PVC's - causes

I have been suffering for the last couple of months with PVC's in the Left Ventricle. Have been experience some relief with low dose beta blocker and an electrolytes formula (MAG - POT - Taurine) which offers some relief. Looking for the "cause/s." Am reviewing Susan's recent communication but would appreciate hearing from others. Can exercise set it off?

Lois Sulka

The short answer is PVCs are caused by a single cell or group of cells in the ventricles that fire on their own inappropriately. The result is that the signal propagates to neighboring cells and spreads, and the heart contracts. But it's not a normal contraction. Instead of beginning in the atria and spreading downward to the ventricles as it should, it begins in the ventricles and spreads upward to the atria, which is backwards. That's why it feels weird and looks weird on an ECG.

Why this happens can be due to a number of things, most of which probably don't apply to you (illegal drugs, excess alcohol, stuff like that). They're also common when structural heart disease is present due to a previous heart attack, infection, or whatever caused some of your heart muscle to be damaged. But having PVCs does not mean you have heart disease. Everyone has PVCs periodically and they're believed to be perfectly normal, sort of the heart's way of resetting itself periodically. It's only when they occur in excessive numbers that they become a problem. They can be ablated just like afib, but unless you're experiencing 20,000 or more per day, it's not usually considered wise to do so.

As for what triggers them, that's like asking what triggers afib. It's very individual and there are no right or wrong answers that apply to everyone. If you find things that help, go with that. If you find things that tend to cause them, avoid that.

And now that I've gone through all that, what makes you think what you're experiencing are PVCs? If you have afib, PACs are more likely, and they can feel a lot like PVCs. Do you have actual ECG recordings showing they're PVCs?

I suppose it’s possible, but the ventricles really only respond to adrenaline (sympathetic nervous system) by increasing something called inotropy which is essentially the “forcefulness” of the contractions. The parasympathetic nervous system (vagal) has relatively little effect on the ventricles. Pacing, in a normal heart, happens in the atria. Specifically the right atrium, which is why all of us are here!

PVCs, as I understand it, usually come from a pretty focused area probably somewhere in the bundle branches. That makes it a quick “zap” if one chooses to ablate it for symptom relief. The caveat being that the operator does have to advance the catheters into the ventricles and thus past either the tricuspid or mitral valves. Tearing those can be big trouble so careful choice of operator is, as always, of paramount importance.

Thanks for your response, Carey. About a month ago, I had an EKG done in the doctor's office and my cardiologist immediately referred me to an EP "for an ablation." While I have had two other ablations arrhythmia's in the LA, first time in the LV. I do huff and puff during exercise and wonder if its OK to do. I have "controlled" Afib (Maze surgery in 2007); I say "controlled" because "gluten" and possibly other food allergies set it off. But the PVC's have been going on way to long for it to be an incidental exposure.

Thanks!

wow! Thanks Wolfgang. Looks like a second opinion on the seriousness of this. TIme to check with Northwestern in Chicago.

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LSulka
Thanks for your response, Carey. About a month ago, I had an EKG done in the doctor's office and my cardiologist immediately referred me to an EP "for an ablation."

Not sure I understand. He referred you for an ablation of what? PVCs are usually only ablated when they're extremely excessive, like 20,000 per day or more. Or was it for ablation of afib?

The ablation under consideration its for PVC's in the Ventricles. I did see the EP today who is local and was very impressed. This is being driven by the fact that I am very intolerate to AA's and Beta blockers; actually all of them. I can tolerate low dose, but not a normal dosage. He is currently evaluating me with a halter monitor and an ECHO will follow to check on the condition of my heart (I requested this since two years ago I accidentally caffeine in a Kombucha drink and it sent me into Congestive Heart Failure with blood numbers in the 3000's which is a marker of heart attack/failure. The following March this same blood test indicated I was back in the normal range 100-300.

So I want to be very careful about surgery and so does he. My cardiologist referred me to him and they are in the same practice. He released me to continue normal activities and I am thankful. It was a beautiful day and got in some additional cycling. Had a goal for the year of 525 miles which I biked last year, but so far have ridden 600+ miles and the weather continue to be nice for cycling.

