Ablation due to PVCs

I had a ICD/Pacemaker installed 3 yrs ago due to cardiac arrest at 52.  Never determined the cause.  All has been good, but 4 months ago, I started having pvcs.  The 24hr holt monitor says I'm having PVCs 89% of the time.  I fell heart pounding and some dizziness about 40% of the time.  My iwatch is where I found it first occurring and 2 months later on my quarterly pacemaker download it was seen.  With that said, they are considering ablation procedure.  Has this worked for anyone with PVCs? How long is recovery?  Thanks in advance. 


6 Comments

PVC ablation

by AgentX86 - 2021-09-10 21:06:46

Many, many, of us have had ablations for atrial arrhythmias but the ventricals pose a lot more problems. Ablations form scar tissue in order to block errant electrical signals.  Scar tissue in the atria isn't a big deal because they don't really pump blood directly (their job is to help fill the ventricals).  You can function well without them (mine do nothing). 

Scarring the ventricals is more problematic but sometimes there aren't any good choices.  I'd research the process, alternatives, and outcomes (both ways) before going into this. Get as much information as you can and make an informed decision.

As far as recovery goes, it should be short.  Atrial ablations are (almost) trivial surgeries.  Recovery ammounts to a few hours on one's back in the recovery room and a few weeks ban of lifting significant weight so the femoral vein can heal properly.  Ventricular ablations shouldn't be a lot worse, that way, but they are more complicated and the chance of complications is higher (and probably more severe).  I'd expect at least some inpatient time. Ask!

A few more thoughts

by Gemita - 2021-09-11 05:30:18

Jandytay,

Have your doctors excluded electrolyte disturbances as a cause for your PVCs or perhaps tried to raise your Base Rate pacemaker setting?  Sometimes a higher minimum heart rate (Base Rate) may help to suppress ectopic beats.  It certainly does for me.

PVCs are awful.  I used to suffer from them as well as PACs (premature atrial contractions) but with a higher Base Rate setting of 70 bpm (from 60 bpm), PVCs are largely a thing of the past.  If you haven't already done so, it might be worth trying conservative measures first before going down the ablation route for benign, albeit troublesome, prolonged, frequent PVCs.

I note you had a cardiac arrest 3 years ago, ?cause unknown, but you have been well until recently.  I wonder if something has changed with your heart condition triggering the PVCs?   If your doctors haven't already done so, I wonder if it would be worth asking them for additional tests, perhaps a stress echo, to see whether you have developed any signs of ischaemia (narrowed/blocked arteries) somewhere before you rush into an ablation for your PVCs.  If there are now signs of ischaemia and reduced blood flow to your heart, this could well trigger an arrhythmia like a PVC and you would certainly want to know about it in any event and take early action. 

I attach a comprehensive link of an in depth study on PVC management, including ablation which might be helpful.  Good luck

https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.119.042434

Thinking it through

by Gotrhythm - 2021-09-11 16:09:13

You have my sympathy. I know well how bad frequent PVCs can make you feel.

Both AgentX and Gemita are very knowledgeable. Making sure you've considered all the options before taking an irreversible step seems wise to me.

But having had spells of PVCs, I know that while they are going on, I'm not mentally at my sharpest. Forget considering options and asking insightful questions. It's all I can do to remember my name. I hope you have someone, a spouse, family member, or good friend to go to appointments with you, ask questions, and help you think through everything.

Thanks for the feedback

by Jandytay - 2021-09-12 10:47:10

Thanks everyone for the feedback.  I have had them reset the pacemaker from 50 to 70 a month ago, before the holter monitor.  It made no difference at all.  I have an echo scheduled for 9/25 so I think that will help identify why too maybe.  I appreciate the links sent and I'll review also.  Just a nervous Nellie right now but do want to feel better soon! 

Pacing rate

by AgentX86 - 2021-09-13 22:23:04

My PVCs showed up when they reduced my resting rate from 80bpm to 70bpm, so my EP had it raised back to 80bpm and they went away.  After a few months they added a sleep setting so it drops my rate from 80bpm to 50bpm from 12:00AM to 6:00AM (EST ;-).  I haven't had a lot of touble at night but the PVC problem usually started after exercise so the night setting didn't bring them back.

The lack of magnesium can also exacerbate arrhythmias (all muscle function, really). Make sure that isn't the problem.  An Mg supplement can't hurt. 

3rd time was a charm for my mom

by seenu302 - 2021-09-19 00:28:09

My mom had around 30% PVC burden and had to go through 3 ablation procedures. Finally, the epicardial ablation (on the surface of the heart) did the trick. Her PVC burden is minuscule now. Her EP said sometimes they get lucky and can fix it in one surgery and sometimes it's tricky due to PVCs not manifesting under anesthesia. The recovery was pretty quick. She was back to her chores in a week or 2 and not that painful overall.

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