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PVCs in RV Apex
I have been advised my PVCs originate deep in my right ventricle apex, which is more difficult to ablate because the heart wall is thinner. I have over 5000 highly symptomatic PVCs/day--I feel every one, and am fatigued and worried most of the time. They have ruined my quality of life. I've had one failed ablation---the doctor stopped 3 hours into the procedure before ablating anything when he discovered they were originating in the apex. I don't tolerate meds, and have tried 5 different types. I want to try a second ablation and am considering the Cleveland Clinic. I am particularly interested in the "Stereotaxis Gentle Touch Magnetic System", which apparently they have. Have there been successful ablations in the right apex? I can't continue with the PVCs as they are. All advice welcomed! Thank you
I'm sorry I do not know the answer to that question. It all depends on what rhythm it is, what his hear is doing at that time, but VFib is nothing to play around with - reasearch VFibrillation and maybe give him son info on it (I'm pretty sure you said that's what happened).
thank you lisa he had a monitior on for 2 weeks but he said all they told him was they got what they needed......i wish he would let someone go with him to talk to the dr,.... can i ask you one more question... i no you can only give me your personal experience and im not asking for medical advice but .if hes not close to a hosp and hs heart starts running away and not stop...how long can it do this without causing a heartattack ?
Barbara; 10,000 is the rate of my pvc's that were caught on a 24hr holter after I had an ablation, before ablation they were 50,000+ in a 24hr period.
The reason that spot in the RV Apex is so hard to work on is because the tools are hard & stiff and that makes it difficult to manuever in there - think of a dowel trying to get the corner of a triangle - does that make it easier to understand?
There is a procedure that kmhejira mentioned called "Stereotaxis Gentle Touch Magnetic System", that uses flexible tools so it's easier to navigate the area, but I haven't found many places that implement it, but I'm still searching.
The only thing that may help is his heart rate slow down in that setting is 1. medication; sometimes it works others it doesn't; he may have to work with his doctor and find one that will help calm his heart rate or 2. an automated external defibrillator (AED) if he goes into VF again or 3. an implanted cardiac defibrillator (AICD;ICD) which will sense his heart going into the higher rates and will bring the rate back down or if it goes out of control to deliver a "shock" internally.
he needs to understand the importance of getting this under control; if he indeed does have this problem it could be a rare form of an arrythmia that can be genetic; especially given the fact his uncle has an ICD also.
The ICD implant isn't that bad of a surgery, few hours and a small pocket made, then the device implanted with leads inserted into the chambers, after awhile patients rarely know it's there, although there are some of us who have complications.
Here's the ICD I have: http://www.bostonscientific.com/Device.bsci?page=HCP_Overview&navRelId=1000.1003&method=DevDetailHCP&id=10106021&pageDisclaimer=Disclaimer.ProductPage
The device will not discharge unless it senses there is a reason to, unless there's a problem with the unit itself (malfunctions are rare but do happen) After surgery, the techs set the device up to sense the rate of the heart and deliver the therapy or shock the heart if needed. When this does happen, patients are usually "kicked" or knocked back by it; but there are some who do not experience this (no clue why though).
here's an excellent article from Boston Scientific that tells about AICD's http://www.bostonscientific.com/procedure/ProcedureLanding.bsci/,,/navRelId/1000.1002/method/Procedure/id/10000951/seo.serve
given his history and the fact he's not that close to a hospital, I would encourage him to get the ICD, it's scarey and intimidating but it may save his life
The reason that spot in the RV Apex is so hard to work on is because the tools are hard & stiff and that makes it difficult to manuever in there - think of a dowel trying to get the corner of a triangle - does that make it easier to understand?
There is a procedure that kmhejira mentioned called "Stereotaxis Gentle Touch Magnetic System", that uses flexible tools so it's easier to navigate the area, but I haven't found many places that implement it, but I'm still searching.
The only thing that may help is his heart rate slow down in that setting is 1. medication; sometimes it works others it doesn't; he may have to work with his doctor and find one that will help calm his heart rate or 2. an automated external defibrillator (AED) if he goes into VF again or 3. an implanted cardiac defibrillator (AICD;ICD) which will sense his heart going into the higher rates and will bring the rate back down or if it goes out of control to deliver a "shock" internally.
he needs to understand the importance of getting this under control; if he indeed does have this problem it could be a rare form of an arrythmia that can be genetic; especially given the fact his uncle has an ICD also.
