Ablation...should I do it?

[RNRita]

So, after having PVCs for most of my life and being totally miserable, I finally found a doc that does them for PVCs in my area.  I went to him for a holter and those two days, I have a minimum of my usual.  It took me a month and a half to get back in touch with him, and he finally called me this AM.  He said he would get another holter and schedule an ablation.  He is supposed to be the best in the area (I cannot afford to go anywhere else), but I think that is a jump from him not even seeing what is going on right now.

Anyway, my questions are:  If you have had an ablation for PVCs, how happy are you now that you have had one?  And the other worry I have is, will I be able to go back to work (I'm a nurse) afterward?  I also don't have money to sit around waiting to be okay.  How long are you out of work?

I haven't read many of the ablation posts because I was told they were not done for PVCs.  I guess I will now!  lol

[bbxx]

RNRITA & Jodie,
Sorry, I did not mean to minimize anyone elses suffering at all.
I did not mean to come accross that way.
RNRITA in a sick kind of way it makes me feel better that you have had thousands recorded. (sorry, I know that is terrible). I am not glad you have them, just glad I am not alone.  

[RNRita]

I feel so many different things, it is impossible to figure it all out.  That is why I want another monitor.

bbxx, I am not lucky.  The days that I had a few hundred were the two days I felt nothing.  Most days I feel them all day long, and the clusters are terrible.  And by clusters, I don't mean a few bouts of bigeminy.  I have had thousands daily on many monitors.  I WISH mine were only a few hundred a day.  But, alas....I am one of the unfortunate.  I guess I'm in good company.

[jkfrench]

Ha, that is very funny.  I play slots and keno (not for money).  My husband plays video games a lot.
bbxx - I know I am lucky that I only have hundreds, but they come in clusters so they fel horrible during the hours that they are acting up.  I just took my walk this morning (up hill) and going down I felt so many.  Again, I'm really worried these are recovery pvcs.
Also, last night I woke up around 1:30 and my heart raced for about 5 beats, then normal, then raced 2 beats then normal.  It did it again an hour later.  Those scare me too.  It is like a surge in the beats.  I know it is supra ventricular something because they were caught on a moniter but those have increased in numbers too.  Do any of you feel those?

[bbxx]

You guys are so fortuntate that you only have a few hundred! WOW!

[RNRita]

Aww....thanks, dahlin'!  I get tons of different feelings that freak me out, at times.  I have a confession to make...I play video games...lol  When I do, my pvcs/pacs are ALWAYS crazy.  That will be my ace in the hole when I get my next holter.  hahahahah  Let them try to figure out what I'm doing.

[jkfrench]

Okay, me too.  When I have worn my holter the minimum amount was 28 but the max amount was close to 400.    They were both pvc's and pacs.  I think I know what you mean about the quick fluttering.  I will feel 2 quick beats together, then a pause and I think those are pacs.  I know that pvc's are described the same way and believe me I know what pvc's feel like, but the timing with the (quick beats) is different.  That is the only way I can describe it.  I also get a wierd vibration feeling.  Every holter I have, states that my diary does correlate with my pvc's so I know exactly when I am having them.However I get them much worse than that too.  That is always my concern.
Are we okay when they increse and decrease from one day to the next.
Also, 50% of the time, I feel them in my upper stomach.  Like an empty feeling for a minute and those are the ones that make me cough.
Hang in there girl.  You are so beautiful (inside and out)
Jodie

[itdood]

Good article, it brings up a good point for RNrita.  If LV is starting to have any issues then ablation would be CLINICALLY indicated.  According to that article it also can help with what's considered to be a low PVC load of 4%.  Keep in mind that 4% is about 4,200 per day.

