I am new to the forum, 58 y, moderately fit (used to swim 500-1000 metres, hike for 3-4 hours with 300-400m hills) had 10 weeks ago my second ablation for symptomatic frequent PVC (bigeminies, couplets, NSVT). First was semi-successful for 3 years.
The PVC temporarily reduced just before the ablation, but EP triggered bigeminies with isoprenilin and found and ablated focus in the left ventricle (first ablation was for the right ventricle) around mitral valve. The PVC returned during two weeks after RFA and then vanished for 5 weeks (completely - I have not had this for years and years), I was cycling, swimming and getting life back! Unfortunately - PVC returned with 16% daily load/ 30% hourly load 7 weeks after ablation (bigeminies, quadrigeminies, couplets) and increase during simple walk and loads. Now during 10th week - same - does it mean ablation fail or there is a chance the heart is still healing, especially as PVC did vanish for a few weeks?
So the key question - what is the time for healing and whether PVC can ramp up towards the end of healing? Also with this history - any hope that ablation may still work?
It is shame that those with successful outcomes less often come to the forums (that I fully understand :-)) and any views of past history are very appreciated!
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First, many thanks for the reply! As you know the subject needs a good think tank :-).
- It was a complex multifocus PVC, with only one focus in LV near mitral valve annulus located (as the PVC reduced before RFA and needed to be triggered by the isoprenaline) and ablated.
- Load(s) mean % of PVC average. As of yessterday it is 15-18% for 24 average, and up to 35% in the peak hour.
- I might done a bit more than easy with excersize, but always scaled back when PVC appeared. Now I could not walk around the ward (in the hospital overnight right now) without going into bigeminies.
- There was not much antyarrhytmics before - as beta-blockers increase (bisoprolol up to 10 mg/day) slowed down the heart and increased PVC %, and made impossible walks. Now at 2.5 mg a day. Flecainide gave me the apparently sinus tachicardia.
Not sure whether the bigeminies and high PVC % now is
My impression is that EPs are not over concerned about early resumption of usual activity levels after ablation for relatively benign arrhythmias.
Many here speak of regretting taking that advice, but presumably we don’t hear from those who had no problem doing so.
I can’t offer any evidence based advice, but your experience of return of significant problems after relatively early resumption of exercise, suggests the two are linked in your case. Whether that means your ablation will fail in the longer term, say 6-8 months, must be guesswork. I imagine your EP will suggest that if your symptoms are manageable, it would be reasonable to wait and see, while adopting a much more cautious rehab programme.
I can’t comment on the details of your question, but it sounds as if you have started your exercise regime too quickly. Suggest you back off completely for another three months and hope that the process of recovery continues.
Hi there, I do not know the answer to your question really but I have had two ablations (for RVOT VT), the first in January this year and the second in August (6 weeks ago). I went back on the treadmill after the first one and was told ok to exercise again (I was a runner), that was in April, within a few weeks of what I would call jogging I started getting the old symptoms back again so I went back on the treadmill and went into sustained VT. Hence the second ablation. I have been back on the treadmill just this week and was given the all clear again. However, I was quite surprised as I expected not to be as I have been getting symptoms since the 2nd ablation. I had alot of ectopics on my treadmill and some couplets. However, I was very, very nervous which probably exacerbated things. During the physical part of the test (towards the end) I did not go into VT (like the first time). However, I am not convinced I am "fixed" although doctor says go and do what you want. I made a decision to stop running as I am convinced it will just rewire itself into the arrthymia now. I have been told I have lots of other RVOT ectopics which is unusual apparently. I'm quite an unusual case really as I have RVOT VT, VT is usually associated with ARVC but I have a normal heart. I have had all the tests. I am 47 year old lady and was very fit prior to all this happening. Now I'm finding on my walk to work, I have to carry a heavy lap top bag (it's quite hilly) and I am getting symptoms. This was not happening prior to the second ablation. Seems to be symptomatic at lower rate hearts now. When I had the symptoms on my way to work I checked my heart rate (as I have a garmin) and it had shot up to 140 from 90 suddenly on walking. I had mentioned this to the Dr observing my treadmill test but he was very dismissive as I had no VT on the test. He says my arrthymia is benign, only risks are syncope. I have written to my cardiologist asking if I can have a tape to record everyday activities as I feel a treadmill test, does not replicate everyday activities. But I was advised to do whatever I wanted. Always good to share stories though. I recovered very quickly from both ablations. I had non sustained VT on the EP study prior to my second ablation but I do wonder whether they have caused something else with the 2nd ablation. Good luck, Jill ps I'm not on any medication
many thanks for your detailed email, I do not have sustained VT during treadmill, but my feeling (now) is like yours and FlapJack - go slowly after ablation, do not push or test your self. Also - with my age of 58 healing time should be longer than stated 8-10 weeks - 3 months. I used to have relatively fast ~140BPM episodes of (apparently) sinus tachicardia, but after taking small amount bisoprolol (2.5 mg/day) this one gone. I know you are off the meds - but small amount of bisoprolol may be OK.
Hi there, I am reluctant to try meds as I have a relatively low heart rate, goes down to 40 something bpm in the evenings. When I first had an ECG monitor fitted for 48hrs it went down to 30 bpm during the night. However, I was very fit then and had only just stopped running due to the VT. However, my heart rate is still in the low 40s in the evenings and sometimes in the day. My Consultant does not think I am suitable for medication but I may have to try some. It's all quite new for me. I was only diagnosed last October and have had two ablations in less than a year. Seems kind of crazy. I kind of feel I'm in a worse situation now after the ablations, especially the second one as I am feeling all kinds of flutterings now during everyday activity whereas before it only occurred at very high heart rates. The guy supervising my treadmill did say its common to get more ectopics after an ablation in the lower heart rates but did not say anymore other than everyone has ectopics! But most of them are asymptomatic. I don't fancy a third ablation as they were more aggressive second time around and I had a lot less sedation and came around before the end of my procedure and felt some uncomfortable sensations in my chest. Good Luck, hope things settle for you, Jill
6 week after ablations is clearlky short - so you may feel lots of weird palpitatons. After first ablation it taken me 6 months to a year recover to reasonable shape, same for a mum of my daughter's friend. So hope they will go away! Good luck!
Thanks for that. Just wondering why they do a treadmill test so soon if it takes that long to settle down? I had both treadmill tests post ablation 6 weeks after. No one has told me to take it easy. I just been told by Dr at hospital to resume normal activities! Oh well, we shall see!
The book 'The Haywire Heart' by Dr John Mandrola may shed light on some of these questions - Everything about athletes and heart conditions, by someone who is both a heart doctor, and a cyclist.
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