The ICD implant isn't that bad of a surgery, few hours and a small pocket made, then the device implanted with leads inserted into the chambers, after awhile patients rarely know it's there, although there are some of us who have complications.
Here's the ICD I have: http://www.bostonscientific.com/Device.bsci?page=HCP_Overview&navRelId=1000.1003&method=DevDetailHCP&id=10106021&pageDisclaimer=Disclaimer.ProductPage
The device will not discharge unless it senses there is a reason to, unless there's a problem with the unit itself (malfunctions are rare but do happen) After surgery, the techs set the device up to sense the rate of the heart and deliver the therapy or shock the heart if needed. When this does happen, patients are usually "kicked" or knocked back by it; but there are some who do not experience this (no clue why though).
here's an excellent article from Boston Scientific that tells about AICD's http://www.bostonscientific.com/procedure/ProcedureLanding.bsci/,,/navRelId/1000.1002/method/Procedure/id/10000951/seo.serve
given his history and the fact he's not that close to a hospital, I would encourage him to get the ICD, it's scarey and intimidating but it may save his life
lisa he has v t without any other heart diease thats been found. he wont let anyone go with him to the dr and only tells us what he has to.....he dont seem to understand that only makes us worry more. i have no ideal what the rod is for . i dont see him often and my information comes from his mom who he keeps alot from. i guess im hoping to find someone that has it at the bottom and know they were able to fix it. is there anything that can be done to slow it down if hes not close to a hosp? the dr said to go to er if it dont slow down in 5 min. but gee hes at least an hour from a hosp if hes at his moms . they did mention a defibillator at one time. his uncle had that {he had other heart problems too} and when the defib, went off it would knock him to the ground. does this happen all the time if you have that or was something else causing it? my nephew said he would never want hat because he saw what it did to the uncle. this is all so complicated....i pray for you all and please rem. us in your thoughts and prayers
I had an unsuccessful ablation also :( I replied in your other thread about this also but wanted to add some things here
When I had my ablation, they induced long runs of sustained VT - Vfib episodes 3 times. Twice in the RV Apex and once in the Right ventricular outflow tract (rvot) - the bottom and upper middle part of the heart (see my profile for pictures that show those 2 places) - I haven't been dx, because my tests were inconclusive, but they said it was ARVD and with the rv apex & rvot episode, I fit the criteria, not that I want that diagnosis.
After surgery, I developed PaC's, and my pvc's were gone for a few days then returned; within a few months they were at 10,000+ again and I was told I was going to need another ablation which I haven't done yet. I've been on a few different beta blocker's trying to find the right one to work for me; but only Inderal seems to for a short term period.
I've never heard a rod being put in the heart, did they say what it was for? He really needs to get his reports and see what they say - that could explain alot more than the dr did. Also, ask what it's for, what specific procedure is going to be done so he can research it.
VT is ventricular Tachycardia, VF is ventricular Fibrillation - vt isn't always dangerous, it depends on where it originates; but VF is dangerous. Here's a link I have for VT/VF http://www.medhelp.org/user_journals/show/228899/VTACH---VT-?personal_page_id=861727
I was diagnosed with Malignant ventricular arrhythmia's - Polymorphic Ventricular Tachycardia and a pacemaker/defibrillator was implanted 2 days later. I had my surgery at Pepin Heart Center in Tampa FL by Dr. Kenneth Yamamura.
If your nephew is having sustained VT and VF episodes, he may benefit from an ICD - implanted defibrillator also.
When I had my ablation, they induced long runs of sustained VT - Vfib episodes 3 times. Twice in the RV Apex and once in the Right ventricular outflow tract (rvot) - the bottom and upper middle part of the heart (see my profile for pictures that show those 2 places) - I haven't been dx, because my tests were inconclusive, but they said it was ARVD and with the rv apex & rvot episode, I fit the criteria, not that I want that diagnosis.
After surgery, I developed PaC's, and my pvc's were gone for a few days then returned; within a few months they were at 10,000+ again and I was told I was going to need another ablation which I haven't done yet. I've been on a few different beta blocker's trying to find the right one to work for me; but only Inderal seems to for a short term period.
I've never heard a rod being put in the heart, did they say what it was for? He really needs to get his reports and see what they say - that could explain alot more than the dr did. Also, ask what it's for, what specific procedure is going to be done so he can research it.
