left ventricle ablation

[Gabby46]

I am scheduled to have a left ventricle RF ablation next month at Cleveland Clinic and have a couple of questions.  I have been having over 25,000 pvcs per day for over a year now which are currently coming from the left ventricle.  I had a previous right ventricle ablation which stopped them there but they immediately started up in the left ventricle at the same rate per day.  I have recently started having heart rate increases to 120-140 bpm with no exhertion. 2/3 of the PVCs on my last holter were in bigiminy or trigiminy. I cannot tolerate any of the medicines used to control the PVC's although I am currently taking Toprol 12.5 mgs as I cannot tolerate even 25 mgs.  So far I am tolerating the 12.5mgs but it is of little benefit, other than helping my heart rate to stay lower, therefore I am having the ablation.  1st question: Does the electrophysiologist have to punch a hole between the right and left ventricle to access the left ventricle, if not how do they get there.  2nd question:  How long is the usual hospital stay after this procedure.  I won't actually see the doctor doing the ablation until the day before as I have to travel 11 hours to get there.  My current electrophysiologist did my RVA but cannot do the LVA so I have to go to Cleveland.  Thank you for your time.

[Momto3]

Sure, you can ask about the studies. We aren't supposed to post URL's, but occasionally the administrators leave them in for other viewers to read.  I'm pretty sure we can post excerpts to studies.  

[PittKicker]

Sorry about the game last weekend..another Pittsburgh team was to blame.  

Thanks for the advice and the heads up on the posting links here...won't make that mistake again.  It's kind of exciting to have a front row seat to these new studies/findings.  If you have any other studies/findings please let me know.  (Can I ask that here?)

Mark

[Momto3]

Hey, it can't be worse than what happened to the Browns on Sunday!  UGH!!  Frye out, Anderson in....Let's see if that helps....  

You might try posting your story as a new post.  It may, or may not, get many responses, but it'll be out there for others to read.  You could post it on the Heart Rhythm Forum in the patient to patient forum.

Just an fyi....we're not allowed to post links to other websites.  I did read up on the study and found this excerpt particulary interesting ; )

"Patients with ectopy-induced cardiomyopathy are significantly older than patients with preserved ventricular function, which suggests either that older patients are more susceptible to the development of a cardiomyopathy or that the cardiomyopathy has had a longer period of time in which to evolve."  YIKES!!  "SIGNIFICANTLY older???"  hahahaha.....I'm happy to see that there are new studies out there to support the possibility of this occurring.

Connie

[PittKicker]

Hi Connie,

We could always use another fan, although we have so little to cheer about these days.  :(  

I bet you've already seen this study, but just in case it's worth revisitng/keeping this 2005 study.  Reversal of Cardiomyopathy in Patients With Repetitive Monomorphic Ventricular Ectopy Originating From the Right Ventricular Outflow Tract

link at:  http://circ.ahajournals.org/cgi/content/full/112/8/1092

Not sure how or where to post my history on the board. Where would be the best place to post?

Thanks again!

Mark

[Momto3]

Great nickname!!  Although, I must admit I'm a former Ohioan so it's OSU for me.  I guess I can learn to root for Pitt UNLESS they're playing in OH...lol

Thank you so much for your kind message.  I read your profile and I know EXACTLY what you were going through.  Since my ablations, I also feel the pvcs more now....They used to be "normal" for me and now they're much more noticeable.  

When my EF first showed signs of dropping, my doctor told me that there was barely a publication out there that would support her theory of pvcs as the cause.  Since then (2003), she has had 2 more patients with the same problem.  

I'm hoping you stick around the boards so you can share your story with some of the people who are just starting down this road...and it's a bumpy one!  You might want to post your story on the forum so many others will see it.  It's a great story : )

Go Pitt!!  See, I can do it  : )

[PittKicker]

I just wanted to say how much your insights and willingness share your experience have helped me personally with my own circumstances.  For the last three years I've been reading everything I can on this site about PVC's and you've been a great encouragement to many!  Thanks!

[Momto3]

After the 1st ablation, I went back to work in about 2 days and it was too soon.  The second time, it took me about a week to bounce back from the fatigue.  About 7 weeks after the 2nd ablation, I did have a prolonged episode of bigeminy (I remember because it was Christmas Eve...lol), but after that things quieted down.  Hope you continue to stay in NSR and are back to your old self soon : )

Pika,

I never saw Dr. Jones, but he did help me with my quesitons here on the forum.  He also corresponded with me to help figure out what was going on.  I agree, he is a great doctor, very kind and thorough. My own EP is also fabulous!  I moved 600 miles away from her office and I still go back for checkups.  There are a lot of wonderful doctors out there; I sure hope you find one you feel more comfortable with.  Good luck!

