Ablation for chronic PVCs. Worth the risk?

[mzak69]

I've been dealing with the darn PVCs on a daily basis for 8 months now. It seems like they are becoming more frequent. I'm taking potassium and angstrom mg for 2-3 weeks with no improvement. Every time I have an active or stressful day I am punished at night with a string of PVCs that can last for hours. They appear to be adrenaline related. It has made my life miserable.

My EP gave me a special script for an EKG for when I got a bad episode, so last night I went to the ER and they hooked me up. They saw PVCs coming every few seconds, and the technician said they all looked identical, so it appears that they are unifocal.

I'm not sure what to do here. I don't have PVCs ALL day, but I do get them EVERY day. Some days are manageable, other days are very frustating. I am living right now for the moments when I am PVC free. Not a good way to live your life.

So my question to all you fellow sufferers is, is the ablation worth the possible risks? And what are they?

Thanks for your responses.    

[tom_h]

I'd look not at the risks, but whether it was worth it as far as results go, as well as financially.  Ablation for PVC's is known to have mixed results.  The procedure itself has minimal risks.  Anytime someon goes sticking wires into your heart, there is risk involved.  But it's pretty minimal.  I guess everyone fears zapping the AV node, and while that is a possibility, it's fairly remote.  Cost varies.  Mine for AVRT ran $77,000 before insurance.  Not bad for a few hours of work! :-)

[mzak69]

I understand your point. In my situation, the PVCs seem to be activated by adrenaline. If I have a lazy, stress free day, I'm not too bad. If I workout, play in a softball game, have sex with my girlfriend, anything strenuous I'm getting bombarded with them afterwards for hours on end.

Yesterday I did yardwork and played softball. Sure enough, 7pm they fired up. When I went to ER a few hours later, I was getting them every 6-15 seconds, and felt every one of them. I've been forced to take Xanax to fall asleep during these episodes, otherwise I am up for hours.

If I can't find a non-surgical solution I will be forced to make a decision. Do all the acitivities I enjoy, and then be punished with PVCs every night at bedtime, or sit around and do nothing and have less of them. It's a depressing situation.

BTW. My dad's triple bypass cost around $50-$60k, and I don't understand why an ablation would be so much more expensive. Maybe it's the hospital in your area.  

[bbxx]

Well I dont have the answer for you. I know I have them every other beat at times.
Its not fun at all, especially when they feel different at differnt times. Recently I had another near faint following some sort of pvc or other...
Yes, the whole thing is frustrating. I dont have the answer but I can relate to the frustration.

[Mom2four85]

when I had mine done back in 2009, I had almost met my yearly deductible and paid $300 for a 4 day stay that included my EP Study w/ablation a ton of testing and ICD implant; my total bill was >$325,000 when all was said and done (I think my ICD alone was $129,000)

For me it was worth every penny since it took me down from 50,000 pvc's that I'd been having for quite a while to none for the first few days; but as others have said there can be adverse reactions to the procedure such as I had.  Was mine a success? yes and no; would I do it again? no because for some like me there just aren't any answers or fixes; except a new heart.  Before, I had rare atrial problems, but after I started having problems both top and bottom in the heart.

I think much like you, mine are mainly adrenaline based and the ANS play a big part in my symptoms and problems.  2 years later I still don't have a lot of answers or relief from symptoms, so ablation was a help in one way but I think may have caused other problems.

I was willing to try anything after 35 years of having arrhythmia's and being in bigeminy most of the time from April 2007 to August 2009.  Depends really on how much you can handle and cope with the symptoms versus the risk and cost of having it done and still may not have a cure.

[curmudgen]

You should consider yourself lucky since you know what triggers your PVC's .......solution reduce your stress....are you on a beta blocker?  I get episodes of PVC's that last for a few hours every day and at times I think my heart isn't going to recover.  I don't think I would really consider an ablation unless they were 24/7 and resulted in fainting .  An ablation procedure destroys heart tissue and there is no guarantee that it will work or cause other problems.  Dealing with your stress is the best solution.  