VT is ventricular Tachycardia, VF is ventricular Fibrillation - vt isn't always dangerous, it depends on where it originates; but VF is dangerous. Here's a link I have for VT/VF http://www.medhelp.org/user_journals/show/228899/VTACH---VT-?personal_page_id=861727
I was diagnosed with Malignant ventricular arrhythmia's - Polymorphic Ventricular Tachycardia and a pacemaker/defibrillator was implanted 2 days later. I had my surgery at Pepin Heart Center in Tampa FL by Dr. Kenneth Yamamura.
If your nephew is having sustained VT and VF episodes, he may benefit from an ICD - implanted defibrillator also.
I was told to read your thread . to make a long story short my nephew is 40 and for no known reason started have heartrates of over 250 and had to go to e r . im sorry but i dont know the medical terms for anything. after a couple episodes they did test the part of te heart that they have to ablate is on the bottom of the heart. they say its very rare and more dangerous. my nephew is not one to tell us much..thinking hes worrying mom and dont want ppl to think hes a baby! he had the ablation in kingsport tenn 2 months ago. hes had 2 episodes with the high heart rate since then that landed him in the hosp and seems like each time its harder for docs to get it to slow down. they told him if the ablation had worked the episodes wouldnt have happenthey saw him again the other day for a checkup and told him they cant do another ablation til after 6 months because the heart hadnt healed . did they put you on meds ? they put hinm on some {dont no what} and they will wean him off in dec and go back into the heart in jan. they said when they go back in the heart in jan,IF it was at a place they could reach they would do another ablation but if they couldnt get to it they will send him to the university of alabama to have a "rod " put in his heart...have you hearrd of that being done? i know im throwing alot at you in one post but you are the 1st one i could find that the problem was at the BOTTOM! what did they call what is wrong with your heart? the nitials of his i think are VT OR VF>> im sorry ,,i forget which...but anything you can tell me im thankful...where do you go to the hosp. at? is it a well known one? thank you for listening
Yes it is very confusing and when I understood the RV Apex/RVOT difference I understood. The CC dr here said they are 180 degrees apart roughly and I found some other info after what you put; a lightbulb went off and I said OH! I've been mad at my EP because I thought he misled me LOL but it was that he didn't explain enough - that seems to be the norm for alot of doctors :(
Now that I saw a picture of the RV Apex it all clicks and makes sense. I'm still not sure the correlation with my P-VT being the in RV Apex and the RVOT both though. I believe from reading it has to do with what dr's have suspected - ARVC/D a genetic thing they said I have, but my MRI was inconclusive, so they said maybe LOL
The dx was 2 positively induced P-Vt's in the RV Apex as well as 1 positively induced P-Vt's in the Rvot....or I think that's what I've been reading hehehe :P Sometimes it all just confuses me, luckily I've met some great people who explain things in patient terms.
If it is ARVC/D my syncope; cardiomyopathy, lvh, mvp/TR and other issues may be explained, if not then I'll keep looking for another piece to my puzzle...
Do you have any family history of unexplained deaths or heart problems? I would love anything you find out on RV Apex issues =) it seems no one else has posted much about this or polymorphic VT - so I'm not much help but hopefully we can find each of us some answers.
Now that I saw a picture of the RV Apex it all clicks and makes sense. I'm still not sure the correlation with my P-VT being the in RV Apex and the RVOT both though. I believe from reading it has to do with what dr's have suspected - ARVC/D a genetic thing they said I have, but my MRI was inconclusive, so they said maybe LOL
The dx was 2 positively induced P-Vt's in the RV Apex as well as 1 positively induced P-Vt's in the Rvot....or I think that's what I've been reading hehehe :P Sometimes it all just confuses me, luckily I've met some great people who explain things in patient terms.
If it is ARVC/D my syncope; cardiomyopathy, lvh, mvp/TR and other issues may be explained, if not then I'll keep looking for another piece to my puzzle...
Do you have any family history of unexplained deaths or heart problems? I would love anything you find out on RV Apex issues =) it seems no one else has posted much about this or polymorphic VT - so I'm not much help but hopefully we can find each of us some answers.