Connie

[PikaPika88]

I wish there are or just a doctor like Dr Jones in my place.  I can tell he's definately has a heart.  He uses prevention and look after his patient.  He cares PATIENT'S FUTURE.  Not like mine Dr....  they got no heart, they don't feel there is a patient sitting in front of them with a chest like a garbage truck loading.... He just reakon is a piece of wood.....  moving wood?  In and out of his office.

You both are in a good care of the Dr Jones.  Your future will be much more smooth and healthy (At least can do what you would like to do).  Anyway, my doc told me I didn't have any pac or pvc.  May be I just have a naughty heart and need a naughty cardio to fix it.  I haven't found one yet!  Nice to see the successful notes.  Thanks.

[Gabby46]

Yeah, I keep waiting for the missed beats and it feels really weird that they are not there anymore.  I kept watching the monitor in the hospital waiting for the little jump when I missed a beat and it was no longer there, just a straight line regular rhythm.  
Did you find it took you a few weeks to get your strength back after your second ablation.  I have done really well so far and immediately felt stronger but still get fatigued a little quicker than I would like.  It's a good type of fatigue though and I recover from it after resting whereas before I stayed weak and fatigued and could not recover my strength.  I can't wait to be totally back to my old self.  Thanks for all your encouragement and well wishes.  I plan to continue on the forum so I can help others by sharing my experiences.  See you around here.  

[Momto3]

That is terrific news!!  I've been wondering how you were doing and now I know : )

Do you find that your "normal" heartbeat feels a little weird?  I was so used to being in bigeminy, etc. that right after the 2nd ablation, being in NSR actually felt weird.  Just wondering if you had the same experience.

Have a great day!
connie

[Gabby46]

Good news, I just wanted to share with you the results of my recent cardiac ablation.  I had the ablation on 8/23 and so far it has been 100% successful.  I had 0 PVC's during 18 hours of monitoring after the ablation.  That's 0 PVCS, instead of 24-25 thousand per day.  I am totally thrilled that my PVC's are gone. I haven't felt any since then however I could be having a few and not feeling them.  I feel so much better already and am getting stronger every day.  I did not have any left ventricle PVC's after all, they were all on the right side.  The Doctor had to re-ablate the same sites as the original ablation and had to make larger burns but he got them all this time.  I am hoping and praying they don't come back.  

I also want to encourage anyone having severely symptomatic pvcs, as I was, to think about ablation.  I wouldn't do it for just a few or if they are not causing life affecting symptoms, but with the amount I was having, it was more than worth the effort to have the ablation.  Thanks again Dr McWilliams for all your support on this forum.  You are providing a very valuable service for people like me who are suffering and just need a little support and information.  Also thank you to all of you forum participants for your support and advice.  Have a good day

[Gabby46]

Its a small world isn't it.  I'm not scheduled to see Dr. Jones until next year but when I do see him I will pass along your message.  The reason Dr. Jones pushed me to have this ablation is the risk of future cardiomyopathy if I don't.  I stay exhausted all the time since the PVC's started and have gotten worse in the last few months.  Thanks for the info on your previous ablations. It's good to hear from someone who has been through it and it was successful.   I am soooo hoping this one works as I would like to get my life back.  Even a reduction to 6000 a day sounds good to me.  I have tried several of the beta blockers, flecanide and ethmozine but had an allergic reaction or intolerance to all of them so they are not an option for me.  Most of them caused extreme extemity weakness and an all over nauseous feeling after taking them for four days. With the ethmozine I broke out in a rash  Right now I am taking Toprol 12.5 mgs which is 1/2 of the lowest dose and am tolerating that but it is no where near enough.  Thanks for the well wishes and I will let you know how it turns out.  

[Momto3]

OMYGOSH!  Dr. Jones is the one who helped me SO MUCH when I developed cardiomyopathy!!  He was GREAT!!  He kept in touch and helped me connect with Dr. Thalmilarisan (another AWESOME doctor at CC) and Dr. T worked with my own EP to resolve the "problem"!!  Small world!!

IF you ever have the chance to speak with Dr. Jones, please tell him that "momto3" is doing great and the ablations are still working!!  He may not remember, but you may jog his memory by telling him I also have moderate mitral regurgitation and I was the one he corresponded with about the possibility of frequent pvcs causing the CM.  Everyone thought it was the valve, but it WAS the pvcs.

