PVC's

Does anyone know if it is typical for PVC's to worsen after a pacemaker implant? I've read some of the posts about PVC's but didn't see anything about whether or not a pacemaker can make them worse. I am now six weeks post implant, the erratic heart beats have calmed some but I am still experiencing a lot of them, especially at night.
I have had a hard time getting in to see my doc or even talk to him to discuss this again but am finally being worked in tomorrow and hopefully he can get this figured out. This is not something I want to have to live with. I can deal with having the pacemaker but the PVC's are still driving me nuts!

17 Comments

Even More on PVC's

by donr - 2012-11-09 01:11:49

K: Frank was writing his comment while I was doing mine. Note that we say the same thing!

I got up to about 1/3 PVC's when we decided something had to be done. That's every THIRD heart beat! At those levels, they become physically incapacitating & you wind up in the ER.

I want it officially recognized that when Frank said that "...they have all but disappeared..." he means the pVC's - not the people w/ more than he had. I'm one of them he was talking about.

Some of the side effects can be dangerous and/or permanent!

Don

Danger of PVC's

by donr - 2012-11-09 01:11:53

K: Hope I got to you before you left for the Cardio's office.

It must take a whale of a lot of PVC's to lead to potential problems from Vtach & VFib.

Like I said, I have them by the thousands sometimes every day. At a 33% rate, they become debilitating. I know - that's what got me into the hosp when i got my PM

Dunno what you go through at night, but It cannot be so bad that it incapacitates you. Probably just really annoys you & you are concerned because they are dramatic & scary.

Yes, the effects of some meds can be permanent. I take one called Flecainide that yesterday my Cardio said he suspected may be starting to affect me in a permanent manner, so I cut my dose. WE downloaded my Pm so we can have a clean slate to match the next download in ten days to see what effect decreeasing it has on my PVC rate.

Obviously the Sotalol isn't taking care of your arrhythmia! Don't even think of Flecainide unless it is a last chance at fixing a problem. It was my last chance before an ablation. It's worked for me for 3 yrs, now.

Your PM will tell you how many you have had since the last download, but not WHEN. Singles & Runs.

Don
\
I know what you mean about having them at night. It's quiet & all of a sudden - there they are!

I promise you, YOU WILL LEARN TO LIVE W/THEM.

You asked if they are dangerous

by donr - 2012-11-09 06:11:09

K: I found a web site today that will answer ALL your questions about the seriousness of PVC's.

Here's the link.

http://drsvenkatesan.wordpress.com/2009/07/09/3-minutes-crash-course-on-ventricular-ectopic-beats-vpds/

It is interesting.

Reading this, I can see why my Cardio only says "They won't kill you!"

Don

Dangerous?

by kwhite62 - 2012-11-09 09:11:29

The side effects of PVCs or meds can be dangerous or permanent?
I am taking Sotalol for Tachy/Brady; doc says it should control all this erratic rhythm. Tried increasing the dosage but it just made things worse. I can deal with the PVCs now and then but I guess what bothers me is at night when they get started they can last for hours.
Can a pacemaker check show how many of these are going on in a 24 hour period? I'm going to ask about that today.
Thanks!!

More PVC's

by donr - 2012-11-09 12:11:19

K: If you are truly having PVC's - they will not kill you unless you have a LOT of them over a long period.

I felt that way about them when I first got my PM, they drove me nuts, also, After talking to my Cardio & his Head Nurse about them innumerable times & continually had them tell me not to worry, "They won't kill you," so many times I wanted to spit, I came to gradually live w/ them.

You are absolutely authorized to get in to discuss them w/ the cardio -it will, hopefully, put your mind at rest - eventually. Unfortunately, It will take a while & a PM w/o meds cannot stop PVC's. I need meds to help my PM do its job. They are not nice to me.

Trust me on a couple issues:

1) You can survive on a rate of about 8,000 PVC's per month very comfortably. That works out to ABOUT 300 per day or 12 per hour. That was my rate as downloaded today for the last three months. There are times when I run at ABOUT 5 or 6 per minute. Never even notice them.

2) You DO NOT want the meds that control PVC's. Side effects are terrible. I call them "The Zombie Effect."

3) You have to learn to live w/ them. That is a terrible thing to say, & I know you do NOT want to hear that, but the alternatives are infinitely worse in most situations. The ultimate solution is an ablation NEAR the AV node - a bad place to work & few EP's like doing that except as a last resort. I felt exactly as you do at one time. Now I rarely notice them.

If you have any questions about living w/ them, pls ask - I'll be glad to help you out.

