who had PVC's after an ablation and was it permanent?

I had two ZIO patch holter monitors this year alone and not one PVC was detected, zero detected with an overall score of "<0.01"...until after my ablation. Now it is daily and will last for hours on and off all day. I can curb it for a bit if I take magnesium, cold shower and a Valium but I don't want to rely on Valium much longer. I was hoping it was short term until after the blanking period. I'm pretty calm and the only reason I take it is to lower my HR and give me a tiny break from PVC. I tend to get it after Multaq -- I don't think it is related because drugs.com doesn't list it as a side effect. but I found I get short bursts of PVC once getting out of bed in the morning and more after my morning dose of Multaq. Then when it is practically more and more PVC I take a Valium and it slows it down to a few an hour for less than 30 seconds at a time...and my heart rate lowers not being in PVC's.

NP said it will go away. I am posting because I read many threads of people having ablations and I don't recall anyone mentioning they got PVC afterwards as a new symptom they never had beforehand.

thanks in advance for any replies.

PVCs and PACs are extremely common following ablation. In fact, I'd almost be surprised if you didn't experience them to at least some degree. I've experienced it myself (PACs) and heard the same thing from literally dozens of others. PACs are more common than PVCs. Are you sure what you're calling PVCs aren't PACs?

Carey I had shared my ecg and you told me it’s pvc. I took a multaq @9pm and my heart is thumping away. It’s annoying and not relaxing because I am sympathetic. I wanted to go on the treadmill tonight but not now with my heart banging away. At least it’s not AF. I’m blessed that multaq is helping.

I have read posts for over a decade on this site since 2004 (lurking lately) and I never heard of anyone getting pvc’s after an ablation. Try googling it. Mayo Clinic has a page what to expect after a RF ablation and no mention of pvc. Nada. Regarding PAC’s, I’ve had them for years and it’s absolutely nothing. It doesn’t affect my lifestyle. I totally can ignore them. In fact since my ablation I have not felt one. PVC however comes with a higher HR and I feel my heart pounding.

The only links I can find when I google “ pvc onset after an ablation” are sites for ablations to correct pvc, not one mentioned an ablation can cause pvc (temporary or permanent) on patients who has twice a year Holter monitors and never experienced a pvc.

Yes, I know I said what you showed us was PVCs, and it was, but I've only seen one recording of a few seconds of your life. Things change, they come and go after an ablation. That's to be expected and nothing to worry about. PVCs and all sorts of unusual heartbeats are pretty normal in the first months following an ablation. And in any case, your rhythm has been seen by Natale's office and declared harmless. Go with that, not what you read online. Keep in mind that most people have no way of knowing what they're experiencing actually is unless they happen to be in a doctor's office with a 12-lead on their chest. Even Kardia and Apple Watch won't tell you if what you're feeling is a PAC, PVC, or whatever, so you can't expect to find people in the forums reporting PVCs. How would they know?

My office visit with Kelley didn’t capture a pvc because that 30 seconds i didn’t get a pvc. I was earlier walking from the parking lot to office to get lab slip to lab, back to office and my pvc was thumping. While back in the waiting room for Kelley (she was in hospital with a patient) I took the Valium and by the time I had my ekg my heart was calm. Maybe I shouldn’t had taken the Valium so she could have heard it but it was annoying and distracting.

I have zero problem of a few seconds of pvc in my life but my pvc can last all afternoon unless I take a Valium, and mg. I am trying to wean from Valium. I went Thursday to Monday without and I had pvc about 50% of the time.

PAC's and PVC's, often times refered to as eptopics are common following ablation. I have written about them often following my ablations.

I am still getting them occasionally especially if I lay on my left side in bed. Also if I sit for an extended period of time. They aren't easy to capture as they disappear as soon as I move.

You are right Casey. I shouldn’t expect people on this forum to know and I can’t find one mention from any peer review on google confirming your statement that’s it’s common after an ablation to get pvc...

Btw, in November I was being monitored and I told the RN six time in a row within a few minutes- spot on - when I had a PAC and she agreed. If in AF with HR in 60s I knew too. Not everyone is symptomatic so when I get hours of pvc it’s annoying.

