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Stroke risk for PVC ablation
Hi. My question is: How much of risk is there of stroke when ablating unifocal PVCs in the left outflow track? Is it something that the doctor HAS to say even though the risk is very slight? Or, is is something that happens somewhat frequently? I average 2300 PVCs in 24 hours with palpitations which have been keeping me from my firefighter job. I am 45. I've been on atenolol and metoprolol... both with progressively increased dosages and neither producing resolution. I am scheduled for an ablation in two weeks. My EP is planning on staring on the right side for the mapping. We have talked about pulling out if noting is on the right and leaving it alone. The PVCs would prevent me from supporting my family, but then so would a stroke. I'm hearing from some that the risk is quite low... less than 1%, but still, many strokes are permanent. My doc is willing to go to the left side if mapping is unsuccessful on the right. Does anyone have any experience with this? Thanks much.
Steve
Steve
Hi everyone!
I've had 2 ablations for frequent PVCs. The first one was for RVOT, and the second one was for LVOT. Yes, the complication rate is a bit higher, but in the hands of a skilled EP, your risks should be minimized.
During the 2nd EPS, the doctor went out to the waiting room to get my husband's permission to approach the left side. He said it was okay, because he knew I wanted to be off the medications and get on with my life. Good answer!! : )
The procedures were successful and after living for years and years with frequent PVCs, I am grateful for many PVC-less days.
I've had 2 ablations for frequent PVCs. The first one was for RVOT, and the second one was for LVOT. Yes, the complication rate is a bit higher, but in the hands of a skilled EP, your risks should be minimized.
During the 2nd EPS, the doctor went out to the waiting room to get my husband's permission to approach the left side. He said it was okay, because he knew I wanted to be off the medications and get on with my life. Good answer!! : )
The procedures were successful and after living for years and years with frequent PVCs, I am grateful for many PVC-less days.
oh wow I just noticed that date said June not July :P thanks for pointing that out.
Hey let us know how the procedure went if you decided to go through with it; I'm having mine soon (Aug 28th) if not sooner, just waiting on my ep to get back from vacation.
Hey let us know how the procedure went if you decided to go through with it; I'm having mine soon (Aug 28th) if not sooner, just waiting on my ep to get back from vacation.
I have dealt with PVCs, PACs and SVTs for twelve years. My cardio and I are only now finally talking about ablation for the SVTs because they have become more frequent and last longer.
I asked him if there was anything they could do for the PVCs while he was in there and he told me that PVC ablation has a lower success rate and if successful is not usually sustainable and I might only see good results for a few months to a couple of years. He also said mine fall in the range of nuisance with 3-5 per minute on average or max of 7200 daily. I have never had breathing issues, pain, fainting, etc. with them although they sure can stir up anxiety.
I mention anxiety because I have found that managing the anxiety that arises from frequent PVCs is often more debillitating than the PVCs themselves and the anxiety actually can make them worse. I don't know what your situation is but you will find many on these boards who suffer from PVCs are able to compete in sports, run marathons, exercise regularly, work physically demanding jobs, etc.
By now you've had your ablation so would love to know how it went for you.
I asked him if there was anything they could do for the PVCs while he was in there and he told me that PVC ablation has a lower success rate and if successful is not usually sustainable and I might only see good results for a few months to a couple of years. He also said mine fall in the range of nuisance with 3-5 per minute on average or max of 7200 daily. I have never had breathing issues, pain, fainting, etc. with them although they sure can stir up anxiety.
I mention anxiety because I have found that managing the anxiety that arises from frequent PVCs is often more debillitating than the PVCs themselves and the anxiety actually can make them worse. I don't know what your situation is but you will find many on these boards who suffer from PVCs are able to compete in sports, run marathons, exercise regularly, work physically demanding jobs, etc.
By now you've had your ablation so would love to know how it went for you.
I completely understand your concerns about stroke in left sided ablations. I have a left sided accessory pathway and have avoided ablation for years due in part to concerns about stroke -- and the fact that I have been able to live a pretty normal life with my arrhythmia for all these years. If my problem had been on the right side, I would have tried an ablation years ago. However, I am now scheduled to have a complete evaluation for possible ablation in September and have looked into the statistics pretty extensively.
