Painful PVCs

Painful palpitations

by Gemita - 2023-11-04 23:02:24

Mae, hello, firstly I am so sorry that you are still suffering from your pacemaker, your heart rhythm disturbances and the effects of your first ablation.  

I have had a look at your Samsung ECG strip.  I have to admit I am not qualified to comment on a paced rhythm, but I will give you a few observations if I may.  The beats look very uniform to me and almost identical except the penultimate one which looks different and a more normal beat.  The rhythm itself though if I count the number of small squares between each beat, is clearly “irregular” and a slow one.  I cannot see any atrial or ventricular pacing spikes.  You mention your ventricular lead has been switched off.  For me this is possibly PVCs, with no evidence from the rhythm strip you provided of any bigeminy/trigeminy.   

I know you are still in the healing period following your ablation and you also suffered post ablation pericarditis.  During the healing period you can expect more in the way of rhythm disturbances.   There is so much going on Mae.  I think we need to tackle one thing at a time now and perhaps the most important thing would be to get help for your symptoms, especially if these are due to continuing inflammation from the pericarditis?  Inflammation will not be helping to stabilise your heart rhythm.  As to whether your non functioning ventricular lead could in any way be a cause for your worsening rhythm disturbances, this would depend on whether you need occasional ventricular pacing?  Clearly the lead is there for a purpose.

I send my warmest wishes for a speedy recovery and respite from your palpitations. Keep hydrated, rest and eat well and please let us know the results of your heart monitoring

PVCs ( ventricular ectopic beats)

by Selwyn - 2023-11-05 09:08:44

I can't see how a non functioning ventricular lead would cause PVCs, and in any event you say you have had these " as long as I remember," so that probably answers your question.

I would not put any reliance on a wrist monitor for diagnosis - that is why the norm is for a 12 lead ECG (EKG). I use a 6 lead Kardia and even that leaves a lot to be desired. Assumptions are just that.

With regard to pectoral stimulation from a venticular lead.. why? Is the lead faulty? Is the pacemaker set to unipolar? ( I had pectoral stimulation and this was instantly cured when they change my lead to bipolar).  A faulty lead would have an increased impedence and need more current to function. 

Anxiety, caffeine, alcohol, thyroid XS, electrolyte disturbances are just a few of the causes of PVC. In your case, it may be that your Bundle of His was split ( if I am trying to fathom out your incomplete bio history).

If you have a long standing problem with PVCs, I wonder why you are not taking any meds for prevention? ( ? your bio).

Pericarditis is nasty. Often recurrent. Likely to be worse with PVCs. If your non steroidal anti-inflammatories and colchicine don't work, corticosteroids may be helpful. Whilst no one wants this, sometimes needs must.

Yes, my best wishes for a speedy recovery. It seems you need some further proper investigation.

Forceful PVCs

by Rch - 2023-11-05 17:17:20

Hi

As Gemita and Selwyn suggested, you really need to have a surface 12- lead to see what these are. If inconclusive, perhaps a holter or Zio should be done! The electrograms may give some clues but I wouldn't wait to see a device tech for this!! I really understand your anxiety and fear. Just run-of the-mill PVCs are distressing as they are and when you have these forcefull or painful ones in a row, I wouldn't wait for an appointment. I would just run to the ER to get checked out!!!! Hope you will get some relief soon!

Apologies for the delayed response..

by Mae11 - 2023-11-06 21:31:23

It was my daughter's 12th birthday this weekend, so my focus was on her and celebrating. 

After raising my dose of ivabradine and raising my base rate to 70, I have only had one of these episodes. When I went it for my last appointment, it was noted that I had had 20 new events, and 3 ventricular in <24 hours. I wonder if this was one of them.. 

To answer the questions asked.. CRP still has not been tested and that adds to my frustration if we can definitively say that I had pericarditis. Before the ablation he had always attributed my chest discomfort to the lead. I always paced very little in the ventricular lead, only about 3%. Once i mentioned the "flicking" feeling under my breast and he could visibly see it during a threshold test he said that we could just turn it off because it was most likely "unnecessary pacing". My leads have both always been set to bipolar. As far as meds, my first EP had me taking 37.5 metoprolol twice a day for the PVCs. Once I started the ivabradine with this EP, he suggested I stop taking the metoprolol because of the extreme fatigue I was experiencing. 

I have considered going to the ER on a few occasions, but have decided against it. I do however agree that this requires some further investigation. I'm hopeful that things are still just settling from the ablation, but honestly have some doubts as hr has already suggested another. I will follow up and let you all know what the results of my monitor are. 

Thank you all for your suggestions and concerns! It's heartwarming to not feel alone in such trying times..