There are people (not directed to you) who in the past sugar coated diagnoses. I like facts. I call my oncologist dr death. She is honest and straightforward. She said when I first met her if I am seeking a sugar coated ignorance is bliss doctor, she is not for me. So (again not directed to you) when people say it’s fine don’t worry, I want to know from what information and experience they based that statement. It’s helpful. My GP once told me I was fat. Next visit I dropped 20 pounds and he said no way I can keep it off and I would gain it back so the following visit I lost another 8 pounds. Motivation from his direct honesty.

Post ablation ectopy is most often discussed as just benign ectopic beats. Sometimes you’ll see descriptions of PVC’s and/or PACs but ectopy is almost always benign unless your having well over 20,000 to 40,000 PVCs a day which can then warrant a stand-alone PVC ablation

The other form of unlikely PVC manifestation that can be less than benign are multiple PVCs in a row with not a single intervening sinus beat interrupting a consecutive run of PVCs ... three PVCs in a row is the minimum threshold for a ‘possible’ VT, but usually EPs don’t get too concerned until a person is getting 7 plus PVCs in a consecutive row...and that will definitely earn one a full VT workup should they have such a run .

Again these are very uncommon... it does not sound like you are getting 20,000+ PVCs a day and they are almost never ‘permanent’. You mention you are trying to reduce your Valium intake. Keep in mind, if you have been taking Valium daily for a long period you may need to very slowly titrate the dose down over a several months of gradual reduction to avoid withdrawal symptoms... and among potential unpleasant withdrawal symptoms, they can, indeed, include ‘palpitations’ as runs of ectopy ... i.e. possible PVC and/or PACs.

Shannon



Edited 3 time(s). Last edit at 10/04/2019 10:47AM by Shannon.

Susan, before having afib, I never had ectopics.
And when I began having afib episodes, I still didn't have ectopics, because a single one seemed to be enough to start afib. So, it was afib or nothing.
But, since my first ablation three years ago, I'm dealing with ectopics. PACs and PVCs. I've been monitored with more than 15000/24h, some weeks after my first procedure.
Three years and 3 more procedures later, I'm still dealing with them. IMO, they're there because the repeated ablations prevent them from kicking afib instantaneously.
I may have runs of PACs, in the worst case, and sometimes they turn to afib for a short period of time (less than one hour). PVCs are frequent at rest, in bi or tri geminal form (my tracings look like the one you've posted). They're no fun, for sure, but neither my EP nor my cardiologist bother about them. So I try doing the same.

Just to clarify.

Can I get an confirmation or otherwise that what we laymen refer to as irregular heartbeats, whether they are PVCs or PACs, or "extra" or "missed" beats can all be lumped into the category we refer to as ectopics? As a way of describing a heartbeat pattern that isn't technically an arrhythmia and generally of short duration if not frequency?

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AB Page
Can I get an confirmation or otherwise that what we laymen refer to as irregular heartbeats, whether they are PVCs or PACs, or "extra" or "missed" beats can all be lumped into the category we refer to as ectopics? As a way of describing a heartbeat pattern that isn't technically an arrhythmia and generally of short duration if not frequency?

Yes, definitely, and you'll find many people reporting ectopics following an ablation on this forum. Unless you've got a recording device going to capture them, and you know how to distinguish between a PAC and a PVC, there's no way for the average person to know which it is, so people just refer to them as ectopics.

Susan, I doubt you're going to find much in the literature about what you're experiencing because it's more of an annoyance than a clinically significant event. And trust me, I know how annoying they can be. There was a time I would go for weeks at a time with a steady stream of PACs occurring, and PACs and PVCs feel about the same.

Ditto to what Shannon said about the Valium. I'd suggest now is not the time to wean off them, and you really shouldn't try to do so without the guidance of a doctor. Stopping benzodiazepines after a long period of usage is very difficult and potentially dangerous. It has to be done carefully. It's not something you should be attempting on your own.



Edited 1 time(s). Last edit at 10/04/2019 07:37PM by Carey.

Regarding post ablation increase in ectopy that is not uncommon, it is ‘almost’ always self-limiting over a typical period of usually less that 2 to 2.5 years max before they mostly subside, and often much sooner.

When post ablation ectopy appears it can be associated with the degree of zapping/stunning of cardiac myocytes (pacing cells) necessary due to the ablation to address the AFIB/Flutter. Pacing cells have a rough life span of around 2.5 years. At the time of your ablation your pacing cells that are in the line of fire, so to speak, will vary in terms of age to variable degrees.

