treatment options for PVC

[rampanand]

I have been having PVCs for  3 years and have been taking 100-200 mgm Amediorone. It appears the medicine has become less effective and side effects are becoming intolerable. A recent 24 holter test showed several thousand bigeminies and trigeminies. Please comment on significance of these beats. I am concerned because a previous test few months back showed only  scattered PVCs.

Would ablation, pacemaker or another drug be a better option for a 77 year old man? I have been told that PVCs are originating in the left ventricle. Would ignoring them lead to more serious problems like ventricular tachcardia? My heart function is good with ejection fraction 60% to 65%, and normol exercise tolerance. My  heart rate is 55 beat, however, at night it slows to mid forties. Beta-blockers have not been helpful

Thanks so much

[BionicBabe]

I've heard amiodorone can have some pretty serious negative side-effects, especially when used long term...but I'm not an expert. Good luck getting the right treatment!

[Momto3]

LVOT is left ventricular outflow tachycardia.  My second ablation was for a left sided foci....and it was successful!

Prior to the ablations I took Inderal for many years (on and off).  Eventually, I chose to just deal with the PVCs since the meds were no longer as effective.

When I had the cardiomyopathy, I had to be on anti-arrythmics.  First up:  flecainide (didn't like the side effects).  Next up:  Propafenone (not too bad, great at controlling the PVCs).  Third stop:  ablations and no more anti-arrythmics.

Let us know what the doc says

[kim62]

I totally agree about the Sotalol. I am currently being weaned off of it because it lowers my heartrate considerably, thus causing my PVCs to be increased. I have a condition where the PVCs trigger VT.  The best drug combination so far after 5 years of this is Digoxin and Cardizem. I have been on so many different ones.Some anti-arrythmic drugs acually are pro-arrythmic. For instance, Flecainide had an adverse effect on me within 36 hours I was have bouts of PVCs and VT right and left that the doctor told me to stop taking it and go to the ER. I have an ICD  now which will pace or even shock me out of the VT as well as paces me upward when the heartrate drops below 40.

[rampanand]

Thank you all for your very helpful comments.
I have briefly tried Sotalol but it did not suit me. My normal heart rate and blood pressure are some what below normal, and beta-blockers tend to lower them further. I was under the impression Amedierone is a gold standard in treating arrythmias. However, I now have doubts. I will discuss Flecainide and Propafenone with my cardiologist.
The PVCs are originating in the left ventricle. So chanceof success with ablation is 50 %. I am planning to check with another EP for second opinion. The pacemaker may work because my normal heart rate is low ,55 during the day and 45 at night. Since most of the PVCs occur when I am asleep, raising the heart rate coould help. What is LVOT Momto3?  

[Momto3]

Hi Bonnytiz,

It is a relatively rare complication in the setting of very frequent PVCs.  At the time, at least 24% of my total heartbeats were PVCs.  My when ejection fraction dropped to 40%, the doctors thought it was because of a leaky mitral valve.  Further tests indicated that was not the case.  A trial of anti-arrythmics had some positive effect on my ejection fraction, so they were nearly certain I had developed PVC-induced cardiomyopathy.  My options were anti-arrythmics or ablation(s).  The ablations were successful and my ejection fraction normalized after about 1 year.

[bonnytiz]

Hi Mom, when I was reading your reply to rampanand re PVC's i was interested when you said you developed PVC-induced cardiomyopathy.  I am concerned now as I am wondering if its common for PVCs to bring this on, I thought they were considered harmless.
I hope you are doing ok.

[Momto3]

You've probably heard this before, but in patients with a structurally normal heart, the PVCs are generally not concerning.  However, some patients are very symptomatic and for these patients medications are sometimes helpful.

Are you taking the amiodorone for any other reason?  That is not a typical medication prescribed for benign PVCs...Also, some of the medications can actually trigger ectopic beats.....UGH!!

When I asked about a pacemaker, I was told it was not a treatment option for us PVCers.  More of a benefit to people with bradycardia.  

Has the doctor ever discussed the possibility of an ablation?  I had 2 ablations, one for RVOT and one for LVOT.  However, the doctors didn't really consider it (or anti-arrythmics) an option until I developed PVC-induced cardiomyopathy.  Prior to that I had PVCs for at least 20 years.
Great ejection fraction!!  

[Brooke_38]

Sorry you're having such a rough time. Unfortunately, a pacemaker would not be helpful for PVC's. I'm surprised that you were given Amioderone as a first line drug. I usually see this used when all other antiarrhythmics fail.

There are definitely other drugs like Flecainide, Sotolol, Tykosin etc.. It would really be up to your treating Dr to decide which is best for you. You can also mention an EP study, if they know where the focus of these PVC's are originating they can ablate and hopefully cure you of this problem.

Good luck