Rapid Increase in PVCs

Hello,

In the past month, I've experienced what feels like a fairly large increase in the number of PVCs.  Over the past nine months, my interrogations indicated that the number increased from 4 per hour, then 7 per hour three months later, then 14 per hour three months after that. Now, when I feel PVCs and check my Apple Watch, I'll have 7, 8 or even 9 in a 30 second period and occasionally nearly 20 in a minute.  They leave me feeling drained and lightheaded with my balance compromised. They are especially prevalent in the late afternoon and early evenings.  My artrium was pacing 59% of the time and my ventricle less than 1% at the September interrogation. I take 12.5mg of metroprolol in the morning and 200mg of acebutolol in the late afternoon.

No lifestyle changes, no changes in medications. No heart failure or heart disease.  I have Sick Sinus Syndrome, diagnosed following a 12-second pause. A dual chamber Biotronik pacemaker was implanted June 2023.  My pacemker is set to  50-110; I experienced pacemaker mediated tachycardia earlier this year and that was remedied with a settings change.  I have an appointment scheduled with the EP Clinc in 10 days.

I'm wondering if anyone has experience or insight into this issue.  I understand that Sick Sinus Syndrome can worsen over time but this huge increase in PVCs has me baffled and wondering perhaps if the acebutolol needs changing.

Thank you for your help! 

6 Comments

PVCs

by Rch - 2024-11-16 21:54:48

Hi

Sorry to hear about the increasing frequency of PVCs. We all know how awful they feel.  How do they look on your app? Are they all the same morphology or different? Are they occurring in a pattern like alternating with normal beat or every 3d beat etc. or are they occurring in groups of 2,3 etc? Also, check your blood pressures when you feel dizzy! If they are of different morphology or occur in groups with symptoms, I would suggest you talk to your urgent care triage nurse or may even visit one. I'm sure they are benign but nonetheless it's better to get checked out. 

I see your HR range is 50-110, which is fairly tight. Mine is 50-120 and I feel that's quite tight as well. But since you are on a fairly good doses of beta blockers, your HR probably  rarely hits the MTR! 

Some members  on this forum have tried to raise the basal rate to mimimize ectopic beats. But I don't know how that would impact the rest of your settings!

Hope you will get an answer soon! We wish you well.

 

PVCs

by piglet22 - 2024-11-17 05:06:06

Hello 

There's quite a bit of discussion on this recently so it might be worth searching the posts rather than go over old ground.

A lot will depend on who you see in clinic. If you see the technicians, you might get a reasonable explanation, but you might get the all clear which isn't what you want.

You need a clear explanation from the cardiologist.

PVCs (ectopics) affect individuals differently

 From mild sensations to more serious symptoms like involuntarily falls or even blackouts. It sounds like you are getting symptoms that need looking at.

Episodes of PVCs can just come and go

 You can have years of no trouble then wham.

The usual first line of attack is to see what the pacemaker (PM) has recorded. This will give you an idea of the relative number or burden. Your numbers aren't particularly high but what counts is how they affect you.

Yes, as you have noticed, there can be a time of day aspect and there can be an activity aspect

 PVCs can make themselves felt during relaxation then go onto light-heartedness when you become more active.

Beta blockers at higher doses can be an effective treatment. Without looking it up, I can't translate your current dose to something that works. I was taken off Atenolol at 50 mg daily and prescribed Bisoprolol. 5 mg Bisoprolol is equivalent to 50 mg Atenolol. The treatment Bisoprolol dose wes 10 mg daily.

That's quite high and can make you struggle a bit, but it can clobber ectopics and give you  a chance to get back to normal. The higher dose works quite quickly. Once subsided, you can reduce the dose. I take 5 mg Bisoprolol daily now, split into a low overnight dose of about 1.8 mg and 3.75 mg in the morning. So back to my original beta blocker dose. Your PM support allows you to take higher doses.

I know it doesn't add up to 5, but it's the best I can do. It's also an experiment 

It can affect your exercise capability, so it's a compromise.

Good luck with your appointment.

Increase in PVCs

by H van Dyk - 2024-11-17 06:44:27

Hi there,

Although your medical team knows best, I feel that your problem could be solved bij increasing the dosage for Metaprolol. Your current dosage 12.5 mg is a bit on the low side. Before switching to Carvedilol, I used to take 100 mg in the morning.
If you look it up, you'll see that the start dosage normally is 50 mg. Most of the time it is allowed to increase to 100 mg (once a day).

Greetings from Amsterdam

 

 

Thank you for your help!

by UkeGirl - 2024-11-17 23:23:54

In reviewing my Apple Watch print-outs, the morphology of my PVCS has indeed changed to include many more multifocal PVCs. I hadn't considered that. Previously, they were almost wholly unifocal. I will take examples of both to my appointment at the EP Clinic.  The reality of my visits to my cardiologist is that he merely advises me "not to worry about it" when I bring up issues.  But the NP at the EP Clinic is very responsive and action-oriented.  I have great confidence in her and the details of my visit are shared with my cardiologist. They practice in the same office.  I will certainly inquire, too, about my medications. Thank you again!

types of cardiologists

by PaceCahr - 2024-11-19 01:09:52

HI UkeGirl - 

I'm glad that you have confidence in the EP clinic sharing the details with your cardiologist.  

A friend of ours who works in a cardiac unit is very fond of saying "There are two types of Cardiologists:  Plumbers and Electricians" 

I suggest that you should establish yourself as a patient of an EP cardiologist in the device clinic for the long term to guide your cardiac care, especially with respect to the changes in your PVCs and any other new rythym changes that you may notice. 

My PVCs were were waved off as benign by the cardio-plumber I was seeing. He never suggested that I see an EP. At the 2 year point, he  told me I didn't have to make any follow-up appointments "unless something happens."  He basically fired me as patient, because I didn't have any plumbing issues (squeaky clean arteries, passed stress test with flying colors, etc). 

Something did happen: I ended up in the ER for a VTACH that needed the paddles to stop, and after almost 2 weeks of testing, they diagnosed cardiac sarcoidosis. No sign of sarcoid anywhere else. Went home with an AICD and now have three heart doctors: a (different) plumber, an electrician, and the Sarcoid Cardiologist.  

I hope your docs do take your changes in heart rythym seriously and works with you to resolve it! 

RNRVAS?

by Gotrhythm - 2024-11-20 15:00:22

I too have exprerienced increased PVCs from time to time, with the accompanying weakness and lightheadedness, and near-syncopy and collapse. Every single time, it has turned out that I had PMT, pacemaker mediated tachycardia. 

The kind of PMT I have doesn't show up on the standard diagnostic checks. It's called RNRVAS. The StJude rep was able to suggest some usual settings that seem to have resolved the problem for now.

I say "for now" because as you have noted SSS doesn't stay the same over time. Finding settings that work around the PMT RNRVAS seems to be a moving target.

I don't know if you have RNRVAS, of course but it's worth asking about when you see the pacemaker tech. Mine was diagnosed when I asked about it. And I knew to ask because of what I learned here at Pacemaker Club.

If you're interested you can find my story and more discussion on my bio page. 

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