In 2003, I had RVOT ablation, and the pvcs were reduced from 22,000 a day to about 6000/day.  I thought that was great, but b/c my EF was still low, the doctor wanted to try a second procedure and see if she could further reduce the number of pvcs I was having.  EKG indicated it was another right sided foci, but when they mapped everything it turned out to be left.  The doctor went to the waiting room to ask my husband if she could try ablating for LVOT.  He said, "she'll kill me if I say no!"  So, they did the LVOT procedure, using the femoral artery on my right leg (used a plug to close it) and crossed over the aorta. I was on heparin to prevent clotting and b/c of the other meds, I didn't feel anything until the very end.  That was mostly a little pressure at the cath entry site and a nasty headache (I think from the calcium something or other they were giving me).  The second procedure required a little more "work" for the doctors, but they got it!!  I agree, you are in great hands at CC!!  

Good luck!!  Please keep us posted!!

[Michael J. McWilliams, M.D.]

Yes, RCJ is Robert Chris Jones.....

[Gabby46]

Dr. Jones was Dr. RCJ on the forum back in 2003 I think.  He told me he was on here at one time.  I have gone back and read most of his responses on here and I agree with you.  I was actually disappointed he was unable to do the new procedure for me as I really like and trust him.  He was honest with me and said he saw very few people with a problem like mine and I would be better off at Cleveland Clinic where they saw many people from all over the world with my problem.  Thanks for you well wishes.  

[tickertock]

DR. Chris Jones as far as I know was DR. RCJ who use to answer questions some years ago on the Medhelp heart forum, I must say I found him to be very thorough, brilliant and to the point very much like Dr.MJM when answering question posted on the forum. Its so good to know where these great EPs are located. I wish you all best Gabby with your upcoming ablation, keep us updated on the success. Take care.

[Gabby46]

Thank you for your answers they relieve a lot of my misgivings about the procedure.  Dr. Saliba at Cleveland Clinic is doing my procedure.   My biggest fear of the procedure was that they would have to make a hole between the ventricles.  I also have a fear of a lot of pain because during my first procedure I was in constant pain which according to my electrophysiologist (you may know him, Dr. Chris Jones in Nashville, Tn) was due to a nerve wrapped around my right femoral vein. (the left one did not hurt at all)  Maybe they can just go in through the femoral artery on my right leg this time.  I was  informed the vein may not hurt this time but it could be worse due to scar tissue.  I will discuss it with Dr. Saliba before the procedure.  Once again thank you, I feel much better about having the surgery now.  I am hoping I will feel much better afterward as with this many PVC's I am constantly fatigued.  

[Michael J. McWilliams, M.D.]

Chris Jones is a very good friend and also one of the brightest people I have ever worked with -- don't tell him that though.  Saliba is very good and is one of my mentors from the Cleveland Clinic.  You couldn't be in better hands.

[Michael J. McWilliams, M.D.]

Hi Gabby,

Do you know who is doing your ablation at the Cleveland Clinic?  That is certainly a lot of PVCs.  The good thing about having that frequently is it helps us localize them and increases the chance of success.

Does the electrophysiologist have to punch a hole between the right and left ventricle to access the left ventricle, if not how do they get there.

This is what they will do--they will place either two or three venous sheaths (large IVs) in your right leg.  They will map the right ventricle to determine if the PVCs are coming from the right side.  Either at the beginning of the case or after they map the right ventricle, they will place a catheter in your femoral artery.  The femoral artery allows them access to your left ventricle by crossing the aortic valve.  They rarely have to cross the heart (intra atrial septum) for a VT or PVC ablation.  They use heparin (an intravenous blood thinner) to keep your blood thin during the case.  You have probably already been told that one of the risks is blood clots and the risk of blood clots is 1% with heparin given.  It is a safe procedure with acceptable risk / benefit profiles in the right patients.  The Cleveland Clinic does a lot of these procedures – you are in good hands.

2nd question:  How long is the usual hospital stay after this procedure?  

If everything goes well, you will be discharged the day after the procedure (ex. procedure Monday, discharge Tuesday).  If you are from out of town, they sometimes ask that you stay in a hotel locally for one more night.  Call the doctors office to ask if they will want you to do that so you know how to schedule your flight (216-444-2200 is the operator).

I hope this answers your questions.  Good luck and thanks for posting.