PVC ablation

PVC ablation, does it have a good success rate?

I recommend getting a good skilled elite experienced EP and following their advice. I only know of one personally who did both of my ablations. Who did you pick? Will your Left Ventricle need ablating or only the right? Did your NP or EP try a BB drug approach first? By luck or faith my PVCs stopped cold turkey in 2.5 weeks after 5.5 months of high burden PVCs trying a BB suggested by my local EP. Perhaps you should ask your EP or NP about options since they are the only ones qualified to give medical advice.

[bmccardiovascdisord.biomedcentral.com]

“Safety of PVCs ablation
In this study, a multivariate analysis revealed that LV and EPI origins were independent predictors of the occurrence of complication. Moreover, two procedure-related deaths occurred respectively in patients with LV and MULTI origins. The result in this study demonstrated that PVC ablation in EPI and LV location were under higher operation risk. Given the favorable prognosis of these patients [12], PVC ablation in EPI and LV location is unadvisable.”



Edited 1 time(s). Last edit at 09/10/2020 03:35PM by susan.d.

Dr. Natale performed my pvi ablation. Not sure just if I'll need ablated just want to know all options if we get to that point and patient experiences. Zio patch coming this week. Flecaniade and metopropol stop PVC's. 25mg Met alone seemed to reduce them from 5k-8k down to less then 1k daily. 3 months to the day post ablation.



Edited 1 time(s). Last edit at 09/10/2020 03:41PM by Kleinkp.

Good post. thanks for the info.

So you still had pvcs after your PVCs ablation? How soon after the ablation did they return and to what frequency? What was your burden prior to your ablation? Did you get a Zio prior to your ablation that showed your burden? Do you have a Kardia to ballpark guess currently until you get your Zio? Did you get an Echo to determine if your heart was showing wear and tear? Is Natale planning to repeat the Echo if you had one?

So sorry to hear this.

Thank you for your post. Looking forward to your reply. Sorry about all the questions but this stuff is informative to us folks.

Had a PVI not PVC ablation with Natale. Very few PVC prior to afibb ablation 1 monthly. PVC started moment I woke up from ablation then stopped 6 days after resuming flec/met post ablation. Stopped flec met 8wks post ablation then PVC started back up again. NP put me back on Met reduced PVC down to around 600-800 daily. Two weeks ago taken off met, now getting 5k-8k estimate daily. I get around 300 between 4am to 6pm then once I relax they come on strong 6-10 per minute non stop asuume PVC are happening during sleep because when I wake to go to bathroom I'm still getting 6-10 per minute.

Each EP is different. I was told for me, to start Tenormin 12.5mg a day the first week, 25mg BID the second week and it worked to stop cold turkey the PVCs by the middle of the third week when I increased to 25mg am and 12.5mg pm.

You may consider asking your local EP directly to get the proper medical advice if you should switch BB and increase until your PVCs stop to avoid an ablation. After mine stopped it didn’t return and I saved not getting the ablation.

Do you still take the BB?

Quote
susan.d
Each EP is different. I was told for me, to start Tenormin 12.5mg a day the first week, 25mg BID the second week and it worked to stop cold turkey the PVCs by the middle of the third week when I increased to 25mg am and 12.5mg pm.

You may consider asking your local EP directly to get the proper medical advice if you should switch BB and increase until your PVCs stop to avoid an ablation. After mine stopped it didn’t return and I saved not getting the ablation.

I did continue Tenormin until my af returned in May. Technically you can’t combine Tenormin with multaq. So I stopped Tenormin and switched to multaq once my afib resumed in may. My PVCs did not return being off the BB. In prep for this last ablation last Thursday I stopped multaq 11 days prior to the ablation and restarted Tenormin. I had to stop Tenormin four days prior to ablation #2. I resumed yesterday Tenormin at 12.5 a day while on multaq.

I honestly feel like if it wasn’t for covid19, I would go to the Er. I have a nasty af now at 148 hr. I had to lay down. The low dose of Tenormin didn’t help today. I’m waiting for my np to call me. I missed today’s cutoff for covid19 testing so they won’t ecv without it. So if I get the test again tomorrow I maybe can be ecv by Monday.

