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.    

[researcher09]

Chris, see chat below from a couple of weeks ago.-----
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researcher09 Blank  
Aug 19, 2015
To: itdoodBlank
Your EF is great and you sound really healthy so good for you.  If you are in PA, then Callans and Marchlinski are great resources to have around if you decide to do something about your PVCs.  There just aren't many EPs around that do ablations on those things.  50 procedures/yr is considered a lot and required to be included in clinical trials.  Don't know if you saw the article on espn regarding endurance training and heart issues for some people.  My sister emailed me after I shared it and mentioned many of her life guard friends that are into endurance training are having heart issues as they got older.

http://espn.go.com/sports/endurance/story/_/id/13386980/velonews-endurance-athletes-damaging-their-hearts
BlankReply
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995271_tn?1408549100
itdoodBlank Blank  
Aug 20, 2015
There's data on runners,   Their mortality / morbidity rates decline until about 10 - 15 miles per week at 10 minute pace.  More than this and the rate start to go back up.   People that train 50+ miles per week have the same rates at smokers with diabetes.  

Check this TED talk https://youtu.be/Y6U728AZnV0

[Chrisruns]

I run marathons/triathlons and i get 5-10K PVCs per day, i had an ablation to correct SVT about 14 years ago and after the ablation is when the PVCs came on bad. th EP says they are not related but i don't believe it. the good news is i have never had a run of svt since. Exercise has always helped reduce the PVCs until i started to train heavy. I think this might be causing them, i am trying to decide on having another ablation to correct the PVCs, i don't want to cut out the training, but i can't live with these anymore!

[researcher09]

How are you doing now post ablation?

[Lifelife123]

Hi mzak69

I have the exact same problem for the last 6 months, I get pvcs soon as I start to move, even walking slowly to the letterbox causes me to have them. If I play with my kids to 3 mins or so I get them for the next couple of hours. And like you I think my are adrenaline related. Even walking to my car after work I have to stop and let it settle down before I continue.

Just want to see how you are getting on right now, have yours got better or worse, and is there any advice you could give me who is new to this.
Thanks so much

[mzak69]

I would ask your EP if he has done ablations before for this type of problem. Try to use an EP who does a lot of ablations and has experience. The more PVCs you get, the more likely they will find the spot that is causing them. I never went through with my ablation because my PVCs weren't flaring up when I was scheduled to have it. My problem is they come and go and I can't get the ablation at the exact time they are occurring. Good luck!

[Hschein]

I would like to know how it goes and if it helps your PVCs.?  Mine aren't terribly bad all day but they get SOO bad when I exercise to the point it skips constantly.  I live an active life and since they have got so bad while exercising I have completely stopped in fear I will drop dead!  I have 3 small children so I have stress about anything happening to me.  My EP has suggested the ablation but I'm hesitant to know it will actually help.
thank you!
Heidi

[SylviaJW]

I think the PVC ablation is a good start.  Im having mine on July 1st.   Sylvia

[jackmaya]

Hi My name is jack,
I had ablation for SVT 5 years ago since then my SVT are under control but my PVC<PAC are not since your post in 2011 how does your PAC,PAC been? are you cured..Please let me know .

***@****

Subject ABLATION
so i know it's from you

Thanks you so much..

Hopefull

[penny_aus]

a doctor told me PVC's are stress. mine seem to go waves. for awhile I get them and then I don't. he told me to find things to keep me busy. I used to get them bad at bedtime. now I read just before sleep and its cut them right down so I'd say the doctor is right and yes I suffer from anxiety and stress which the heart reacts to

[chatham]

I have 18,000 a day. I will be getting the MRI next, but I expect it will be normal. I have a BB that lowers my heart rate too much (I run marathons and train a lot), so the doctor told me to cut them in half. I also have Adavan that I cut in half (equals 1/2 mg). That is the best. It calms me down and enables me to handle them as they happen every few beats basically. I am very fit and do not want to reduce my activity. I have lowered my stress and even go to meditation class now. Short naps are good too as well as deep breathing. We'll see how it goes, but the Adavan is the best. Unfortunately, I do not want to live on anti anxiety medication forever, even if it is a teeny tiny amount.