Don

PVC's

by ElectricFrank - 2012-11-09 12:11:47

It's common to here reports of increased PVC's after getting a pacemaker. Since the PVC's are early beats caused originating in irritable cardiac tissue they might be caused by inserting the leads in the heart wall. (I just thought of that one). More likely though is that the PVC activity was part of original reason for getting the pacer.

About the only thing that can be done for them is meds, which can have other side effects. Since they generally are benign other than feeling them I just let mine go. At one point I was having around 2500/day, and there are others on here that have outdone me! Oddly, they have recently all but disappeared.

Anyway if you read this before seeing your doc be sure to ask him about any side effects of meds. They offered them to me and after reading up on them I said no.

frank

Difference of opinion

by donr - 2012-11-10 11:11:24

K: Frank & I had an off-line discussion of our difference of opinion on the link I gave out. I have read the link in detail & also checked a bunch (at least a dozen) other ref's on Google & all equate PVC's w/ Ectopic Ventricular beats.

My comment that EXCESSIVE PVC's can lead to VTach & VFib are based on at least one written report & advice given me by my Cardio when I first started having them; also echoed by his head nurse on several occasions.

Frank's position is based on his experience w/ them & his research. He opines that all connections between the two (PVC's & VTach/Fib) are based on Statistical studies, not scientific studies that find positive cause/effect connections. One of the problems w/ doing much directly is that it can lead to deaths of patients, a totally unacceptable outcome of a study, especially when you recognize that doing anything that induces a life-threatening event (VTac/Fib) is not a smart move.

Finding that connection is going to be tough.

Put the two of us in a room & you do not have to worry about a brawl or even a shouting-match argument. A rational discussion, most likely. Probably more civil than a couple cardios would have under the same circumstances.

So - I would suggest you read both our points of view & make your own decision as to who to follow.

Remember that neither of us is a cardio, just a couple engineers who look at data & info from a common sense, scientific viewpoint.

Don

Whoops, Doc

by ElectricFrank - 2012-11-10 11:11:50

Another small, but important thought. It isn't a difference between Statistical and Scientific studies. Actually medicine considers statistical studies to be the gold standard of the scientific method. It's actually a legitimate approach if used properly with an understanding of the limitations. When dealing with the human body it's about all we have. We don't have a way of turning PVC's off and on so we can measure it's effect on VTack/VFib. Shutting down PVC's with meds involves a method that creates it's own effects on other cardiac systems. Also, there isn't a nice 1:1 relationship between the PVC's and most anything in the heart. Even if stopping the PVC's would stop the VTack/VFib it could take hours or days to confirm it since they can come and go naturally over time. So monitoring the VTack/VFib and PVC's, then doing a statistical correlation hopes to relate the two. But suppose the patient had experienced an MI and the damaged area of the heart is causing both arrhythmias. Treating the PVC's likely won't help the situation and might even cause more problems in VTach/Vfib area, which would account for the one study showing that stopping the PVC's resulted in a higher mortality.

All this could be helpful and lead to an effective treatment, but only if the doc understands the potential issues. This takes time and skill and most docs lack both. So it is easier to simply tell the patient that medicating or ablating the PVC's reduces the risk of sudden death. The patient is happy and the doctor is happy.

Am I making sense. I was a bit tired when I answered your PM last nite, Don, and wasn't too clear.

frank

Specific drug that is alluded to...

by donr - 2012-11-10 12:11:16

...in Frank's article. Flecainide. The warning on it says not to be given to people who have experienced a heart attack because of just what Frank's notes say.

A lot of heart meds under the wrong conditions can be extremely toxic.

Don

One more comment

by ElectricFrank - 2012-11-10 12:11:46

Letting the PVC's upset you is a good way to make them worse. They tend to show up more during times of anxiety. This starts a vicious loop where the PVC's cause the condition that causes the PVC's.

By the way the article link Don posted covers Ventricular ectopic beats. The article includes a number of ectopic beats which are not PVC's so gives the impression that PVC's are risky.

I found this in my notes, but don't have the link unfortunately.