[mzak69]

I agree that stress triggers the PVCs, but also any type of strenuous activity. If I want to have less PVCs, then I have to stop doing the things that I enjoy like playing sports, working out, having sex, etc. Not how I want to live. I keep hoping that the mg will help lessen the PVCs, but I can't really say if it has yet.

[mzak69]

It sounds like you had alot going on with your heart. In my case, it is structurally ok (no a-fib, svt) except for these adrenaline related PVCs that appear to be unifocal in nature.

So, I am wondering if an ablation would be a suitable solution to relieve them. I can't believe an ablation would cost my insurance company more than a triple bypass, but I suppose anything is possible.  

[tom_h]

I don't want to get off the subject of this thread, but here were some of the major charges for my EP study and ablation:

COMP EPS W/ATTEMPT INDUCTION  $10,914.00
EPS W/LT ATRIAL RECORD  $13,949.00
CATHETER ABLATION SVT  $18,540.00
TACHYCARDIA MAPPING  $2,187.00
CATHETER SUPPLIES  $21,699.00

My out of pocket charges ....... $250.00

[coun79try]

i know how you feel about every 30-40 days my heart speeds up and skips every third or fourth beat and the Dr can't figure out why but my Dr is trying to get me to do the same thing and if i can make myself believe that there is a 20% chance it can fix me than that's what I'm going to do because I'm only 31 and i feel like i can't do the active things i love because of the fear of knowing what i may have to deal with that night. Your seen it may be a little worse than mine because i can't really find a pattern to mine they just show up once a month, i can almost even pin point the day it will happen. I can say this my wife grandfather just had this done for a very rapid heart rate a skips beats and he said his heart fills brand new again, hasn't had any problems. Good Luck

[Mom2four85]

when i first went in back in July 2009, I went in to have the ablation for very frequent unifocal pvc's; and I only had rare psvt...it was going to be quick and easy >95% success rate quoted and I would no longer have any problems...I became my EP's worst nightmare and had him and all the others I've seen scratching their heads.

it depends on the day and what test was done whether my heart is "structurally" normal

Here's an example:
July 2009 my first echo - structurally normal heart
August 26, 2009 EP Study w/ablation
August 27 2009 Cardiac MRI structurally normal heart (nothing found)
August 28 2009 Cardiac catherization showed - nonischemic cardiomyopathy (HOCM); LVEDP was 34; systemic hypertension
April 2010 Echo - HOCM (lvis thickened and walls thinned)
March 2011  Echo - structurally normal

I've been told by 4 cardiologist and 2 EP's this is NOT my heart that it's my ANS system...2 cardiologists and 2 Ep's say it is my heart (HOCM) and I have classic symptoms of it.  This is why I still have no answers; so I'm going to a doctor who deals with HCM patients at cleveland clinic in weston FL when the weather cools down some.

sometimes, until they go in and are actually working inside the heart they think things are normal until they run into problems like with me...most of the time though ablation may help and be a cure

[mzak69]

When you had your ablation, were PVCs the only reason you got it? Or did you have other issues at the time? Did you have any SVT, myopathy, prior to the ablation?  Do you believe that the ablation brought on these other issues, or were they already present?

My greatest concern is that I have the ablation done for the PVCs (which kept me up until 2am last night BTW) and then other problems arise.    

[mzak69]

It sounds like you had several issues to deal with at the same time. For me, the PVCs are benign and unifocal but have changed the way I live my life. I'm literally avoiding many of the things I enjoy out of concern that they will cause more PVCs. My nights are a struggle. Just about every time I have an active day, I get a string of PVCs starting around 8 or 9pm lasting for hours.

This is the weirdest, most bothersome thing I have ever had to deal with in my life and I want it to end asap. If an ablation can do that, I'm game. Taking pills for the next 10, 20 or 30 yrs doesn't appeal to me, and frankly I doubt they will help anyway.  