[runroo]

I had no symptoms of pvc's until my family doc noticed an abnormal heart rate.  I went on Holter monitor and had 22,000 in 24 hours.  Quit caffeine for a month and had it again, then I had 33,000 in the 24 hours!!  No risk factors, low bp, no history, not overweight, but I have worked straight overnights for 16 years, I also have ran 33 + ultramarathons which are 50K's, 50 milers, and 100 milers in the past 8 years.  No idea what is causing these pvc's.  Going in a couple weeks to see EP for possible ablation.   Any ideas of why I get these?  Anyone else work nights or run ultras that have these?  

[tom_h]

Debbie, I have not seen angkev on here since that lat post date above.  That's not to say that they don't monitor without posting though.  In the meantime, if you want to understand more about the procedure, I'd recommend the journals of user "Jannie411"  if you go to her site, she has a very complete record form leading up to until well after her procedure.  I've provided a link to her journal of the procedure itself: http://www.medhelp.org/user_journals/show/281881/Jannie411s-Ablation---Part-2---The-Actual-Ablation-Procedure--Pre-Ablation-Notes--and-Notes-for-the-Ladies
I have a journal as well, but it's not as complete.


To give you basic answers, the procedure takes anywhere from 2-6 hours.  You may or may not be sedated for the procedure.  I was under general anesthesia for the entire 4 and half hours of mine.  Recovery is minimal.  You walk out under your own power most of the time the same day you arrive.  You take it easy for a couple of days, and get back into it slowly.  I was out of work 3 days plus the weekend.  Jannie and I had the procedure for SVT, but it's nearly identical for your situatiuon.  See the previous posts for additional information, charges, etc.

[Debbie0105]

Can you tell me about the procedure and recovery?  I too have about 10K PVCs daily and have not a quality life right now.   am thinking about having the ablation but have heard stories that it didn't work or got worse.
So glad to hear about yours. Where did you have it done at?

[klm5]

I've been on Flecainide since Feb after lopressor didn't work.  It was doing the trick up until a few weeks ago and now I have symptomatic PVCs again with chest pain/SOB during work outs. I've tried an increased dose of the Flecainide only to find that I could not tolerate the SEs.  I plan to get an ablation in the hope of not having to take daily meds and the desire to work out like normal 35 year olds do.  I would at least try an antiarrhythmic if you fear invasive procedures.    

[angkev]

I would recommend having an ablation. Had mine last August. Befor ablation, 30,000 pvcs per day!! Now, maybe 10-20. Doctor said I am very lucky to not have permanent heart damage. Insurance is great in paying the majority of the expenses. Best of luck.

[havenasp]

I would suggest having it done.  If you can reproduce the problem, timing and whatnot.  The EP specialist should be able to do this as well in an EP study.  The success rate, I've been told is either 100% or 0%, no inbetween stuff.  It either works or it doesn't.  After the 1st one, if it comes back, your chances are greater that they can pinpoint it and get it.

I wish my problem was like yours, in that you can nail it down to being active/adrenalin etc...  

My Ep specialist just told me to quit caffeine, cigs, and lose the stress.  (we all know that's easier said than done.)  did the holter monitor, 30 day event monitor, 1 cardiolite stress test, 1 w/o cardiolite, had an angiogram done... I finally took his advice and cut back on stress/cigs/caffeine but still have the PVCs.  all i can do is laugh at their suggestions sometimes.  (by the way all previous tests were negative for anything, minus last stress test that showed PVCs)  Am now getting ready for my 2nd 30 day event monitor.
He is really reluctant to do ablation or even an EP study.  My PVC's do not happen as frequently as most people IE 50k a day or even 25k a day.  I would put them at about 4 to 5k a day on days that I'm active and out walking around in stores etc...