"Premature ventricular complexes (PVC) mean that the extra beats originate from the lower pumping chamber called the ventricle. There has been much discussion over the last 10 years or so of the significance of PVCs. Early studies have demonstrated that patients in the first hours of a heart attack who have PVCs in the critical care unit (CCU) may be at slightly increased risk of having cardiac arrest as a complication of their heart attack. Unfortunately, that observation became more generalized to PVCs that occur in otherwise healthy people. This led to treatment with powerful heart rhythm medications in people who did not have a life-threatening heart rhythm disorder. In some cases, these powerful heart rhythm medications can create heart rhythm problems that they were meant to eliminate, and patients with a low risk of sudden death or cardiac arrest actually experienced cardiac arrest because of the heart medications. One famous study in patients following a heart attack with PVCs showed that the patients treated with placebos, or sugar pills, had a better survival rate than patients treated with powerful heart rhythm medications, even though the heart rhythm medications completely eliminated PVCs."

frank

Another Thought from my Cardio

by donr - 2012-11-11 06:11:46

Kathy: I just now recalled something my Cardio told me about going to sleep & awakening in the middle of the night.

When you turn off the light & it is completely dark & there is not a sound, not even a mouse, you suffer sensory deprivation. A technique used in torture. There is NOTHING for the hearing & vision to to focus on. So, what does it do? It finds your heart beat & focuses on that.

The solution is to establish a background of "White " noise - like a small fan running or a room air conditioner running on low speed. There are commercial "White" noise makers sold for just this purpose. They generate a rushing sound that creates almost all sound frequencies to distract w/o having any intelligence in it. Add to that a Christmas Tree sized nightlight & you can remove all reasons for the ears & eyes to torture you.

A lifetime ago, when I was first trying to control my PTSD symptoms, I went to a hypnotist. He taught me how to perform self hypnosis to relax & get rid of anxiety symptoms. I laughed at his methods of inducing a hypnotic state. First he turned on an A/C unit to create White" noise. Then he started talking - very low & monotonously, asking what were the most stupid questions I can imagine. The one I remember best was "Can you imagine the distance between your ears?" When he asked that one, I always burst out laughing, much to his chagrin! He asked me one night what was so *&&^% funny. I told him that I wondered if he meant straight line through my head, or over the top of my head like on a map of the world. Since you cannot talk yourself into a hypnotic state, to relax yourself, you concentrate on breathing. The idea is to focus your attention so strongly on some trivial thing that your conscious mind gets hideously bored & just shuts off & you either go into a short term hypnotic state or go to sleep!

It works!

Good luck.

Don

Doc visit

by kwhite62 - 2012-11-11 10:11:26

I thought I had given an update on my appointment with my Cardio/EP but I guess that is what it was...just a thought!
I went Friday and had a very good visit with him. He was actually listening and responding and seemed genuinely concerned. Not that he wasn't before but he just seemed more "connected" this time. Maybe after my "mini-meltdown" on the phone with his nurse he realized I was about at the end of my rope.
Anyway, he made some minor adjustments to the PM, like lowering the voltage a little and adjusting my upper end heart rate. He did some other stuff which I can't remember. He said I could also take an extra half dose of the Sotalol at night if the PVC's worsen at that time but I have not had to do that and don't really want to. So far the adjustments he made seem to be helping. I'm still having some PVC's but it hasn't been as bad. And at least I can lay down at night without that "flip flopping fish out of water" feeling going on in my chest! I'm still not sleeping well though and long for a good night of rest. Got any suggestions?
I have yet to access the link you offered, Don, but plan to read that today. And, you offered advice on how to live with the PVC's....how do you cope with them?
Frank and Don.....Thanks so much for the help. Y'all have been SUPER!
Kathy

How do I cope?

by donr - 2012-11-11 11:11:58

K: I'll be darned if I know! I just no longer am really sensitive to them!

Pretend, for a moment, that there is a great, big ,white elephant in the corner of the room. Take a good look at him - check out the tusks, humongous flapping ears, trunk swishing around the place, looking for food, wrinkled hide covering it like a cheap caftan.

OK, forget the white elephant. Yeh, sure. It's still there. Give it time & it will slowly fade from your sensing.

Ever hear of tinnitus? A fancy name for ringing in the ears. I've had it ever since July 1956 when I picked it up on the Army's Cal .45 pistol range. Have not had a silent moment since. Now, you probably see/hear ads for a OTC Med called "Quietus" on TV. It uses people who are driven nuts by tinnitus. I do not fall into that category, either. Right now, as I sit here typing, I hear it. Give me a short while & it will recede into the depths of being forgotten. Another one I have just ignored into submission.

K, here's the best I can tell you about how to cope w/ PVC's: Learn to accept the fact that they will not kill you. This takes faith in your Cardio, me, anyone else who has told you that. If you cannot do that, you are lost. Second, learn to believe in your PM, that it will NOT let your heart skip a beat. Couple those two successfully accomplished & you are 90% of the way there. Those were the ONLY two things I consciously did - all the rest was like the white elephant in the corner disappearing w/ time. Perhaps part of it was to sense one & say to myself "Oops, another PVC." How good can it get? I have them, know it, and have to rely on my wife to check my pulse to feel them. She'll count for 30 seconds & report that she sensed one or two - I felt NOTHING!