The difficulty in quoting percentages for complication rates is that each patient's condition is very individual and the parameters that can potentially lead to strokes are wide and varied. Also, Drs are reluctant to quote specific percentages for individual patients because of the complexity of the many parameters, so they tend to only quote very general statistics, which to me seems somewhat disingeuous, but certainly is more protective of their own practices. It is important to note that some phsycians and facilities have far lower (or higher) complication rates than others, but patients may still be quoted "general" statistics -- as gathered from a pool of phsycians and facilities from around the world -- rather than statistics that directly reflect the data related to the specific patient, phsycian and facility. If possible, always try to get statistics that reflect your own condition, and your phsycian's and facility's experiences.
In my own research I have found that the 3 most important parameters related to possible stroke (and other complications) seem to be 1.) The age and personal and family history of the patient. If there is a strong family history of strokes, or the patient is elderly, there is a slightly increased rate of stroke both from thrombosis and from bleeding. 2.) The skill and experience level of the physician and facility. As noted above, some people and places are better than others due to training, experience, attitude and equipment used. 3.) Individual physiological anamolies. Some patients may have slight anatomical differences in their hearts, vessels and brains that may increase the likelihood of stroke. Sometimes some of these can be determined by testing before ablation, but not all phsycians and insurance companies agree that pre-testing is worthwhile or necessary since these anamolies are uncommon.
Now, before you start feeling too worried, please note also that with the phenomenal increases in ablation technology and equipment, along with newer protocols for patient screening, ablation appears to be safer and more effective than ever. If your doctor thinks you may be at higher than normal risk, s/he can do some investigative tests (such as echocardiogram, blood tests, nuclear scans and MRIs, CT Scans, etc.) and screenings before your ablation to help identify some of the risk factors for stroke. Your physician can also use updated equipment, such as cool tip irrigated catheters (which seem to cause less damage and clots than the older, non-irrigated kind), stereotaxis magenetic navigation for retrograde aortic approach to the left atrium (which in some patients helps to avoid the transeptal puncture that is one of the riskier steps for clot formation in left sided ablation) ICE (intracardiacechography, which helps them actually see clots that may be forming while in the heart so they can "vacuum" them out immediately before they circulate in the body) or even cryo-ablation (cold ablation rather than "hot" burns as with RF energy) which is associated with a lower complication rate of stroke.
It is important to realize that each of these alternatives in testing and technology is associated with it's own consequences, so you need to work with your doctor to make sure that the protocol you are getting for your ablation is the best one for your particular situation, not just a "one size fits all because that's way the doctor or facility always does it" approach. Also understand that many physicians will disagree on the best approaches and protocols to your specific case, so you need to be confident in your doctor or gather several opinions. There are some good studies that suggest the use of advanced catheter equipment, appropriate pre-testing and ICE all do contribute to lower rates of stroke and thrombosis, so if you are concerned, call and ask your doctor about this, either by specifically mentioning these details or by asking in general what steps they will take to help avoid stroke risk -- hopefully s/he will be able to reassure you with the answers.
When patients are appropriately selected, provided with the appropriate protocols for their individual situations and treated by skilled and experienced phsycians and facilities, the actual complication rates can even be lower than the general statistics that are so often quoted by pamphlets, web sites and facilities advertising their ablation practices. While there are no guaruntees and even in best of hands things sometimes happen, there are some steps that you and your doctor can do to help lower your risk as much as possible. Being an informed and assertive patient who is well aware of the risks and benefits of your own case -- and being under the care of a skilled and forthright physician who will work with you to provide the best individualized care -- is one way you can help to improve on the statistics associated with complication rates and improve your own peace of mind about the procedure.
The difficulty in quoting percentages for complication rates is that each patient's condition is very individual and the parameters that can potentially lead to strokes are wide and varied. Also, Drs are reluctant to quote specific percentages for individual patients because of the complexity of the many parameters, so they tend to only quote very general statistics, which to me seems somewhat disingeuous, but certainly is more protective of their own practices. It is important to note that some phsycians and facilities have far lower (or higher) complication rates than others, but patients may still be quoted "general" statistics -- as gathered from a pool of phsycians and facilities from around the world -- rather than statistics that directly reflect the data related to the specific patient, phsycian and facility. If possible, always try to get statistics that reflect your own condition, and your phsycian's and facility's experiences.
In my own research I have found that the 3 most important parameters related to possible stroke (and other complications) seem to be 1.) The age and personal and family history of the patient. If there is a strong family history of strokes, or the patient is elderly, there is a slightly increased rate of stroke both from thrombosis and from bleeding. 2.) The skill and experience level of the physician and facility. As noted above, some people and places are better than others due to training, experience, attitude and equipment used. 3.) Individual physiological anamolies. Some patients may have slight anatomical differences in their hearts, vessels and brains that may increase the likelihood of stroke. Sometimes some of these can be determined by testing before ablation, but not all phsycians and insurance companies agree that pre-testing is worthwhile or necessary since these anamolies are uncommon.
