn't ablate with RF energy because it would have been too dangerous.  Now that the PACs are back with vigor, she's going to ablate them again, but this time she'll be prepared to do cryo-ablation further up into the heart which is safer in that area.  My procedure is scheduled for May 7th.  I'll let you know the outcome.

Jim

[Woon82]

I appreciate your advice and support.

I hate to say the number of PAC's are pretty constant every day.  I'd say when they took the 1st 24 hr test I was having a good day!  

I know my heart pretty well just because it has been a problem since I was 16 years old. Also with the Dysautonomia I  can pretty much feel every beat depending on how much beta blocker and exercise I get. (no need to check my pulse with my finger, I can tell you what it is most of the time.)

I'd like to try to accept the rhythm but it has gone from a few PAC's once in a while to 20% of my beats in only a few months. My heart rate has dropped from an average 80 beats to 60 because there are so many "missed" beats.  Honestly, I'm used to this but I think it is getting worse and not better.

Your right I need to discuss this with my doc.  And I will.

I'm glad your ablations have worked out well for you. The PSVT would be the one thing that would bug me the most. Hopefully you can control that with medication.

Thanks and happy April 1st.

[ireneo]

I haven't heard of ablation for PAC's. Some people have them for PVC's but it's difficult to pin those down and ablate completely. And the concern with PVC's seem to be that it might trigger some V tach or worse which can be life threatening.

PAC's, even if they go into atrial flutter or a-fib, won't be immediately life threatening. Maybe that's why your doctor is hesitant to do the ablation. Your PAC's seem to average 14 a minute which is quite a few. Do they do that every single day of the year or was that one of your bad days? That would make a difference  whether the doctor is willing to ablate.

Your best bet is to discuss this thoroughly at your next appointment. See what dangers there are, if any, associated with this many PAC's. How difficult would it be to ablate. And with your dysautonomia and valve problem, is having a perfectly normal heart beat even possible?

I've had 3 ablations for my arrhythmias and still have some (PAC's, PVC's and PSVT) but it's tolerable. I'll just accept that my heart is jumpy. Otherwise I'm in good shape.