But like i've told him it's not that frequency that bothers me, it's the profound symptoms that come with them, to the point of the feeling of passing out.  Not sure what else to do here, as there's a definite electrical signal issue, and they don't want to do anything about it.  Another problem is the closest 2nd opinion dr is 150 miles away.  otherwise it's a close co-worker of his that is at the same hospital...

[donna4140]

Im also on 25 mg of atenolol also,and it seems to work well for me too.Mzak69- maybe you could try atenolol and see if it works for you as well.Atenolol does make you tired ,but if your on a low dose  it shouldnt be a problem.

[debbier]

Hi,

I have not been on the board for quite some time.  I had an ablation Jan 2010.  I had 24/7 pvc's.  I seen an EP he recommended an EP study.  I also had one episode of A-fib and occasional runs of svt.  I was more concerned with the PVC's than anything else.  I tried metatoprol it did not work for me either.   The pvc's could not be ablated since they were orginating too close to my artery.  I was ablated for the afib and svt.  The pvcs lighted up he assumes from the disturbance caused by the ablation.  I was also placed on 25mg of Atenolol.  The Atenolol was a miracle.  Two days later my pvcs were completely gone.  I am now down to 12.5 mg of Atenolol and get the occasional pvc's.   Pvc's unforantely can move locations and once you get them you always have them.  I have days were I get my share but I know not to get crazy anymore and it passes.    Good Luck to you!!!

[donna4140]

I would say it wouldnt hurt to talk to an experienced ep doctor about an ablation. You can always go in for a ep study just to see what they find,and to see if it would be beneficial to have an ablation. I just had a cryoablation 3 weeks ago for atrial tach & afib. So far..so good, no episodes. Only the occasional skipped beat. For the week after I had alot of skipped beats,but have subsided. I looked at it this way I was so sick of my life pretty much being run by my heart issues that I decided to just do it,and take the chance.If your doctor says they can be fixed ,then why not!!

[curmudgen]

You are facing the dilemma that many of us are in ...to deal with the PVC's or destroy heart cells and hope that works or doesn't cause additional problems.  Neither my PC or Cardiologist think I have really reached the point to ablate. I relish the PVC-free time that I have. Therefore,  I am choosing to deal with what I know and not take that chance with ablation.  Are you continuing with the Potassium and Magnesium and since they don't seem to work why continue to take them?  I am on 200mg BB (metoprolol) and 5mg CCB (Norvasc) which seems help reduce them to a tolerable level ( on and off for 2-4 hours/day).

[bbxx]

You probably mentioned this before...but how many pvcs did they record you having?

[mzak69]

As far as the meds, you said yourself that BB's didn't really help with PVCs so I didn't think it was worth it. My EP thinks that an ablation is a last resort for PVCs but will do it since I have visited him several times with the same issue. He said that he wasn't sure if it would help.

So I am still at square one, confused.

[tom_h]

Given the current American diet, I'd say that sooner or later, the vast majority of us will be on a beta blocker and a statin.  My primary care physician had me stay on a smaller dose of Metoprolol, the beta blocker I was on prior to my ablation as a prophylaxis, saying that if well tolerated (and it is), it keeps the BP low, and to some degee helps in the event of a heart attack.  I don't know if there's been any studies regarding very long term use of a beta blocker, but I regard it as I do my daily dose of vitamins, and it's included with them in the handful I take each morning.  I've been on it for about 6 years now.  I experience no serious side effects other than the lag in getting my heart up to speed during physical activities.  I am curious to hear about your aversion to drug therapy.

Keep in mind that when discussing ablation vs. drug therapy, my cardiologist came right out and told me that he and others felt that experimenting with different antiarrhythmic drugs, beta and channel blockers carried a much higher risk than the EP and ablation procedure.  So, I think that eliminating the root of the problem is better than masking it with drugs ....... in most cases.  The thing is, is yours one of those cases where ablation results in a better quality of life afterwards?  Of course, this is something you and your physician need to discuss.

[mzak69]

Tom,

My concern is being stuck on BB's for life. I am hoping for a permanent solution that doesn't involve taking more drugs every day, if it's possible.