PVAs affect on the occurance of PVCs

I have always wondered if the occurance of frequent (documented) PVCs are lessened, or disappear after a successful PVA ablation. Physiologically it should have no affect, except with the thought that PVCs more often occur in LAFers due to increased endocardial irritability. Given that without seeing these premature beats on a rhythm strip, you can't really tell by "feel" whether they are PACs of PVCs, it might be hard to say with any conviction.
If a person had LAF and documented frequent PVCs and afib, and had a successful PVA, with the disappearance of ALL premature beats, then we could know that our frequent PVCs are caused by endocardial irritability.
Does anyone know?

Pam

No, but after my PVA ablation it SEEMED that I had a lot more PVC's and PAC'S. Also bigeminy develped which I had never heard of before. All feel similar to afib.

Pam

I have asked the question before, but what is a PVA ablation? I have severe Afib and PVC's. Three or four years ago an Electrophysiologist tried to get me to let him do an a/v ablation so I wouldn't feel the Afib's. I already had a twin-lead pacemaker that would keep my heart beating. I kept being indecisive whether to do it or not. After a year of him trying to get me to agree to have the ablation, I wore a holter monitor (again), and he and the pacemaker representative were looking at the results and both told me that having the atrioventricular ablation would aggrevate the PVC's and they would become more 'pronounced'. Well I certainly didn't want that. I wanted to not feel any of them after an ablation. Then they got to wondering if Afib kicked off the PVC's or whether the PVC's kicked off the Afib. In my case most of the time the PVC's start first followed by Afib. Not all the time but most of the time. I also have bigemy beats. Runs of tachycardia too. You name, I've had it......

Glenn Camp

Pam,

I'm going to give you a different scenario to ponder, however I'm thinking out loud and this may seem a bit strange, but that's not new for me. What if your fingers were constantly twitching and you could not control them, so you burned the nerves in the hands, to denervate the fingers, and then this stopped the fingers from twitching. Would this then mean that the fingers were the problem or was the problem coming from the brain? The end of the electrical transmission, at the pulmonary vein where the ectopic foci seem to be the problem, may be in a sense, like the fingers. By the time the electrical transmission arrives at the pulmonary vein, it is erratic because of lack of certain neurotransmitters following through, from cell to cell. By denervating the end product of the erratic signal, it calms the twitching, per se. On the other hand, you could be right, as well, but based on the studies Mike presented, it seems to be more of an autonomic problem.

Richard

Glen: I did answer that question on Ready for PVA/Glen, but it means Pulmonary Vein Ablation. PVC means premature ventricular contraction. Afib is almost always kicked off by a PAC (premature atrial contraction). While a PVC could kick off afib, it is usually a PAC, and they feel exactly alike. You cannot tell the difference without seeing it on a rhythm strip. By the way, I wouldn't agree to an AV node ablation. It makes you 100% pacemaker dependant. There are other less radical ways to deal with afib.

Just my thoughts
Pam

Richard:
Interesting analogy with the finger twitching, except while the finger twitching is controlled by the brain, the heart beating is not. The heartbeat is the only thing in the body (as far as I know) not controlled by the brain. This is why severe head injured patients who have flat EKGs or brain death, can still have beating hearts. My understanding is that the ablation just blocks the pathway from the rogue focus to the next junction, the AV node. Those rogue impulses are still there, and still fire, but the impulse cannot travel through the the PV ostium, hence no atrial systole would come there.
I'm certainly not always right, so someone please tell me if I'm wrong.

Njb:
Were you talking about the time immediately after ablation? Are you now afib free? If so, are you also free of other premature beats?

Thanks everybody,
Pam

What is Bigemy? And what does it feel like?

Thanks
Frank

Pam,

I corresponded with Dr Jais at the Bordeaux Clinic about this very point. According to him a successful ablation will have no effect on the frequency of PVCs.

Hans

Hi Frank,

I had a PVA at CCF on November 17, and post-ablation, I've developed bigeminy as well. It was a new term and new experience for me. As I understand it, "bigeminy" describes when each heartbeat is followed by an atrial premature beat. It's a "beat," and then a quick "thump, thump" that follows. That's how it shows up on my "sports heart monitor." In my case, it feels a little like afib, but I have some accompanying symptoms like shortness of breath, and chest discomfort along with it. My rte isn't as fasst as when I'm in afib, however, so that's good. My afibbing has been around 140+. but when I'm in bigeminy, it's around 100 or lower.