[littlegreenman1]

Physician / Provider Pocket Total Charges
First ER Visit. $399.51 $2,439.00
Holter Monitor $47.60 $890.00
Ambulance $966.25 $966.25
Second ER Visit $735.44 $1,481.70
Initial EP Visit $18.90 $270.00
Ehco - Preop Labs $983.29 $2,749.19
Hospital Charges $4,249.61 $75,739.50
Anethesia                 $0.00 $4,085.00
EP Fee                 $439.20 $12,930.00
Post Ablation ER Visit
(take a week off) $191.34 $2,235.60

Grand total                $8,031.14 $103,786.24

Pocket amount paid does NOT include $2000 health savings account. (Which I blew at the first ER visit) Total amount billed was discounted about 35% overall.

[Mom2four85]

I say go for it and at least try the ablation; they may go in and find nothing or go in and find exactly what's causing the problem and be able to fix it.

[mzak69]

I would bet that the costs vary depending on what type of insurance you have. Also the area you live in can be a factor. The docs and hospitals will milk everything they can out of the plan. The better your insurance, the higher the cost. Would you agree?

[littlegreenman1]

I think the cost is what it costs...

The cath lab is expensive...
The catheters themselves, I'm told are $5,000 each - disposable.
Docs have airplanes to fly and malpractice insurance to buy...

I have good insurance, and I like the way its structured. Cheap premiums. High deductible. It forces the patient to be a consumer and consider cost. How much would your health care habits change if your deductible was $5k?

[curmudgen]

I really don't think the doctors try to get the maximum payment...most of them bill by codes and there is a price list you can ask for at their office/hospital.  How many of us shop around for a more reasonable price for lab tests or outpatient services?  Not easy to do comparison shopping when you are in need of medical care.  That said, the system is broken - costs are way to high and we the consumer get the shaft.  I count my blessings that I have medical insurance and don't mind paying a small co-pay now and then.

[mzak69]

I was under the impression that the insurance company has maximums or allowed amounts that a dr or hospital can charge for a specific procedure. I would assume that can vary depending on the part of the country you are in or the type of plan you have.

I may be wrong though.

[kane3]

Hey saw something about a BB being written, and wondering if you have been on this type of medication before? If not, you should talk to your physician about it. In your case with the adrenaline rushes, it could help cut that down alot possibly leading you to a better night. I hear you about the life part being turned upside down. Pvc's are such a battle, such a mind battle, and pretty much a life battle. I wish there was an easier way to deal with these things!! Everyone has there triggers, some knowing, some not. I hope you can try and find the right path in dealing with yours, good luck!!

[mzak69]

I tried metaprolol. It only made me feel really tired, and I still got PVCs. I'm hoping there is a better, more permanent solution.

[lolajaneweaver]

I would say yes to the ablation, but ONLY at a major cardiac facility that deals with this every day.  IE Cleveland Clinic, Mayo, Johns Hopkins, etc...do your research about who is close to you.

I had mine done at the CC in my area last week, successfully.  No PVCs at all as of 1 week later on a holter.   There are multiple reasons for PVCs and at the very least over time, they CAN weaken your heart.

I would do the ablation again 10x over, but like I said, ONLY at the best of facilities.  Good Luck!!

[Mikew904]

I just had an EP study and the Ablation.  It was a "difficult" one, the Dr knew that going in.
He told me typically they take about 2-3 hours.  He spend 5 hours in there (7 on the table)

It did not work for me, but the proceedure wasn't that bad.  You may want to ask your Dr about the risks, I was under the impression that the risk of me not having one was not in my favor (to say the least)

Good luck

[Mom2four85]

I'm interested to know where it says over time pvc's weaken the heart?  do you have any research for that? I would love the links if so to read and take to my dr.

I know I've found research that shows very frequent pvc's (>15% daily) may lead to cardiomyopathy and weaken the heart but so many discount this research.

I've had arrhythmia's since age 9 and from age 40+ had 50,000 pvc's found and have been told by numerous dr's if your heart is structurally normal; pvc's are nothing to worry about and won't do anything to your heart and the chance of developing CM was rare.