Theoretically, if all the pacing cells that were partially zapped, but not fully taken out, were all late stage 2.5 year old cells ready for soon apoptosis (cell death), in any event, then one could expect to have very short lived excess ectopy as the fresh regenerated cells are quickly restored. Assuming that person had much, if any, post ablation ectopy. But in reality most folks with a noticeable degree of post ABL ectopy will have a wide age variation of those pacing cells that were partly damaged ... an analogy might be damaged sputtering cells but not cleanly taken during the ABL, and possibly around the margins of a lesion set.

And since there is likely a wider age range of these pacing cells that became partly dysfunctional rather than fully zapped, there can be a variable duration to the time frame such post ablation ectopy might contiinue before all such partially dysfunctional cells are fully replaced by fresh new fully functional cardiac myocytes with roughly an upper limit of around 2.5 years for this cell regeneration to take place.

People that have had a fair number of the typical cookie-cutter PVI-only ablations in which typically lesser-experienced EPs simply repeat the entire ablation again, over and over, instead of being skilled at detecting, targeting and zapping only the specific more limited areas during any follow up ABLs that are needed, in which either reconnections have occurred or new triggers have evolved that were never detected and addressed in the prior ablations, week to be more prone to excess periods of ectopy frustration for some time. Those larger number of total repeat ablations, especially done in relatively short order, can lead to greater ectopic nuisance from the often larger amount of total lesions created across multiple repeat ablations in the same areas.

This is just one of many reasons why we urge people to seek out highly experienced operators who target only the remaining offending cells and are not simply repeating an entire index ablation in an effort to be thorough, but also often because a less experienced operator has not been fully trained in real time EP sleuthing of non-PV triggers beyond the PVI, and thus may feel less comfortable searching for individual trigger areas away from the PVs.

Obviously, there is more nuance and variation to how ectopy manifests than these more basic descriptions above indicate, but it gives you a ball park idea of what to expect and reassurance fir the vast majority of those who do develop most of you

It’s not possible to predict who will get some degree of post ablation ectopy, but in the vast majority of those cases it will be benign and self-limiting with usually a gradual diminution of ectopic activity over the first 2 plus years post ablation. There are exceptions as Gill has noted, but the vast majority will not have to deal with long term intensive
ectopic nuisance.

I have also noticed anecdotally in following so many afibbers and their ablation reports, that folks who have had several ablations involving repeated linear-line ablation (such as mitral isthmus line ablation which is less often done these days), seem to have more issues with longer term ectopy at times ... but not always.

For those that do have longer term ectopy, talk to your EP about a low dose regimen of Flecanide or another AAR or rate control drug to help reduce symptoms but don’t do this during your blanking period. Also, be sure your magnesium levels are well repleted and that you are getting a good amount of food-based potassium in your diets too that can help minimize ectopy to some degree as well.

Cheers!
Shannon



Edited 1 time(s). Last edit at 10/04/2019 11:04AM by Shannon.

Shannon, good advice however I’ve not been on Valium long enough, or pill popping often enough to be addicted...yet. This past two years Before March, when my mom died and the AF marathon began, my GP gave me only one 30 dose bottle Rx for Valium, filled early 2017. CA has strict controlled substance laws-from doctors (two page signed report sent to the state that I have to fill out with questions why I need it, (I think it’s for my GP benefit) what my quality of life would be if denied, questions filling up two pages) to pharmacy where a picture ID is required and recorded...so Valium isn’t all that easy to get so I use it sparingly if possible. I didn’t use up the quantity back in 2017 Rx and it expired. Then in March to the time of ablation I had maybe 6 AF max -Valium before ER to see if I could convert without a cardio conversion—and I used up 6 pills from a new Rx (March) for Valium....I got rid of the nearly full expired bottle. I got a Rx this week if I need it because my pvc are aggressively often. Yesterday I took a pill in AM because multaq gave me a party favor of pvc. I don’t think I’m addicted yet to get the symptoms you mentioned because I’m aware of the consequences of taking a Valium and I ration for those times the pvc are constant without a break. Magnesium helps, cold shower and if I’m lazy I take a frozen item out of freezer and briefly for less than a minute put it on my body. If it works it save a Valium. I have contractors over today to fix my botched pond (coping border around pond some they forgot to cement and my husband fell in) so likely I’ll take a pill if they upset me by not fixing the problem. It’s dangerous as is. I too almost fell in the other day. Construction work, death, changes in health etc are known as stress triggers which for me an occasional Valium helps to curb my heart.