[RNRita]

is_something_wrong:  I think I am having a lot more PACs lately.  PVCs feel like missed beats in my pulse.  This new thing (not really NEW, but different) is a fluttering sensation or vibration (not mild, though) and when I feel my pulse, it sometimes feels like a quick beat, but sometimes I feel absolutely NO change in my pulse and this never makes sense because my chest feels so very weird.  That is why I want the heart monitor because if they are PACs then I guess that is why they feel so different.

itdood:  Nope.  That is why I want a holter while they are acting up.

jkfrench:  The minimal amount that I had on my holter was 497 one day and 290 the second day.  I didn't even think I had ANY those days...lol  He must have thought I was crazy.  But I told him that since then, they are almost constant.  But they aren't, really, just feel like it.  HOWEVER, that being said, I KNOW I can bring them on now. I know exactly what to do!  lol

[jkfrench]

Hi Rita,
I'm sorry you are still feeling miserable.  I do too, but at least it just goes on for a couple of hours or so each day.  Then they seem to subside.  But those hours, they come in swarms so it still *****.  
I have a question for you.   What was the minimal amount that you had?  I would love to get an ablation too so I am curious if your minimal is just a couple of hundred or so and he still agreed to do it.
Thanks in advance!  - Jodie

[curmudgen]

Check out this web page -- scroll down to Treatment and Management...

http://www.nature.com/nrcardio/journal/v5/n5/full/ncpcardio1180.html

[itdood]

Good point, I was going to mention Cryo too.  I'm not sure if Cryo is being used for benign PVCs, anyone know?

[bbxx]

I am still holding out on not having an ablation. For me, my reason is that I do not have any faith in doctors, so I would have to be very bad off to have it done. I am not convinced that ablations dont stir up other electrical issues.  I am probably not the one you want to hear from. I guess for me it would have to be passing out or near fainting or something besides just scared, cause the fear of the risks and what ifs when I think of ablation, is worse to me than the fear of the what ifs with pvcs. What they really need to do is have documented follow ups of a thousand people with many thousands of pvcs who had ablations and follow them over 10 years and see if they were symptom free for 10 years without any other heart issues popping up.

[curmudgen]

Have either of you discussed the difference between RF and Cryo ablation with your EP.  I know Cryo is newer and perhaps more forgiving than RF.  Any thoughts.

[itdood]

I have very similar experience here but decided against ablation.  My PVCs are very well documented.  My holters had many days’ worth of 5,000 PVC events per 24 hours.  My PVCs originate in the same spot in my RVOT.  The resulting QRS waves on my PVCs are extremely bizarre and HUGE.  They were able to tell my source based on the shape and timing of the resulting QRS waves.  

PVCs that are classified as Unifocal, benign, isolated, and originating in the RVOT have the highest success rate for benign PVC ablation but still only around 60% from what I remember.  I've since gone back into remission.  for now....  The EP at the time recommended that I wait it out for a few months before we make a decision and in that time I went into remission.
I went to an EP who had just finished his fellowship at Penn.  

I'm not trying to talk you out of it at all.  I'm just trying to provide some insight into the process I went through in making the decision.

Some of the things to be mindful that I was using in my decision making process

-Unifocal has obvious higher success rates
-RVOT sites have higher success rates
-Certain areas in the lower chambers can acutely create harmful ventricular ectopy when they are ablated
-If the source is in the left ventricle the EP will have to poke through the septum to get to it, this can have side effects

I think one needs to know the source and classifications of their PVCs to make any comparison to other outcomes.

Makes sense??  

That said, do you know the source and classification of your PVCs?

[is_something_wrong]

I would guess your PVCs are monomorphic.

Before I would consider this I would continue doing Holters until you hit a day with lots of PVCs. It would be somewhat annoying if you had two or more spots producing PVCs and the really bad one kept silent during the tests and didn't get ablated.. Maybe this is not the case but nice to find out :)

I'm sorry I can't give you any advice but I have a question.. How do you experience your PVCs if you check your pulse? Are they skipped beats or double beats?

The reason I ask is that I feel double beats and my doctor told me they are PACs. He also told me that PACs feel like double beats while PVCs feel like skipped beats; you can't sense the actual premature beat. I guess this somehow makes sense because a PAC is a stronger beat because it includes the atrial contraction. But.. how do you feel them? I haven't monitored them for years, so I have a constant fear that I have PVCs now suddenly..