That's my experience and understanding of bigeminy.

Billo

Pam

Forgive my untechnical language here. You said the heart is not controlled by the brain. This is not strictly true. The vagus nerve which influences heart rate starts somewhere in the hypothalamus (an area of the brain which has no BB. The pons of something.... So whilst the CNS originates in the brain so does the vagal area of the ANS. This is how MSG affects the CNS and hence the ANS and heart rate and rhythm. Also seizures in the brain can cause sudden cardiac death due to the brain not sending the right messages for the heart to beat properly.

I'm awfully tired just now so hence my terrible explanation. I hope PC pops in and explains it better.

Fran

Pam,

Here's a couple of sites that explain the symp/parasymp. system and the connection of the heart and the brain. The heart will continue to beat if the head is severed, as does a chicken continue to run around after the same, but this is a built in protective mechanism, and not the normal operating system. I wonder if there is a cross-over problem between the two?

[www.parkinson.org]
[www.ndrf.org]

Richard

Fran and Richard:
I knew when I said that, that I would have a war on my hands. I suppose as Fran, I was too tired to explain further. It would be more accurate to say that the heart is not strictly controlled by the brain in that the brain doesn't tell the heart to beat or not to beat, as my example of a head injured brain dead person on a ventillator, whose heart beats. From the perspective of various receptors, they can speed it up or slow it down, but not to cause it to beat or not to beat. (I think)

Pam

Fran,

I believe your explanation of brainstem control of HR was right on. The brainstem is a much more primitive part of the brain and pretty much controls the "vital sign" functions (BP, HR, respirations). Temp is more in the domain of the hypothalamus. If head trauma caused brainstem herniation through the foramen magnum at the base of the skull, all vital signs would be adversely affected with a lethal result. Otherwise they should remain intact.

Pam,

As Hans has reported, the incidence of PVCs should not change after an ablation. Furthermore, pure PVCs should never trigger AF. The danger is that they can trigger VF, an immediate life threatening situation. There is essentially no way short of an EKG or the equivalent to differentiate a PAC from a PVC. Some PACs result in a PVC. Other PACs can result in a dropped ventricular beat and this results in more time for ventricular filling. Consequently the next ventricular contraction albeit normal cranks out more blood into the aorta, causing what feels like a PVC.

PC

Some PACs result in a PVC. Other PACs can result in a dropped ventricular beat and this results in more time for ventricular filling. Consequently the next ventricular contraction albeit normal cranks out more blood into the aorta, causing what feels like a PVC.

I had thought that PACs and afib cause increased endocardial irritability and thus increased PVCs, but I have never heard of a PAC resulting in a dropped ventricular response unless the person had some degree of heart block, or was actually in afib. As we both agreed, one cannot tell a PAC from a PVC based on "feel" alone.

Pam

Pam,

Whether PACs and AF cause increased cardiac irritability or the reverse is the $64 question. Does AF cause elevated CRP or is an elevated CRP from inflammation cause AF. Hans has pondered this conundrum for some time now.

Some PACs are transmitted through the AV node and result in a PVC. Others encounter a refractory AV node and end there. But their retrograde impulse can travel back toward the SA node and obliterate the oncoming NSR impulse. This results in a dropped beat.

PC

PC:
Are you talking about nonconducted PACs or nonconducted P waves?

Pam

Pam,

PACs and atrial contractions initiated by the SA node (NSR) all create P waves or the equivalent. We would not know of their existence if they were not conducted, at least in the atria. That's the difference between atrial flutter and atrial fibrillation. Flutter creates distinct albethey very rapid P waves, AF does not. Moe's thoughts about what was happening during AF wrt PACs was nothing more than a theory for many years, simply because no P wave could be identified.

"Nonconducted" in this context is an oxymoron. For this reason it is a bad term, but generally means that there is no ventricular conduction of the atrial impulse.

So there is no significant difference between a nonconducted P wave and a nonconducted PAC. They both result in a dropped ventricular contraction or dropped beat.

When there is a specific rhythm or periodicity to the firing of the aberrant atrial focus resulting in repeated dropped beats, it's called bigeminy, trigeminy, etc. When there is pathology in the AV node causing the dropped beats, it's called heart block, first degree, second degree or third degree.

PC

The term nonconducted P waves is often heard in CCUs, and of course they conduct in the atrium or there would be no p wave seen on the rhythm strip. I have to agree that it is an awkward term, but generally means not conducted to the ventricles, thus no QRS comples.

Pam