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To Ablate or not to Ablate?
Just wanted some opinions here, I'm VERY confused as to what to do. I have a history of unifocal(mostly) PVCs, with bigeminy, couplets, and a handful of triplets on each holter. The max numbers they hav e caught is around 3,900 a day. I am very symptomatic and I frequently experience dizziness, light-headedness, and SOB(esp. when the numbers are high). I can also go hours without one PVCs and some days are terrible, while others are easily tolerable. My doctor has recently said "just to got and get an ablation" since they bother me. I am having a hard time deciding what to do because I just can't seem to get over the fact that I would be risking my life during the ablation for something that may not even be harming me. It is terrible at times living with these but I dont know if it's worth the risk. I also can't really take off nursing school right now and I am worried that the ablation may cause a worse arryhthmia? Does anyone have any input or ablation info/stories? It would really be helpful to me right now, I really don't know what to do...
thanks for your kind words.
By way of update:.
Had the ablation yesterday. Nurses and Doctors helped with any anxiety I was experienced. A very reassuring environment.
Procedure went very well and was filmed by the State's main television organisation _channel 9. I was actually interviewed this morning (the day after the ablation) for the segment which will appear on the news later this week. Apparently they were trialing out some new 3 dimensional heart scanner that assists in identifying the ectopic focus. One of life's unexpected surprises.
Nurse 2b- Importantly, other than feeling a bit tired, no adverse implications. The nurses tell me the most common thing requiring further treatment is the catheter site itself-haematoma or infection. At this stage, I would have no reservations in recommending you have the ablation-for me it is all about quality of life and I simply could not put up with these things any more. Trust your instincts (which hopefully is not clouded by the amount of info you know about these things). Advances in electro-physiology and ablation technology is a wondrous thing. I wish you well in your decision making process.
I awoke this morning waiting to feel a PVC but there was none. What an amazing feeling. It is amazing how one becomes sensitised to these annoying things. Doctor is very confident the ablation was successful.
Will report further.
By way of update:.
Had the ablation yesterday. Nurses and Doctors helped with any anxiety I was experienced. A very reassuring environment.
Procedure went very well and was filmed by the State's main television organisation _channel 9. I was actually interviewed this morning (the day after the ablation) for the segment which will appear on the news later this week. Apparently they were trialing out some new 3 dimensional heart scanner that assists in identifying the ectopic focus. One of life's unexpected surprises.
Nurse 2b- Importantly, other than feeling a bit tired, no adverse implications. The nurses tell me the most common thing requiring further treatment is the catheter site itself-haematoma or infection. At this stage, I would have no reservations in recommending you have the ablation-for me it is all about quality of life and I simply could not put up with these things any more. Trust your instincts (which hopefully is not clouded by the amount of info you know about these things). Advances in electro-physiology and ablation technology is a wondrous thing. I wish you well in your decision making process.
I awoke this morning waiting to feel a PVC but there was none. What an amazing feeling. It is amazing how one becomes sensitised to these annoying things. Doctor is very confident the ablation was successful.
Will report further.
Good luck,,,,,good luck....good luck........let us know what you thought jonesy and i hope all of the angels in heaven smile down on you during your procedure and you walk away from it with a new lease on life....fill us in !!!!!!!!!!!!!
Thank you all for your responses! I am researching and hoping to make a decision soon, I will let everyone know what I decide! I see my EP on the 23rd and hope I will get some more info and maybe I will find some peace with the whole ablation thing.
I am having an ablation tomorrow for frequent PVCs-over 16,000 a day. My pvcs are thought to originate from the right ventricle-LBBB which are more amenable to ablation.
Yes there are risks, but I have balanced that up with a quality of life issue. It helps to have confidence in my cardiologist and I am going to get through this.
Look forward to sharing my ablation experience with you.
Mj
Yes there are risks, but I have balanced that up with a quality of life issue. It helps to have confidence in my cardiologist and I am going to get through this.
Look forward to sharing my ablation experience with you.
Mj
Hey i read your post.....i understand completely what you are going thru Nurse2B....i went thru the same thing before my ablation a couple of years ago...i kept putting it off, doing more research, yada yada yada until my situation began to get progressive and then my hand was forced....i was the biggest scardy kat there was and also worried about dying on the table to the point i wrote my kids good by letters and put them in the fridge for them to find in case something happened because i was absolutely sure i was never going to come out of the O.R, Now i look back and think if i knew then what i know now i never would have hesitated....i had PVC's, a fib, tach,etc, etc., etc. it is a situation where you have to find a safe place in your mind and heart to make your decision but i really agree 100% w. what is something wrong posted.....i think for others it may very well be when it gets to the point where you just can't take it anymore then you act. I didn't have the luxury of that and seriously almost did myself in...in retrospect now it was the greatest choice i could have made (or i guess not made in my situ). Its like a leap of faith when any of us face anything serious medically.....i hope you find a good place in your heart and mind for this and all i can weigh in with is that i got my life back but almost lost it being so darn stubborn thinking i knew more than the docs....lol...........good luck to you.....
Hello...
Your question "To ablate or not to ablate" is fair and certainly one asked by many who are experiencing bothersome symptoms. PVC ablations are pretty common and the success rates are quite high (upper 90%) with only 1 procedure. Potential complications of ablation occur in <1% of cases and include myocardial perforation with cardiac tamponade due to catheter manipulation during mapping or rupture during ablation in the RVOT (common site of PVC origination), and very rarely heart block due to inadvertent slippage of the catheter toward the His bundle. Excessive ablation in the septal portion of the RVOT can result in injury to the left anterior descending or left main coronary arteries with resultant myocardial infarction. Death from the procedure is extremely rare.