Lisa: Hi. I am so glad you wrote--thus far you are the first who seems to have a situation similar to me. Although "apex" makes you think it would be in the top of the heart, the "apex" is actually the bottom of heart (confusing, eh?), so it sounds like yours is in the same spot as mine. The reason the apex is more dangerous is because the heart wall is thinner there, so there is a greater likelihood of perforation during an abation. Oh how I wish my heart was misfiring in the RV outflow tract, which is far more common and a much easier place to work in. Through some internet sleuthing, I have discovered what is called the "Gentle Touch" ablation approach, which moves the smaller, more flexible catheters by magnets rather than my hand. It supposed it much more accurate and easier on the patient, and is also better for working in more difficult places in the heart. Several places have it, including the Cleveland Clinic.
Unfortunately, the day of my procedure, I was having the least number of PVCs that I've had in months....dumb luck, eh? So, that made mapping more difficult. But, no, I didn't have the tachycardia/heart stopping that you experienced. That sounds horrible....I'm so sorry you had to go through that!
Beta blockers and calcium channel blockers don't work for me as my blood pressure is already quite low, so they just made me feel worse. I had resisted anti-arrhythmic meds because of their long list of side effects and I'd rather not be on medicine the rest of my life. When the ablation failed, the doctor put me on flecainide--it has been just under a week, but so far, I don't see much change.
I have about 6000 PVCs/day, which is a moderate amount, but I feel every single one. They make me fatigued and I also experience intermittent chest tightness and pain. These symptoms have turned my life upside down.
I'm sorry to hear you are a fellow sufferer but, again, appreciate you writing...let's keep in touch....
Unfortunately, the day of my procedure, I was having the least number of PVCs that I've had in months....dumb luck, eh? So, that made mapping more difficult. But, no, I didn't have the tachycardia/heart stopping that you experienced. That sounds horrible....I'm so sorry you had to go through that!
Beta blockers and calcium channel blockers don't work for me as my blood pressure is already quite low, so they just made me feel worse. I had resisted anti-arrhythmic meds because of their long list of side effects and I'd rather not be on medicine the rest of my life. When the ablation failed, the doctor put me on flecainide--it has been just under a week, but so far, I don't see much change.
I have about 6000 PVCs/day, which is a moderate amount, but I feel every single one. They make me fatigued and I also experience intermittent chest tightness and pain. These symptoms have turned my life upside down.
I'm sorry to hear you are a fellow sufferer but, again, appreciate you writing...let's keep in touch....
Very interesting post, I've been trying to understand my problem & ablation and some things you've said makes it clearer. I would love to know more info on the CC procedure; I know I am at the stage to need another ablation and haven't heard of this.
I've never seen anyone else post about the RV Apex, so I'm confused about it, but what you wrote is part of what my dr told me. My EP said it was a dangerous part of the heart that was thin and difficult to work on; which correlates with what you're saying - but I thought it was the bottom of the heart not in the RV Apex; but makes sense now.
When he went into the RV Apex, he induced me twice into polymorphic ventricular tachycardia and my heart stopped, did you have any problems like that? I had over 50,000 (fifty thousand) pvc's before and was very symptomatic also. My ablation worked for a few days but I developed PAC's and my pvc's returned completely in a few months time to 10,000+ but I haven't been back in quite a while.
After he did the RV Apex he didn't stop even though he induced me; he said he thought it was a fluke. He then went to the RV outflow tract which induced the VT into Vfib again, then found a 3rd spot that had the same outcome.
Like you I've tried many different meds, to no avail - only Inderal gives me some short term benefit. Please keep me updated and let me know if you decide to go with Cleveland Clinc and how things go =)
I've never seen anyone else post about the RV Apex, so I'm confused about it, but what you wrote is part of what my dr told me. My EP said it was a dangerous part of the heart that was thin and difficult to work on; which correlates with what you're saying - but I thought it was the bottom of the heart not in the RV Apex; but makes sense now.
When he went into the RV Apex, he induced me twice into polymorphic ventricular tachycardia and my heart stopped, did you have any problems like that? I had over 50,000 (fifty thousand) pvc's before and was very symptomatic also. My ablation worked for a few days but I developed PAC's and my pvc's returned completely in a few months time to 10,000+ but I haven't been back in quite a while.
After he did the RV Apex he didn't stop even though he induced me; he said he thought it was a fluke. He then went to the RV outflow tract which induced the VT into Vfib again, then found a 3rd spot that had the same outcome.
Like you I've tried many different meds, to no avail - only Inderal gives me some short term benefit. Please keep me updated and let me know if you decide to go with Cleveland Clinc and how things go =)
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