Regarding your original questions, Carey, I have had three atrial ablations since 2007. I have a gluten allergy that the heart reacts to. But it has been much easier to control since I was introduced to "Pill in Pocket" by this group. I'm just not sure if it will work as well with PVC's and need to check my upper limit (Mgs).

If there's anyone here who doesn't realize it, the more time you are out of rhythm, the harder it is to get back into NSR and hold it. According to the cardiosurgeon's staff who did my Maze surgery, for more than 15 yrs. I was out of rhythm even though I was on anti-arrhythmia, channel blockers, and beta blocker drugs and none of it did any good, which made open heart surgery an excellent choice performed by a cardiosurgeon this a very high level of success.

L

So are you saying you are experiencing more than 20,000 PVCs per day?

That's what will be determined with the 7 day halter meter.

I am required by my cardiologist to participate in his practice’s Kardia Care Plan with 6 lead and BP cup.
I am waiting for them to ship it to be but I downloaded the app. Under education, they describe pvc as following:

“PVCs are the most common ventricular arrhythmia. As with PACs, these are usually benign and not a predictor of future heart disease or problems.

They are spurred on by the same stimuli as PACs, for the most part. PVCs are usually only a problem in a patient with sustained PVCs (>6 in a row) or in a patient with significant heart disease.”


I’m getting hours of pvc, way more than 6. I shared online my on this site. So according to the above “only a problem if more than 6.”
I can’t tell the difference between AF and pvc. My HR today averaged 130 on my Apple Watch during a walk around my backyard. I have pvc because I walked. If I lay in bed sleeping I don’t get them. Once I stand out of bed I get them. If I drink I get them. If I’m perfect still and sitting up straight I don’t get them.

I am really hoping this is part of my healing blanking period. It’s been 3 weeks 3 days since my ablation.

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susan.d
So according to the above “only a problem if more than 6.”

No, it's not just having more than six. It's having runs of more than 6 in a row. The ECG you posted didn't show any in a row.

Thanks Carey! Did mine show every other beat pvc? Both my EP and NP to Natale said I’m ok but it has to be wear and tear to my existing leaking valves when HR is over >130 frequently...like if I walk, drink, or stand up.

paramedics fire dept said I had tachy pvc With their 12 lead ekg, while ER said to another nurse “she is in arrhythmia, wait, back in sinus”. is pvc considered an arrhythmia? I can’t tell without a monitor at times the difference in symptoms of AF and pvc. Both share high tachy, syncope, rapid hr. I used to be able to detect AF or even a PAC. I never had pvc before my ablation. I’m hoping it’s temporary due to my healing process. Any supplements or suggestions on how to control this cousin beast?

Your ECG showed bigeminal PVCs that came and went. Yes, that would be considered an arrhythmia, but not a serious one.

Don't mix up the PVCs and tachycardia. One doesn't cause the other. This is pretty normal post-ablation stuff and should gradually taper off and return to a normal rhythm. You might have ectopics now and then forever. Some people do, some don't. But it shouldn't remain a constant problem and being able to do normal activities without tachycardia will return.

You've got two EPs, an ER doc, and two paramedics who all think it's nothing to worry about. You should believe them. It's not going to do your valves any harm.

I’m antsy because it’s affect my quality of life. >110 HR gives me syncope plus the symptomatic banging in my heart is not pleasant especially when I want to sleep. I was in nsr this past 2 hours on the couch watching Netflix. I rather be outside to garden, build a fence, make a cabinet, but I cannot.

No high HR this past 2hrs- calm heart sitting like a lump on the couch. This isn’t my lifestyle. I went outside and was bending over removing some leaves from my pond and my HR shot up. I had to return inside because I was dizzy. I am always thinking of safe landing spots when experiencing dizziness and left the pond area to prevent a risk of falling in. No angina today but I am not active to trigger angina. You may think i’m making a big deal of syncope but I used to faint, positive for tilt table test and have multiple scalp scars/stitches when I fell. I don’t like waking up in a small puddle of blood. Especially on concrete or from falling off a step stool.

Trust me, everyone here knows how uncomfortable a high heart rate is. We've all been there, done that, some for many years. But believe me, I don't underestimate the seriousness of the fainting. Anyone who's spent more than a few days as an EMT would agree it's potentially a huge deal. But this isn't a normal feature of recovery from an ablation. Have you spoken with Natale's office and your EP about it? What have they said?