Next time I see Dr Natale directly for a follow up I am scheduled to wear a monitor. Then the results will be fact and not guesswork what path to follow if my pvc exceeds parameters.

Susan,

The advice still stands, regardless if had been a classic addiction or not to a Benzo. And that advice is simply to be very cautious and titrate very slowly when weaning off a Benzo unless the person has only a sporadic and limited history with these meds. The less total time and the lower the average dosage one has been on with these drugs, generally the less time the titration period is needed to wean off with minimal to no withdrawal-like symptoms.

Your ectopy may not have anything to do with your Valium use, but it is a ‘possible’ contributor to be aware of when you are asking for input on your current excess ectopy experience.

And a person could still experience an increase in cardiac palpitations even with a moderately consistent but variable use of Valium or another benzodiazepine, and that doesn’t necessarily imply an addiction at all.

Keep in mind too, as noted before, that when either myself or Carey as moderators of this forum, and indeed, as is true for many of our long-time very generous and thoughtful contributors, we often try to reply to the specific posted comments or questions by an author of the post, and yet we also try phrase parts of our reply to better address the interests of our larger base of readers as well relative to the current topic.

Best wishes on your ectopy diminishing sooner rather than later, and no doubt at some point this benign nuisance should ease up considerably.
Shannon

Thank you Shannon and Carey for your advice and time. I appreciate it and I hope my recent multiple posts were not a spam to your great forum.

Spam? Of course not.

Lay off the Benzodiazepines. They are so addicting. I have been titrations for 2 years slowly off Klonopin. It is a Bastard but I will kick this. I wish Ihad never seen a Benzo.
Worry and fear will cause ectopics. I had ectopics for a year after my second ablation where my LAA was isolated. NOW, I am doing great and realize that fear was causing a lot of my ectopics. Fear and checking my Heart every 10 minutes.
Dr. Natale did both my Ablations and this forum has been such a inspiration to me. Shannon has been so good to me and my family plus so many other knowledgeable individuals. Jackie is a Gem.
Anyway, It will be okay. The Maestro of AFIB Ablations done you’re procedure and time is on your side BUT DUMP the Benzos.

I didn’t need to take a benzo today...yesterday too with pvc. Heart is calm for once finally. During the night I couldn’t sleep more than 3 hours interrupted by pvc that was annoying but I just managed without a benzo. I felt so good today I went on my treadmill for 15 minutes on a slow 1.0 but I will work up the speed each day. I’ll repeat in a few hours and work up to 45 minutes at a faster speed. Baby steps.

I don’t like drugs in general. I avoid even Tylenol. I had a real bad GERD today (multaq party favor) and I didn’t take a Prilosec but 1/4 cup of sugar free vegan ice cream and I’m managing the pain. Ice cream is pure junk because it is coconut fat and the sugar free is sketchy which according to my cardiologist is bad but it was between that or a Prilosec.

smackman: what symptoms do you get if you don't titration off Benzos?

just curious. I used to be a sound sleeping until Sept 4th, 2004. The second my head hit the pillow I was out. Until I started Flecainide. The side effects listed includes insomnia. I would stay up until 5am trying to sleep and during the day doze off an hour at a time when sitting. One ER visit in 2004, the start of Flecainide, I had to be cardio converted and I told the ER doctor that I don't sleep. She said that was why I was getting AF...so I got an Rx for a benzo sleeping pill 5mg. I only took half a dose every night [except if I was in AF and had taken one of those 6 Valiums years later and then that night I would skip the sleeping pill because I could only take one benzo in 24 hours I was told] from 2004 to August 18th when I stopped Flecainide because I was in the ICU with a flecainide overdose and I was able to sleep once Flecainide was out of my system. I honestly never thought of titration. Never crossed my mind or that of my doctors and cardiologists when I was making doctor visits because I was so orthostatic and falling and dizzy and getting AF until I had enough and got ablated. I blamed my symptoms on the cold turkey Tenormin I also had to stop....back in 2004 when I first got my AF, the attending [4 days new] had me stop cold turkey against the advise of my husband, a pharmacist, who told her I had to be weaned down but we both lost the battle to reason with her. Anyway, 6 months of fainting, stitches, concussions until I restarted Tenormin.