Now, before you start feeling too worried, please note also that with the phenomenal increases in ablation technology and equipment, along with newer protocols for patient screening, ablation appears to be safer and more effective than ever. If your doctor thinks you may be at higher than normal risk, s/he can do some investigative tests (such as echocardiogram, blood tests, nuclear scans and MRIs, CT Scans, etc.) and screenings before your ablation to help identify some of the risk factors for stroke. Your physician can also use updated equipment, such as cool tip irrigated catheters (which seem to cause less damage and clots than the older, non-irrigated kind), stereotaxis magenetic navigation for retrograde aortic approach to the left atrium (which in some patients helps to avoid the transeptal puncture that is one of the riskier steps for clot formation in left sided ablation) ICE (intracardiacechography, which helps them actually see clots that may be forming while in the heart so they can "vacuum" them out immediately before they circulate in the body) or even cryo-ablation (cold ablation rather than "hot" burns as with RF energy) which is associated with a lower complication rate of stroke.
It is important to realize that each of these alternatives in testing and technology is associated with it's own consequences, so you need to work with your doctor to make sure that the protocol you are getting for your ablation is the best one for your particular situation, not just a "one size fits all because that's way the doctor or facility always does it" approach. Also understand that many physicians will disagree on the best approaches and protocols to your specific case, so you need to be confident in your doctor or gather several opinions. There are some good studies that suggest the use of advanced catheter equipment, appropriate pre-testing and ICE all do contribute to lower rates of stroke and thrombosis, so if you are concerned, call and ask your doctor about this, either by specifically mentioning these details or by asking in general what steps they will take to help avoid stroke risk -- hopefully s/he will be able to reassure you with the answers.
When patients are appropriately selected, provided with the appropriate protocols for their individual situations and treated by skilled and experienced phsycians and facilities, the actual complication rates can even be lower than the general statistics that are so often quoted by pamphlets, web sites and facilities advertising their ablation practices. While there are no guaruntees and even in best of hands things sometimes happen, there are some steps that you and your doctor can do to help lower your risk as much as possible. Being an informed and assertive patient who is well aware of the risks and benefits of your own case -- and being under the care of a skilled and forthright physician who will work with you to provide the best individualized care -- is one way you can help to improve on the statistics associated with complication rates and improve your own peace of mind about the procedure.
Oh I forgot to add:
my doctors have said they don't normally do surgery or even meds unless you have other symptoms, fainting - dizziness etc; on anything under 6,000 - 8,000 pvc's 24/hr - which is when they consider "abnormal"
my doctors have said they don't normally do surgery or even meds unless you have other symptoms, fainting - dizziness etc; on anything under 6,000 - 8,000 pvc's 24/hr - which is when they consider "abnormal"
I was wondering that too, but with different situations and diff doctors maybe cirumstances we are not seeing - since it's in the left outflow track maybe?
I got a 2nd opinion and I have 54,000 pvc's 24/hr holter; which accounts for about 42% of my heartbeats (128,000 total) I know they told me last Sunday from the ER it looked like mine were getting more frequent...ugh or the holter day was just one of those "good days" I didn't believe my doctor when he told me if I didn't have surgery what would happen...I'm still on the fence! lol
I've found a few places with numbers thanks Wisconsin - the rates do seem great 80-85% that cures them all and 80% cures for 3 mths. (Im just drooling at that prospect)
I think they have to tell us everything of what can happen just to cover their liablity just in case. There's a 1 in 500 chance of a serious complication rate according the the AHA.
There is no way I would have surgery on my heart, minor or major without a second opinion, but that's just me.
I got a 2nd opinion and I have 54,000 pvc's 24/hr holter; which accounts for about 42% of my heartbeats (128,000 total) I know they told me last Sunday from the ER it looked like mine were getting more frequent...ugh or the holter day was just one of those "good days" I didn't believe my doctor when he told me if I didn't have surgery what would happen...I'm still on the fence! lol
I've found a few places with numbers thanks Wisconsin - the rates do seem great 80-85% that cures them all and 80% cures for 3 mths. (Im just drooling at that prospect)
I think they have to tell us everything of what can happen just to cover their liablity just in case. There's a 1 in 500 chance of a serious complication rate according the the AHA.
