Need help deciding between ablation or meds for PVC's post PPCM

[codapop]

I was dx with PPCM (peripartum cardiomyopathy) in 2004 after baby number 4. My only symptom was PVC's. My holter monitor showed 20,000+ PVC's per 24 hour period. I was put on Toprol and seemed to do fine with that. My EF went from 45 to 55% over a three years. Then I got pregnant again and had him 5 weeks early (my EF was 35-40% at the time) My last holter monitor showed 23% of my beats are PVC's. The doc said that is tons. I am still only on Toprol and not an ACE-I because I am nursing, though I know they can put me on hydralazine/nitrates. My cardiologist wants me to undergo an ablation for RVOT PVC's instead of the meds. Has anyone had a similiar situation? I am supposed to decide within the month and have no idea what to do!

[marlinspike]

It really reassures me when I hear about you guys having so many pvc's in a day and still being okay. Mine are playing up at the moment and causing me massive anxiety, even though the numbers are a lot lower and all the tests 4 years ago said I was fine. Funnily enough, I find myself on these forums a lot more when they are bothering me too.

[upbeat633]

It's been very busy for me with lots of travel to Canada for family matters and other trips for business. Whew. I think I was so busy I didn't notice the pvcs half the time, and honestly, when I'm not bothered by them too much, I don't visit here as often.

But I did have some pvc free days and it occurred very shortly after I had clams on the BBQ. This was extactly like the only other time in my 20 year history of a pvcs, that I experienced a pvc free day.

Coincidence? Well, maybe, I've had clams on the BBQ lots of times between the two occurences, trying to replicate this, but to no avail. Shucks. Still it's not a bad thing to try I'd say, clams and a dark, dark beer.

I do check in to the forum a couple of times to see if there is anything I can write that might be helpful to others but it's not as frequent as when I'm slammed with the strong pvcs, the kind that won't let you think of anything else but them, even when you think you've become an expert at ignoring them they sucker punch you. It's kind of like being in a room full of people (20,000), you get used to a certain level of noise, but if there are a few people causing a commotion (strong pvcs) you can't help but look to see what might be happening that's different than before. You know how I like analogies.

[Momto3]

Great to see you.....and only 20,000 PVCs!!  PROGRESS!!  : )

Hope you're doing well.

[upbeat633]

I have high frequency pvcs like you, and higher, by last count I got as high as 30,000/day. But it has eased off a little since then, maybe 20,000/day :-) yippee.

The electrophysiologist I saw while I was ticking along at 30,000/day, didn't think much of it. He suggested that ablation was so much more invasive and with much higher risk than the pvcs themselves that he said he wouldn't consider an ablation even if asked to do one, nor would he consider anti-arrythmics (i've tried 3 different beta-blockers without success, but most recently sectral/acebutalol has shown a "little" promise)

NOW, all that being said, by echocardiogram, I have good EF and no enlargement, so that puts me in a different category than you or Momto3.

I suggest talking to another doctor for a further opinion and/or posting your question on the expert forum to get a response from the doctor here.

[Momto3]

In January 2002, my Holter recorded 22,000+ (24% of total beats) PVCs.  My doctors were not concerned because my EF was 55-60%.  In December of the same year, a subsequent echocardiogram showed an EF of 40%.  I tried anti-arrythmics for 7 months, but because of the side effects and not wanting to take them forever, I considered ablation.  If it didn't work, I'd have to take the meds, but I wanted to give it a try.

I had an ablation in August and about 6 weeks later, a Holter revealed about 6000 PVCs!!  I was very happy, but my doctor wanted more improvement.  So, in November I underwent a second ablation and since that time, I have had very few PVCs.  There are days when I have PVCs, but nothing that goes on and on like before.  It has been an amazing change!!  My first ablation was for RVOT; the second was for LVOT.

I was ultimately diagnosed with PVC-induced cardiomyopathy.  It took awhile, but eventually, my EF normalized and today it is at 60% (and only RARE PVCs).

Good luck!!