so when I was getting the same symptoms back in August 18th from 15 years on a benzo, I honestly didn't connect the dots. I have not taken a sleeping pill since the ICU and switched to Valium when needed during my very high 180s HR atrial fib's just to calm down my heart. In fact, the nurses at the ER said it was a good idea. Fast forward to after the ablation two and a half weeks ago, I started the first week after the ablation to take a Valium as needed if my PVCs were really so symptomatic that I couldn't sleep. I have weaned myself off the past few days since I wasn't on it that long...2 weeks...to a half a pill a day to a half a pill every two days to nothing the last two days. Last night I only slept 3 hours with waking up three times....perhaps Multaq has the same side effects but I think I blamed it on Multaq Gerd and GI issues last night that kept me up.

so I am curious what symptoms you, Casey and Shannon are referring to by not titrations?

Hello Smackman! I'm so very pleased to see your progress in this battle. Good for you!

Thanks for posting the reminder about the anxiety factor and the detrimental effects of constant obsessing about symptoms and checking with 'gadgets' that result and can interfere with rhythm stability. I know many people who are constantly checking either HR or blood pressure and then becoming more "hyper" as the results often fluctuate based on emotional anticipation. That can also affect stomach acid production and that whole complication of interference with a proper digestive process as well. We can be our own worst enemy.

Best to you,
Jackie

Jackie: AMEN!

everyone is different. One advise may not cover the target audience.

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susan.d
everyone is different. One advise may not cover the target audience.

Where there is smoke there is fire.

I’ve posted this before, but it’s worth a look for those affected by benzos. This is still, as far as I know, the Bible for getting off of benzodiazepines. This is a few years old, but nothing has changed.

[www.benzo.org.uk]

Thank you for an interesting link. Valium has a 200 half life or 8.3 days.

I was clueless. Too late now

Nah, not too late. From what you've described your usage has been light and sporadic. You could probably just stop, but talking to your doc about how to taper off would be the safer course.

The Half-life of Valium depends upon the person, 36-200 hours half-life for active metabolite. I used to take Valium, and most of it was out of my system by the next day (24 hours). Nevertheless, I got tired of the lingering effect, which is in part why I quit. I never had any withdrawal symptoms, I just stopped.

I'll weigh in on the post ablation PVC experience - I certainly had them, and captured them on my Kardia at the time. They occurred in bigeminy for a few seconds at a time. So it's certainly not uncommon to have them. EPs weren't concerned at all and the PVCs went away after a few months. I have seen neither hide nor hair of them in years now.

Thanks Wolfpack, Smackman and Andy!

For sharing your experiences, Smackman with the benzo impact you have so admirably dealt with, and Andy for the withdrawal schedule for those who wish to wean off those drugs ... and Wolfpack, for your recounting the overwhelmingly typical experience you had with post ablation increase with benign ectopy, for those Afibbers who even have any or much ectopy at all after their ablations. Your recount, Wolfpack, is precisely the kind of relatively limited experience with such ablation-related ectopy that the vast majority of post ABL Afibbers experience, by far, assuming they have any at all.

Cheers!
Shannon

I would be zero bothered with a few pvc. But I don’t get a few. Yesterday I was chilling out by my new pond feeding my fish and watching my new fishes I bought the day before acclimate to their new home. The koi I baby to feed so I was outside for an hour really relaxed until I got pvc. I ignored them. I got extremely dizzy so I decided to walk inside because my husband had an accident and fell into the pond recently and was cut up from the boulders and I didn’t want to swim with the fishes. The moment I got inside my pvc turned steady tachy. I was curious how fast it was...2 squares for a bit on my ekg machine (not Watch) and it slowed to a steady 3 squares. I decided to take a cold shower because it helped in the past. 3-5 minutes of tachy and then it stopped and my hr was low at 67- been in the 80-90 after ablation.

So for me being symptomatic, I was very lightheaded and dizzy with a pounding chest as well with angina two hours later, fixed with nitro, it’s not fun and this tachy I hope isn’t going to continue as a pattern during my blanking period.

Shannon, thank you for explaining this. I am 16 months out from my second ablation done at TCAI in Austin. I had runs of ectopic beats until last fall, until all went silent last December. I would have a few here and there throughout last spring and summer. As a former afibber, I am very aware of my heartbeats. The end of August, I seemed to have PACs/PVCs every evening when I laid down. I would sit up and they went away. I am very confident in my ablation but these episodes were disheartening. What you described as far as life of cells makes sense and gives me hope that these ectopics will wind down. Thanks!