The best med for this is called "Tincture of Time." Just let it pass, all the while doing your best w/ the only two suggestions I made & you will find that they recede into your background.

Oh, BTW: If you go to bed EXPECTING to have them, you will. Now there's a tough one to break. Here's a suggestion on how to beat that: Turn out the light, lie on your back w/ a small pillow under the knees (Helps relax the leg muscles; Arms by your side, fingers relaxed w/ knuckles out. See if you can find a small pillow to put under your neck so your head hangs back, allowing the airway to be less constricted. Close your eyes. Breath in through your nose slowly to about the count of 6 or 8 till your lungs are completely full. Hold the breath for about 4 seconds; exhale slowly through your nose; do not inhale for about 4 seconds. Repeat this for abut 20 min. Concentrate on your breathing to the exclusion of all else. ALL else. Drive every other thought out of your mind except the breathing. Relax every muscle in the body. Breath. breath. Breath. Think of nothing else. You cannot possibly make 20 min of this. You will go to sleep in about 5 min. After a few sessions, you should NOT sense PVC's.

This may also improve your sleep!

Don

Good advice....

by kwhite62 - 2012-11-11 12:11:49

Thanks, Don. I never thought of comparing them to the tinnitus.....I, too, hear it as I type! But you are right....the more I think about the tinnitus the more I hear it and the louder it gets! But it does fade away when I get busy and don't think about it.

I am beginning to be comforted in knowing that the PVC's won't kill me. The stress of worrying about them I'm sure makes them worse. I'm learning to trust my doctor, although I still do a little research and ask questions of you guys when something new comes up!

I'm going to try that breathing exercise at bedtime. I read and pray before bed which seems to relax my mind some but I think the breathing would compliment that and help to relax my whole body.

Thanks for the suggestions. You have been very helpful!

Kathy

Lowering Voltage for PVC's

by ElectricFrank - 2012-11-12 02:11:16

That could help a lot. The higher the voltage the more the pacemaker stimulus could irritate the heart wall. It's best to have the lowest voltage to do the job.

I also know what Don is talking about with sensory deprivation. When I camp in the desert the only light is the stars. It is also very quiet. One night I had a large bird land on the trailer roof just after I was settled in bed. There was this wosh wosh of wings and a ear splitting thump as it landed. That got my attention.

Glad things are working out better,

frank

Precious Sleep

by kwhite62 - 2012-11-12 09:11:38

Don, I didn't get a chance to try out your breathing and relaxation techniques when I went to bed last night....I turned on my fan, turned off the light and I think I was asleep before my head hit the pillow! Woke up a couple of times but went right back to sleep and didn't wake up until my alarm went off...blasted alarm! But oh how good it felt. I just need a few more of those nights to catch up!

Frank, I think the voltage adjustment has done the trick. Doc said it was just a small adjustment but it seems to have worked. The PVC's are not gone but it is soooo much better.

Can I ask another quick question? Now that my incision is healing up and the swelling has gone down, is it normal to sort of "feel" the pacemaker move a little inside it's pocket? And is it really like a pocket? What keeps it from moving across your chest or up or down or wherever? I know it's going to take some time to get used to it being a part of me but at this point it's still pretty weird.

Thanks guys....I really appreciate y'all putting up with all my questions!

Whooooo, Hooooooo

by donr - 2012-11-13 12:11:52

Kathy: Great! Doesn't matter to me whether it was the fan or Frank's voltage adjustments - what matters is that you got to sleep.

Your question: Yes. it's a real pocket. They separate the subcutaneous fat from the muscle & slide the PM down inside of it. Naturally, it's a bit bigger than the PM, otherwise they could not get it in. There is a loop on the PM for them to put a suture through to hold it in place, but all surgeons do not take the time to do that. Yes, you can move it if you push on it. You can even wiggle it. BUT... DON'T!!! It can become habit forming & it even has a name - "Twiddling" or some such nonsense. Face it, the PM has a finite thickness - about 1/2 inch or so; this means that the underside of the fat will not re-bond to the muscle right up to the edge of the PM & hold it firmly in place, always allowing a little wiggle room. I've had a PM since Feb 03 & it still moves a bit. Really feels funny sometimes. Also itches like fire during the summer when I perspire. Beats the daylights out of the alternatives!

Keep sking, that's what we are here for. Glad to help.

Don

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