There is no way I would have surgery on my heart, minor or major without a second opinion, but that's just me.
I do believe any ablation involving the left side of the heart is more complicated and therefore has greater risk. I just don't know the numbers.
My question is why a doctor would be willing to perform an ablation for so few PVC's in a day. PVC's are difficult to ablate any way and to try on someone who has 2300 a day is interesting. I don't think I have excessive PVC's and PAC's but they do run from 1-5 a minute (1440-7200 a day). There was a time when I had a bad spell and had 15-25 a minute for about 5 months. That was annoying but my cardio just had me wear the monitor and said, "Yep, you're having PVC's and PAC's." They eased off and I'm back to my usual.
Then there are the people on board having tens of thousands a day. I can't imagine that.
Not to downplay your experience but I wonder why it keeps you from your job. And considering the risk involved with ablations (I've had 3 done for my tachy problems) you may want to get a second opinion, perhaps a different medication regimen that might ease your discomfort.
My question is why a doctor would be willing to perform an ablation for so few PVC's in a day. PVC's are difficult to ablate any way and to try on someone who has 2300 a day is interesting. I don't think I have excessive PVC's and PAC's but they do run from 1-5 a minute (1440-7200 a day). There was a time when I had a bad spell and had 15-25 a minute for about 5 months. That was annoying but my cardio just had me wear the monitor and said, "Yep, you're having PVC's and PAC's." They eased off and I'm back to my usual.
Then there are the people on board having tens of thousands a day. I can't imagine that.
Not to downplay your experience but I wonder why it keeps you from your job. And considering the risk involved with ablations (I've had 3 done for my tachy problems) you may want to get a second opinion, perhaps a different medication regimen that might ease your discomfort.
Great question, I am watching this in hopes of an answer also.
My EP told me they will have to go into the right side, then go through the left side, which is where they think my probem is, and there are increased risks, but getting a definite % out of him is impossible.
He thinks my problem is in the lower left ventricle, which he said is a very thin part of the heart and they are going to have to do so many burns it may cause problems.
He said every patient is different and the average % may or may not be accurate with me - oh yeah that just makes me trust him right? lol not by a long shot - I'm an adult I want to know specifics if I ask a question.
Anyone know where to find specific numbers like this?
Ksig, why so many ablations? I am really not looking forward to more than 1 surgery, but the more I read, the more I see others have to have more than 1. How far apart did you have yours? Were they for the initial problem, or did you have new symptoms crop up?
Thanks, Lisa
My EP told me they will have to go into the right side, then go through the left side, which is where they think my probem is, and there are increased risks, but getting a definite % out of him is impossible.
He thinks my problem is in the lower left ventricle, which he said is a very thin part of the heart and they are going to have to do so many burns it may cause problems.
He said every patient is different and the average % may or may not be accurate with me - oh yeah that just makes me trust him right? lol not by a long shot - I'm an adult I want to know specifics if I ask a question.
Anyone know where to find specific numbers like this?
Ksig, why so many ablations? I am really not looking forward to more than 1 surgery, but the more I read, the more I see others have to have more than 1. How far apart did you have yours? Were they for the initial problem, or did you have new symptoms crop up?
Thanks, Lisa
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The risk is higher if the procedure has to go into the left side, as the entry of the catheter is the right side, I believe/understand. Going into the left side more than doubles the risk of complications, including stroke and death, again my understanding.
I believe the risk of complications, not necessarily stroke, is about 1%, which is high but not as high as open heart surgery which I survived.
I believe the risk of complications, not necessarily stroke, is about 1%, which is high but not as high as open heart surgery which I survived.
Hi, Steve
I understand your concern for your well being as related to having a stroke subsequent to an ablation. Before my first left atrium ablation, I had the same concerns. I was given the stats and risks on this procedure. After the discussion, I went ahead with the surgery. In fact I have had 4 ablations. I had the talk each time. I felt that my QOL had to improve so I was willing to take the very small risk. I had my work done at a west coast university hospital with a stellar reputation. I am very happy I had the work done. Good luck to you as you think over your options.
ksig
I understand your concern for your well being as related to having a stroke subsequent to an ablation. Before my first left atrium ablation, I had the same concerns. I was given the stats and risks on this procedure. After the discussion, I went ahead with the surgery. In fact I have had 4 ablations. I had the talk each time. I felt that my QOL had to improve so I was willing to take the very small risk. I had my work done at a west coast university hospital with a stellar reputation. I am very happy I had the work done. Good luck to you as you think over your options.
ksig
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