Re: PVCs on EKG 11 years after ablation (AV Block type 1)

Hi

I just had a PVC ablation at Ft Pierce in Florida, EP named Dr Restrepo from Florida Electrophysiology Associates, and thought I'd post a summary in case of interest to anyone. I am 77 and previously had a successful ablation for Afib (Pulmonary vein isolation) about 12 years ago at Mass General (Dr Barrett) when I lived in the Boston area.

When the PVCs started I did the usual experiments around supplements and eliminating triggers - just as I did with the AF 12 years ago with the same limited effect - AF always came back. Here the PVCs always returned as well. . I did a Myzio 2 week monitor and that showed 15% PVC burden (quite a lot) with a couple of Supra Ventricular Tachycardias. I also got a Kardia and it showed I was rarely in NSR without any PVCs. Kardia also reported a couple of AFiB incidents which I learned not to trust as I had had no runs at any time since the AF ablation any time I did an EKG and also no AF showed up on the Myzio..

I saw the EP before Xmas- very experienced doctor from Colombia with 12+ years experience in the US with UT Texas and University of Maryland Medical Center. PVC ablation was one of his specialities.


I didn't know what to expect when I showed up at 6.15 am on Friday except I knew a Foley catheter was NOT on the schedule. That had cost me an extra day or 2 stay in Mass general 12 years ago . Hematuria - likely bad insertion of the tube. I guess they don't use those much any more for the complications that they can cause, incuding infection. I did expect a General Anesthesia (which I always tolerate ok) but that was not to be as it tends to supress the PVCs. Unlike AF ablation where NSR is best for ablation time, PVCs are better when they are occurring at abation time (although they can be conjured up some of the time). So i was in sedation and a local anesthetic for the groin catheter insertion and the EP study and catheterization. I was completely out of it so was more or less the same as having a general anesthetic.

When I got home I was delighted to see NSR on every single Kardia I took - no PVCs - and feels like NSR too. So far then at least the op was a success, This was very different with the AF ablation where for a few weeks I had some quite alarming complaints from my heart at the treatment it had received. Ths time ..nothing.. unless something manifests later. It is just 24 hours from the op at this point.


They did use a vein/artery closure - angioseal and vascade.. This makes me think they used the artery as well as the vein. I have to apply fresh bandage for 3 days then the small closure fixture dissolved after about 2-3 mths, I'll find out more when I get the followup report.

I was a little worrried by the sundry NIH reports which all show the easiest and safest PVCs to ablate emanate from the Right Ventricle Outflow Tract. The complication rate is less than 2%. Many of the articles show increasing complications when the Left ventricle is involved and increasing with age and more complications when things like the Epicardium are involved or close to the AV node.

I'll be intererested to find out what preciely was done. Just as with the AF ablation where I had a 'standard' PVI I got the idea my own single focal point PVCs origination was likely to be RVOT - as detected with a 12 lead EKG at the original consult.

So far so good then... I'm glad I did it. While no structural heart damage was present and it's unclear whether 15% or even 20% PVC burden necessarily leads to that I feel it was worth the minimal risk and the hospital appearance. I'm also glad Medicare and Blue Cross supplemental picked up the tab!
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Just so you know, I split this post off from the original thread and made it a new thread. That's because the original thread was 2 pages back, which made it very hard for people to find.

I was going through the same as you except I had a 43% burden. The EP said no anesthesia because of the same reasons of suppressed PVCs. I wanted instead of general to try propofol. I was told they would try but odds are they would wake me up and the pain of an ablation is nothing. I was told in the waiting room listening to a patient telling me the opposite.

I was admitted for 3 days trying Sotalol and getting pressured to get a LV ablation. No plugs btw and I was told I’ll be laying on my back for 6 hours.

It could still happen but I determined and I told insisting on brand name Tenormin. It took 9 weeks to get approval and customs from Germany. It stopped my PVCs. This is the third time…after my first and second ablation I had a 30s burden but Tenormin stopped them cold turkey.

I’m mentioning this for those with PVCs to try it.

I now am jumping through hoops getting approval for my refill. I only got 3 months supply and It may take the entire time to get my refill.