Multifocal PVCs

Hi everyone 

I am new to the club. I have an ICD as a result of one episode of VT and due to third degree heart block.

Over the past few years I have developed multifocal PVCs and I am very symptomatic. Tried all drug therapies to no avail. I have had two unsuccessful ablations which have targeted one spot and the EP has said there are at least four other spots which haven't been attempted.

Does anyone have any experience of treating multifocal PVCs please? My readings tell me that due to their nature this also makes the risk of another episode of VT more likely. Any advice please!



by Gemita - 2023-07-30 20:31:28

Phil, Firstly welcome and I am sorry you are having such a miserable time with multi focal PVCs. 

As a matter of fact, I have intermittent multi focal Atrial Tachycardia.  For me this arrhythmia is often triggered by illness, like an infection.  For example when I had Covid this arrhythmia started and has intermittently continued.  I was also found to have electrolyte imbalances at the time.  I was told to increase my beta blocker, Bisoprolol to calm it.  They may also suggest a calcium channel blocker.  One of the reasons why I have not had an ablation is because I know that it would take several attempts to eliminate all possible trigger sites as indeed you are experiencing with your multi focal PVCs.

I expect your doctors have ruled out all possible causes for this arrhythmia before you consider another ablation which would carry further risks.  How is your level of anxiety?  Arrhythmias can make us feel very anxious because they can affect blood flow when they are frequent and prolonged, making us breathless at times and they may cause chest discomfort, weakness and fatigue too.

I would perhaps get your electrolytes checked if you haven't already done so, as well as have additional checks looking at your thyroid and general health.  Try to stay well hydrated, but go easy on caffeine and any alcohol.  Get plenty of rest, take meds as recommended by your doctors.  I am sure your doctors will try to prevent your arrhythmia from worsening and triggering VT episodes which could then trigger defibrillator therapy.

Above all, don’t let these disturbances get you down.  They can be calmed and you will get through this.  Focus on your breathing and try to slow it down.  Good night from the UK

Multifocal PVCs

by Philli1 - 2023-07-30 22:16:29

Thanks Gemita for your quick response.  Yes you are correct in all that you have highlighted.  I have narrowed the same triggers down and more to what you have said.  Anxiety, stress, caffine, alcohol, sugar, salt, over eating.  I am pretty conscious now of what exacerbates the ectopics.  Unfortunatley the beta blockers and calcium channel blockers only lower my heart rate and do not stop the pvcs so I have now ceased all medication.  You are right also about the ablation.  I am not being offered any more attempts by my EP so I am left now with how best to cope which is ok most of the time but sometimes its difficult.  Thank you again Gemita.  Its great to know someone else is familiar with the challenges multifocal pvcs present.


by AgentX86 - 2023-07-30 23:39:04

Ablation for PVCs isn't something to take lightly.  An ablation is essentially killing heart muscle to create "fire breaks" so the errant signals are localized.  In the atria, this isn't all that important because the atria don't do much anyway.  However, in the ventricles, it's the equivalent of a heart attack.  It's destroying the muscle that pumps the blood.

Slowing the heart may be exactly the wrong thing to do.  Slowing the electrical system (which beta blockers do) is good but the lower rate can cause even more trouble.  A PVC is a premature ventricular contraction. Slowing the heart down, gives the PVC more time to fire.  Speeding up the heart reduces the chance of a PVC.


Ask about a higher base rate pacemaker setting

by Gemita - 2023-07-31 03:51:02

Phil, your Bio history is empty but from your comments about 3rd degree heart block and one episode of VT, presumably sustained, I am assuming you must have a pacemaker as well as a defibrillator to treat your condition?

I can fully understand your difficulties with rate lowering meds like beta blockers and calcium channel blockers which would drop your heart rate and blood pressure too much, but something is clearly needed to help calm your multi focal PVCs, to help prevent them triggering VT episodes and ICD shocks in the future.

I agree with AgentX86’s comments, many of us find that a slowing heart rate can most definitely be a trigger for a PVC or indeed for many other arrhythmias and rate lowering meds like beta blockers may actually worsen our condition rather than improve it.  

My arrhythmias (atrial and ventricular) are actually helped by a higher, steadier heart rate which my pacemaker allows.  I don’t know what your lower rate setting (Base Rate) is set at and whether this could be raised to help outpace these slower, pausing multi focal premature ventricular contractions?  

My Base Rate is set at 70 bpm and I have had noticeable success in reducing all my arrhythmias.  It doesn’t work all of the time, but it is one effective treatment for most of the time.  I would ask about this Phil?

Multifocal PVCs

by Philli1 - 2023-07-31 06:00:19

Thanks AgentX86 and Gemita.

Your comments are very helpful. Thank you. I do have an ICD with pacemaker capabilities and totally dependent on the pacemaker. It does make sense what you have both said. It's a challenge especially also in the recovery after exercise. It helps to have others who are aware of the concerns. Thank you again.


by Old male - 2023-07-31 08:53:52

Welcome to the group.  Have an ICD for the past 9 years.  Diagnosed with Ventricular Tachycardia.  Device has performed it's intended function to prevent cardiac arrest along with pacing currently set at 80 bpm.  Based on the many reports from those having Ablation, I have declined that option.  Having scars from 2 heart attacks, I can't see how adding more scars can be good.  Know that many here may dispute my reasoning and there are some with good results.  I have learned to live with Afib and still work.  The ICD is there to intervene if a dangerous rhythm develops.  Thankful to God and modern technology. Life goes on.


by AgentX86 - 2023-07-31 20:15:10

I just wanted to make it very clear that there is a huge diffrence between an atrial ablation and anything done in the ventricles. Whe ventricals pump blood.  A reason for further scarring the ventricles would have to have some big justificatoin.  A few PVCs (or a lot of them) wouldn't come close.  By contrast, the atria do next to nothing.  They aid the filling of the ventricals at maximum heart output.  They're effectively a left-over from the times running down our dinner was our only job. A little scarring here doesn't affect us much. 

Ablation for Afib and/or Aflutter is easily jusified.  I've had, not only three ablations, but a maze procedure, where they literally burn patterns in the heart muscle that look like a child's maze, to isolate the errant Afib paths. None of that worked so they completely disconnected the ventricles from the atria and I'm paced only in the ventricles. The atria do absolutely noting.

...and I get loads of PVCs.  When my pacemaker was implanted, my EP set the rate  to 80bpm, with the intention of backing it off to 60bpm over the next couple of months.  After a month, he set it to 70bpm and my PVCs went wild, so set it back to 80bpm. IThat's where it's been for five years. He did add a sleep mode to help sleep at night. 

The PVCs are breaking through again, so other than to try increasing my metoprolol a little, there isn't much else that can be done. Sucks.


Ablations and PVCs

by islandgirl - 2023-08-02 00:00:46

I've had numerous ablations in the atriums due to aflutter and tachycardias.  I have ventricular tachycardias and an ICD and have had 2 SCAs (first survived after CPR and 2nd saved by multiple ICD shocks).  I also have numerous very disrupting and uncomfortable PVCs.  My EP told me a long time ago ablation for PVCs has a low correction rate and not recommended. He continues to work on my rhythm.  I am on numerous antiarrhythmic meds. See if they will work with you on adjusting your ICD.  That did help me when I got a new device.  


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