E.P. Visit Observations

[Artaud]

I saw the E.P, nice guy, young, he introduces himself as an "Electrician", oddly enough, so am I. Something tells me I have a better chance of being killed on the 15,000 volt and below systems that we work on than he has of being electrocuted by someone's heart.

I was astonished when he came right out and asked I I wanted him to burn-out the source of my PVCs. Though I didn't rule that out, I'm still seeking a pharmacological solution. Tomorrow I start Verapamil, discontinuing the Atenolol. I'm a little apprehensive. My swallowing induced arrhythmia didn't impress him at all. He said it's a trigger and we need to determine what to do about it. He told me of a patient that when the patient yawned and stretched, his heart rhythm would become disturbed. He had him on the operating table, and had to keep waking him to yawn and stretch so he could map the source.

One odd thing I get is back-to-back PVCs, he said it's bigeminy. He said you don't feel the premature beat, just the pause, so, it's a premature beat, a pause, normal beat, premature beat, pause, normal beat. Never thought of it that way. He mentioned my PVCs coming from the Right Outflow Track, I guess it's the same as RVOT, (ventricular is added in the acronym). He said it's a common source for Benign PVCs. Supposedly it's easier to get to for ablation, but it didn't take me long to find a story of a woman that underwent ablation in the RVOT, but it didn't work, they decided the source was on the outside of the heart and would require another procedure, surgery, to ablate it  

In the waiting room, talking with patients, one told me they now have a leadless implantable pacemaker. Weird.

http://www.post-gazette.com/news/health/2014/05/27/UPMC-implants-wireless-pacemaker/stories/201405200202

[pvctom]

Hello Artaud,

I am on Lopressor 25 mg twice a day, In conjuncrion with Altace per HOPE study. Do hope your bout of Ectopics will subside .... I have had this lengthy bout of Ectopics on and off for 12 weeks now. I used to take Sectral Beta Blocker years ago for my PVCs. It seemed to really help. But no Doctor has prescribed it for me in years. I remember my EP study done in '98. I was Grateful for the nice E.P. I had then. Anyway, hope your PVCs get better...

[Artaud]

I've been to the E.R. twice, the family doctor once, my cardiologist (who did my stress Holter Dec 2013), a second cardiologist that wanted to do a nuclear stress and possibly an angiogram, all based on my "Irregular T-Wave", being inverted, and he would not listen to the fact that I've had an inverted T-Wave all my life.

I've bern to an E.P. that asked if I wanted an ablation before really talking with me virtually at all. He said the source of my premature beats was the RVOT.

I went to a second E.P. that suggested a list of Antiarrhythmic medications that could be used. His assistant did a 12 lead EKG long enough to catch a premature beat in each lead. He adamantly said the source of the premature beats is in the Purkinje fibers, not the RVOT. He said it can still be ablated. I suggested a different Beta Blocker, and he scoffed, until I mentioned Acebutolol, which he felt may be applicable, mentioning ramping up the dose.

To my cardiologist's credit, he wanted to put me on a low dose Beta Blocker and a Calcuim Channel Blocker. Oh how I with this bout would pass.

[Jerry_NJ]

I take atenolol (BB) 25 mg twice a day and Diltiazem (CCB) 120 mg twice a day.  The CCB was added so I could come off of high dose BB.  I take both to maintain a "rate control" of permanent Afib.  

I understand the CCB is more about the plumbing (wiring : ) ) while the BB is about the signal generator...but they work together on me to maintain a rather peaceful heart rate.. it goes into the upper 50s when sleeping (actually just woke up so I could make the measurement - may go lower when fully asleep).

Of course with permanent Afib there is not running or skiing in my life any longer... the HR goes up to safe maximums when I simply walk seriously on the level.  Uphill takes some pauses to rest.

[Artaud]

Please see the following:

"Vaughan Williams classification

There are five main classes in the Vaughan Williams classification of antiarrhythmic agents:"

http://en.m.wikipedia.org/wiki/Antiarrhythmic_agent

Class IV, antiarrhythmics, Calcium Channel Blockers.

Regards.

[seaweib]

Calcium channel blockers are not considered anti-arrhythmics.

[Bromley]

Yep. I can relate to this experience. Thanks for posting it. Actually, you can probably find some literature online that states the prevalence of various types of idiopathic vt's, and some limited statistics on ablation success rates for various types of vt's. If I remember correctly, RVOT is right up there in terms of prevalence.  And thanks to some of the work done at the university of PA, and elsewhere, there are some strategies to deal with just about every idiopathic vt there is. Mind you, the statistics on ablation success rates and so forth are still limited in some areas...at least in the few papers that I was able to find online and read. This is  a little different than success rates for wpw ablations and atrial fib where I am pretty sure there has been more activity.

[Artaud]

I agree with the anti-arrhythmics comment, to a degree, but never considered most Calcium Channel Blockers to carry the same risk. For instance, Most Beta Blockers are fairly safe, but some, such as Sotolol, require close monitoring for the initial titration and dose increases.

This is an interesting article, though brief, on the different classes.

https://en.m.wikipedia.org/wiki/Antiarrhythmic_agent

[tom_h]

I remember day #1 of a "Power" course I took.  The professor introduced himself, then asked the students who had been steeped in TTL (state of the art at the time) for the last 3 years if we were ready for some "manly voltage".  He added that what were had been messing with for the last 3 years was for "pu--ies".  I always remember those words when I take the panel cover off my breaker box in my home.....


I could occasionally induce brief arrhythmia or an occasional SVT episode by stretching and breathing deeply.  If the combination was just right, it would fire right up.  As you can imagine, I was easily induced in the EP lab for my study.

Sorry, I can't offer any help.  I hope the switch goes according to plan.  My cardiologist when convincing me that an electrophysiology study would be in my best interest said, "fiddling around with anti-arrhythmics carries just as much risk as an electrophysiology study".  Mine for SVT carried better odds of success than perhaps what you might see for PVC's, but it's something to certainly weigh.