I don't recall what your current meds are, but if they include things like beta blockers and BP meds, those might need adjusting. And speaking of BP, do you know what your BP typically is? Do you know what it is during the periods of tachycardia?

That is why I have syncope. Cold turkey off beta blockers and two BP meds. My BP is low.
Same experience in 2004 when I was fainting after being decades on Tenormin and was told to cold turkey it. It took 6 months of tests and syncope before they let me resume the beta blocker.

Then on August 18th after the flecainide overdose, ICU discontinued my beta blocker because my hr was 24-37 for days. Again syncope. Went back 2 weeks later on small dose (12.5mg instead of 50mg) Tenormin and felt better.

Now I’m on multaq so I had to cold turkey it again.

I know what you're experiencing with ectopics, and particularly with PVCs. They're no fun, especially when they appear in bi or trigeminal pattern. They sometimes combine with PACs, giving me some kind of chaos feeling like afib. ECG tracings show it's not afib, but some runs of PACs with PVCs here and there. In between, there are normal beats with nice P waves.
When PACs are present in short runs, my avg HR goes back and forth between 105-135 BPM. PVCs in bigeminal form give me an avg HR of 85-90 BPM.
Of course, I'd like getting rid of that, but all the meds I've taken to date have had adverse effects far more unbearable than the ectopics they even didn't succeed to suppress.
I live with them, just trying to avoid things or circumstances I know they may increase the odds having HR troubles.

Why are you taking a beta blocker at all?

Carey, I would love to take a beta blocker but Dr. Natale said I can’t be on both multaq and Tenormin.

I realized why I may have syncope. Not from my Apple Watch but from one of the three ecg monitors I got free for being a beta tester was I able to watch my rhythm. I hovered at 37 for at least 5-7 seconds at times then it goes tachy and then low again.

I never had tachy and pvc together. It’s always starts as tachy upon standing from sitting or laying to standing then my hr lowers and I get pvc and if I bend over to pick anything up or as an exam pick up a 5 pound pot from range to sink...or any number of normal life stuff I do... I get tachy. I was way better the first 2 weeks post ablation symptoms wise than now. Admitted for the ablation I walked around the ward. I was driven to the market and walked around. I can’t do that now. The walking will bring in tachy, syncope and angina.

Yesterday I started getting real long waves of prolonged QRS. That was very symptomatic. Multaq lists it as a 28% side effect. My Kardia device arrives today. I’ll record it.

I’m concerned by your comment that it’s possible I could have ectopic beats forever. Before ablation I would get a random pac after a cardio conversion but now it’s on more than off all day pvc. I wonder if ablating the septum can contribute to it. My EPsaid he never burns the septum or posterior wall but he said he is no dr Natale who has more experience and skills.

I can’t sit all day. It’s not me. I want to be able to clean my house, do marketing, resume my carpentry work, gardening, go back on the potter’s wheel with making pots and stuff, travel, have a life.

I don't understand at all. Tenormin is a beta blocker (atenolol) and you indicated earlier you were taking a beta blocker. Could you email or PM me a list of your current meds to help un-confuse me?

If you're concerned about prolonged QRS send a strip along with the meds and I'll have a look. I doubt it's a problem.

Ablating the septum had nothing to do with your PVCs, and I doubt they'll be permanent. Ablating the septum and posterior wall aren't highly advanced techniques and if your EP never ablates them then it's a very good thing you went to Natale.

I am not taking a beta blocker. I suspect my syncope to beta blocker withdrawal which this is the 3rd time. Thanks Carey. You are so helpful. I actually didn’t have much pvc and angina today so I used my treadmill twice at 1.0 slow walk and took a walk (1000+ ft) to neighbor without a problem.,

Sharing study of VA post ablation:
[www.ncbi.nlm.nih.gov]

I have LV PVC's also. What I find real helpful is NO simple carbs - complex carbs only - and not overly. Too much of even a good thing can be triggers. Another biggie is sugar.
Good by cookies, cakes, and such. We all need protein, but not necessarily a lot - the right kind too. Alcohol is another thing also. Even a beer a day puts me in PVC's. I've had Cardiomyopathy with PVC's for over 20 years and I keep it well under control with these previously mentioned points.