I do not leave my house. I self isolated since March 16. It’s so insane to get tested for the 6st time. The Rn’s at the Cath lab have never been tested. I took a poll. But rules are rules.

PVC don't really bother me besides being annoying. My plan is to stay off meds at least until December that's when I'll have a 7 day Zio. I don't have a take it easy button and luckily PVC seems less when active. Texas is sending 48hr Zio patch to get a better idea of the numbers this week.

I'm told PVC usually decrease with time, as long as they don't increase dramatically I'll keep the course of no meds.

Hope you feel better real soon Susan!

Thanks for your kind words. This is CA so I need to be covid19 tested prior to an ecv. I missed the test stat deadline today so the earliest ecv will be Monday unless it’s an emergency and then they treat me as covid19 positive. I would not be a happy camper if im stuck being negative in the covid19 ward.

In the meanwhile my af is at 152.

Does the Zio patch tell them where the PVC's are coming from left,right?

I don’t know that answer if the Zio can detect which ventricle. I suggest you call iRhyrhm at 8886932401. Afterwards email them for a pdf copy of the report. I have their email address for that department when the time comes. They have a great support team. I did call and asked questions.

I remember someone at my GP commented on my 12 lead that they suspected it was from LV.

My Zio report had a summary of how many beats of PVCs, my longest and shortest run of PVCs and burden %, etc —see attachment link.

I found my Zio report about two months after my ablation when it became noticeable.

From my scan, is what info they test so you can expect from yours what the test includes.

I had a 17.2% burden, 240,504 single PVCs (I’m not sure if the number is total beats or episodes), 40 couplet and only one triplet, 25 m 49 s of longest bigeminy episode and 25 m 33 s of longest Trigeminy episode. My report was 34 pages of daily strips. Zero pauses, zero AV block, zero VT and 73 episodes of SVT from 68-164 hr. Average 114.

Two months later I repeated it when I was having PVCs practically all the time. That report showed way higher burden.

I hope this helps so you can see what to expect from the Zio analysis report.
[i.postimg.cc]



Edited 1 time(s). Last edit at 09/10/2020 11:48PM by susan.d.

No, it's not going to tell them that. It mainly just counts events and doesn't provide any sort of detailed diagnostic information.

You are right Carey. I prefer my EP’s 12 lead and their knowledgeable interpretation. As for monitors— I am a fan of ePatch. The monitor detaches from the sticky patch so you can always replace with the 6 extra patches if it starts to peel, the adhesive doesn’t bother me, and side by side comparison with the Zio patch, I think it’s superior. My worst holter was from ACS Diagnosis. The battery only lasted 4 hours and I had to set alarms to swap and both batteries didn’t work well, plus the results didn’t give a % burden or total beat or event count. The pro was that it was live with 24/7 monitoring which I didn’t need for PVCs.

Does the 12 lead tell them where the PVC's are coming from?
[/u]uote=Carey]
No, it's not going to tell them that. It mainly just counts events and doesn't provide any sort of detailed diagnostic information.[/quote]

Quote
Kleinkp
Does the 12 lead tell them where the PVC's are coming from?

No, the only thing that will tell them where they're coming from is an electrophysiology study, which means inserting catheters into your heart to record activity from the inside. No type of external ECG can pinpoint exactly where the PVCs are coming from. And, truth is, it doesn't really matter. If you knew that information it wouldn't change treatment in any way.

The thing is, you're not experiencing enough that an EP would recommend ablation. The criteria for that is usually 20,000 per day. PVCs are annoying as hell but they're harmless, so the criteria for doing invasive procedures is set fairly high because it's hard to justify the risk of serious complications to treat a harmless disorder.

So your options for now are medication, whatever you can do yourself that seems to help, and hoping for the possibility they'll stop on their own.

Incidentally, do you know for a fact that you're experiencing PVCs and not PACs? Has a doctor seen your ECGs and told you they're PVCs?