As for an ablation for PVC's originating from the left ventricle, the risks are significantly higher. Many EP's will not do ablations for L sided PVC's because the risks may outweigh the benefits. Certainly if the PVC's were causing damage to the heart muscle the benefits to risks would be different.
Of the 5 ablation procedures I've been through...1 was for RVOT-VT...I spent 1 night at the hospital and was back on my feet within 2 days. Of course with restrictions on heavy lifting. As far as new onset arrhythmias post ablation...that is not common, not to say that it can't happen. Have you exhausted all possible medications for your symptoms?
Your question "To ablate or not to ablate" is fair and certainly one asked by many who are experiencing bothersome symptoms. PVC ablations are pretty common and the success rates are quite high (upper 90%) with only 1 procedure. Potential complications of ablation occur in <1% of cases and include myocardial perforation with cardiac tamponade due to catheter manipulation during mapping or rupture during ablation in the RVOT (common site of PVC origination), and very rarely heart block due to inadvertent slippage of the catheter toward the His bundle. Excessive ablation in the septal portion of the RVOT can result in injury to the left anterior descending or left main coronary arteries with resultant myocardial infarction. Death from the procedure is extremely rare.
As for an ablation for PVC's originating from the left ventricle, the risks are significantly higher. Many EP's will not do ablations for L sided PVC's because the risks may outweigh the benefits. Certainly if the PVC's were causing damage to the heart muscle the benefits to risks would be different.
Of the 5 ablation procedures I've been through...1 was for RVOT-VT...I spent 1 night at the hospital and was back on my feet within 2 days. Of course with restrictions on heavy lifting. As far as new onset arrhythmias post ablation...that is not common, not to say that it can't happen. Have you exhausted all possible medications for your symptoms?
Hey, good to see you back! The risk of throwing a clot and causing a heart attack or stroke is there and I'm told that depending on where the PVCs are coming from, it may be a little higher or lower in certain areas. I think that the left side is more dangerous and based on the ECG, my dr thinks that is where mine might be. My medical knowledge is a blessing for others and a curse for me sometimes:) It makes me worry more because I kno wwhat could happen. My dr. seems to think that mine are unifocal but may not be 100% unifocal, there may be a spot that throws out a few here and there but I am told that they may be able to get rid of the majority of the PVCs. I am more worried about 1. the risks 2. the possiblity of creating an arrythmia that I will have to deal with after procedure 3. possible after effects of ablation. I am really at a loss as far as what to do at this point, I'm worried I am going to make the wrong choice. Thank you for the response, and once again, I am glad to see you back!
Dear Nurse2b,
I hope you are OK.
I'm not sure why you think you're risking your life with an ablation, as far as I know, the risk is approx. similar to a stress EKG test. Risks are if the electrodes pierce structures in your heart and causing fluids in the pericardum, if that happens, you get them drained away. It happens in 0,1-0,2% of the cases and is usually not life threatening.
If a dangerous arrhythmia get provoked, there are no safer place than in an EP study, there are defibrillators and IV medications seconds away.
Just by using an ICD (and no medications) chance of converting a V-fib is more than 99%. And it's extremely unlikely you get V-fib provoked at the EP study.
(I'm not 100% certain here, this is what I've read but my sources may be inaccurate. It's always best to ask the doctor what the risks are).
What you should ask your doctor (based on your answer from Cleveland Clinic) is if they can ablate multifocal PVCs. If the doctors say it's possible, I know I would have done the ablation.
I think the doctors through this process have scared you a bit, mentioning ARVD and other dangerous heart diseases. In my case, I can easily find scary diagnoses myself, I know how you feel.
I cannot say what you should do or shouldn't do. All I hope is that you get through this, you're going to be a really good nurse, and you have lots of knowledge to share with your patients, both regarding the physical and mental side of a disease.
Good luck, I hope you do the right thing, and I really hope you'll be OK. Please keep us updated :)
Best wishes!
I hope you are OK.
I'm not sure why you think you're risking your life with an ablation, as far as I know, the risk is approx. similar to a stress EKG test. Risks are if the electrodes pierce structures in your heart and causing fluids in the pericardum, if that happens, you get them drained away. It happens in 0,1-0,2% of the cases and is usually not life threatening.
If a dangerous arrhythmia get provoked, there are no safer place than in an EP study, there are defibrillators and IV medications seconds away.
Just by using an ICD (and no medications) chance of converting a V-fib is more than 99%. And it's extremely unlikely you get V-fib provoked at the EP study.
(I'm not 100% certain here, this is what I've read but my sources may be inaccurate. It's always best to ask the doctor what the risks are).
What you should ask your doctor (based on your answer from Cleveland Clinic) is if they can ablate multifocal PVCs. If the doctors say it's possible, I know I would have done the ablation.
I think the doctors through this process have scared you a bit, mentioning ARVD and other dangerous heart diseases. In my case, I can easily find scary diagnoses myself, I know how you feel.
I cannot say what you should do or shouldn't do. All I hope is that you get through this, you're going to be a really good nurse, and you have lots of knowledge to share with your patients, both regarding the physical and mental side of a disease.
Good luck, I hope you do the right thing, and I really hope you'll be OK. Please keep us updated :)
Best wishes!
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