PACs and PVCs What To Do?

Hi All,

My friend is asking me if there is anything to be done to stop PACs and PVCs. I know about the good results with magnesium, potassium and taurine. I am also familiar with the usual answer from cardiologists that they are harmless. At the same time, I believe that a very heavy load of these cannot be healthy.

I have a question: Is there a way to ablate these PACs and PVCs away? And, will Dr. Natale do this type of ablation, if indicated by the case?

Thank You All,
John

If they can find the area they are coming from during an ablation they can be ablated. Evidently this isnt always so easy for whatever reason.

Natale group in Austin has the tools to do it and it will probably be done by Burkhardt who handles many of their VT ablation cases. PVC ablation takes precise mapping and navigation so it should be done with robotic magnetic navigation which Natale's group has. Weiss at Intermountain do a lot of them for their heart failure patients and he says it offers immediate relief just like SVT ablations with similar success rate, in the 90s.

John - the essential nutrients required for normal, healthy heart electrical conductivity ... magnesium and potassium are fundamentally essential. Yes, one can take too much but there are specific protocols for increasing safely and effectively. Taurine serves to help balance out specific requirements of each.

Afibbers are typically found to be deficient in magnesium, often high in calcium (supplements) and sodium (from diet) which promotes ectopy and arrhythmia. Many people have been helped by normalizing intracellular stores of electrolytes. It also helps ensure a successful ablation, because burning cells inside your heart does nothing to replete the existing deficiency.

Jackie

Quote
Researcher
Natale group in Austin has the tools to do it and it will probably be done by Burkhardt who handles many of their VT ablation cases. PVC ablation takes precise mapping and navigation so it should be done with robotic magnetic navigation which Natale's group has.

This is the first I've heard of ablating just for PVC's. I've been reading quite extensively in these forums, but have never come across a tale of someone being ablated just for PVC's...It is rare, or have I just missed it?

Is this something that is typically only done as a standalone procedure, or is it something that would be combined with a Natale afib ablation?

From the above quote, it sounds like this is something that Natale defers to Burkhardt, so I'm wondering if someone who ended up with frequent PVC's after an afib ablation by Natale would then be recommended (by Natale) to see Burkhardt for PVC ablation?

Apache, I don't think most want to undergo a procedure unless they have an effect on life. They have been talked about here, but years ago and not frequently. From memory, Hans had 8,000-10,000 or more per day. He used his "PAC Tamer" formulation <[www.afibbers.org] and didn't bother with another ablation. There are 86,400 seconds in a day so this is pretty frequent, especially since they tend to bunch and not be equally spaced.

My friend (a WPW ablatee) that I wrote about here years ago <[www.afibbers.org] found she gets debilitating PAC's during high-end exercise (she's a ski patroller, among other things). However they don't occur if she keeps to a ketogenic diet. If she falls off the wagon and pushes herself the PAC's are so frequent they impair her ability to exert at that level. She also consumes Mg++, K+ & taurine. She carries extra mag when she goes on a hike, hut trip or is working the slopes.

George

Hi John,

Yes Dr Natale does excessive ectopic ablation on his existing patients when called for though it's not very commonly needed. Usually in the process of a touch up the Ectopy will calm down. Though on occasion, especially when someone has had multiple different nature AFIB ablations prior to coming for to ST Davids or CPMC some post touch up ectopy can't kick in for a while... Typically these are slowly self limiting and settle down over 6 months to 2 years time frame but more rarely can warrant going in specifically to track down one or more particularly consistent ectopic foci that need zapping.

As researcher noted, Dr Burkhardt would likely be the one a new PVC-only patient might be referred too when contacting St Davids for help with that issue.

The large majority of the time though, such annoying runs of ectopy tend to be self limiting over time.

Be well,
Shannon

Apache and George, I was strictly referring to PVCs and not PACs. In Weiss's presentation, the PVC patients were described as highly symptomatic and that also resulted in high demand for services from heart failure specialists. So that is a small subset of patients of heart failure patients with symptomatic PVCs. Weiss said that PVC ablations for those patients offered tremendous relief to the patients as well as the lessening of burden on Intermountain heart care providers for such patients. The conventional wisdom for ablation is when PVC burden exceeds 20% or around 20,000 per day whether heart failure has manifested or not. Some progress towards heart failure (as indicated by progressive lowering of LV ejection fraction) way before 20,000 PVCs according to UCSF study on 15 year monitoring study (all healthy at the start with no HF). The UCSF study found no magical cutoff, rather a logarithmic relation between heart failure risk and PVC burden that intersects at 700 PVCs per day for zero probability of heart failure. At 20,000 PVCs, there is 100% probability of progression to heart failure unless a person dies before then.

This is different than PACs and AF although for some unlucky people, AF does progress towards heart failure and the pathology is not well understood.



Edited 1 time(s). Last edit at 01/29/2016 11:11AM by researcher.

I was under the impression that PAC's are harmless, but PVC's are more of a risk for initiating VF, which would probably be fatal if it manifested. I am thinking they would try to assess the risk of VF in an Ablation, when they do the EP Study.

Yes, that is the current view although the same group at UCSF looked at their 15 year data set and wrote about PAC's as "Wolf in Sheep's Clothing" with regard to what is classified as subclinical AF and increased risk for stroke if PACs is frequent enough. That data wasn't as quantitative as the study on PVC and heart failure so inconclusive as to when one has to start worrying about stroke risk. There was also a Danish study a while back and I don't think that one is anymore quantitative. The Intermountain data set is extensive but on patients that already have been diagnosed with AF. To do a study right, there would need to be time lapsed MRI and EKG on a large cohort that started out healthy.

I too have a heavy burden of ectopics after 8 years of a successful ablation by Marcus Wharton 8 years ago. Now for the past 2 months ectopics every day. Seens trigeminy or every third beat seems to be pretty common. Is Trigeminy considered AFIB? I purchased the alivecor app for my iphone and sometimes it indicates normal ecg and sometimes possible afib. I have sent the strips straight from the app to my doctor and am awaiting his response. I have been off warfarin for 8 years, but am wondering if I need to be on one of the new anti coagulant drugs with the amount of ectopy that I am having. I really have no symptoms, no workout issues etc, but am aware for sure of the skips and fllips.