PVCs, PAF and ablation

[Kittyca]

Hello everybody,

I would be very grateful for advice.

My problem is that after covid booster Moderna (September) I started feeling lots of ectopics (never had before). Tried deep breathing, flecainide 50 twice a day, metoprolol 25 mg but nothing helped.

My cardiologist sent me to numerous tests: ecg, echo, cardiac mri and all of them came normal. Only 48 hours Holter shows 10% PVCs (a bit more than 10000).

I also have had PAF since 2003 and on PIP (200 mg flecainide plus 1.25 bisoprolol). Haven’t had any episodes for about 12 months but used to have 3-4 episodes a year lasting up to 38 hours. With AF you never know when an episode starts.

I have had today a nhs appointment with electrophysiologist and firstly he told everything was ok, PVCs are not dangerous and it’s better to ignore them. As soon as I told him that I can use my private insurance he changed his mind and told that they would never go away by themselves, medication was not effective for PVCs ( my bradicardia) and the only option was an ablation for both PVCs and AF and the sooner the better. The doctor is very good .

I also spoke with private cardiologist (insurance) who advised to wait and see. This is also a very good doctor.

The question is how long to wait because I have read that in about 5 years (even in 2 years) time PVCs can damage heart muscle.

I tried to ask this question to both of them but answers were rather unclear and evasive.

For now I don’t know what to do: either look forward to ablation or wait and see?

With ablation I am scared that it is a heart surgery and can leave scars etc.

With medication my pulse goes down to 40-41.

Are 10% PVCs too many and can be dangerous?

I would be very grateful for any thoughts.

[mjames1]

I've had PACs on and off for over 40 years, often like yourself, over 10,000 a day. I never had a cardiologist or ep tell me that they were dangerous or needed to be ablated. I could be a year with them and then a year without them. Or two weeks with them and two weeks off. Since I've started flecainide over a year ago, they are like 99% gone. It's unusual for ectopics to be treated by ablation, so unless they really interfere with your life, I wouldn't unless convinced otherwise by at least two electrophysiologists.

So other than ablation, what might be worth a try is modifying your meds a bit. Maybe ask to switch from metoprolol to diltiazem or upping (or lowering) your flecainide dose. Of course, get your ep on board with this. But hopefully, one day they will just go away by themselves.

[Kittyca in reply to mjames1]

Thank you very much. I am thinking of arranging another appointment with different ep

[DawnTX in reply to Kittyca]

Better to have a second opinion with this. If you are that unsure, you need to feel better about what you are doing with your body. Yes, oblations, do cause scarring. It depends on where they have been done and how much. My third was also a major plus a couple of other places. I think that put me over the edge. My IEP does not want to do anymore and now he won’t be because I got my special pacemaker on Monday. We all have to realize when it comes to ablation. It really can be hit or miss if they do not get the correct spot. That is true of almost everything they do in there. The implant of my leads had to be very specific, and could not be even a millimeter off. Thankfully as long as I do my part and keep it from moving everything should be fine for the second part of my surgery. best of luck whatever you decide but the fact that you noticed a difference when he heard about your insurance would bother me also. Hugs

[BobD Volunteer]

Few reputable EPs will try to ablate for ectopics from my experience and I have always been told that whilst irritating , they are benign.

[Kittyca]

Thank you very much, Bob. Just in case: do you happen to know the names of reputable EPs. I definitely need a second opinion, tried to read reviews on doctify but it’s very difficult to understand who is good. Especially if you know someone in London area

[dmac4646 in reply to Kittyca]

Dr Richard Schilling

[CDreamer]

I’ve seen 3 EPs who all trained under Prof Schilling from Barts. All excellent.

[CDreamer]

You may find this article from Mayo Clinic useful

my.clevelandclinic.org/heal...

[WildIris]

I also had very frequent ectopics, since I was young, and was always anxious about them. I still have a lot of them, apbs and pvcs being the most frequent 17,000 on one Holter monitor. I didn't have afib until heart surgery to replace a leaky aortic valve. I was told that the leaky valve would get worse and replacing it would help my heart function and reduce the ectopics, but of course it also left me with paroxysmal afib. So I guess any kind of heart surgery is a bit of a gamble. I also had an ablation long ago that didn't help or hurt much. Giving up sugar, losing weight and relaxation and being more aware of how anxiety affects me have helped the most. I still eat when I'm anxious but its much healthier food now, like an apple.

[WildIris in reply to WildIris]

I should add that the ablation was indeed just for the ectopics. This was about 20 years ago and my ex-husband had an ablation for afib at the same time. He had good insurance, maybe that was part of the doctor's thinking.

[Victor805]

interesting Kittyca

The day after my Pfizer booster I had noticeable palpitations which I now know was likely AF.

A few weeks later I had a second more significant episode and ended up in hospital and pharmaceutical treatment was commenced. .

I often wonder whether there is association with perhaps mild heart inflammation tipping susceptible individuals to an AF episode.

Not in a position to comment on your current concerns

Cheers

[ETHEL103 in reply to Victor805]

Same here with moderna booster.Ablation for flutter last May all done and went well.Jab in Septerber A fib and increased ectopics.Not sure I will have a fifth jab.I had a headache for a month too.

[Hidden in reply to Victor805]

Hi Victor - some months ago there was a thread on here by someone who said he was in his 60s and in good health but 2 months after receiving his second Pfizer vaccine he developed AFib and that he knew two other people in exactly the same situation. I was about to respond negatively to the idea that a vaccine might trigger AFib but on a whim looked up when my AFib began relative to my (Pfizer) Covid vaccs and, surprise surprise, my AFib started exactly 2 months after my second vaccination! I mentioned this to my daughter who is a professional who does a lot of medical research and she sent me an article saying that preliminary studies had showed a small correlation between Covid vaccs and AFib - particularly Pfizer. The percentage of people developing an arrythmia after vaccination was very small but significant enough to investigate further.

There's too many factors at play here to come to any conclusions, but interesting. And enough to make me decide not to have the booster (which would be my fourth Covid vacc).

[Victor805 in reply to Hidden]

Hi TopBiscuit

Thanks for you comments. My cardiologist was prepared to accept that any vaccine may cause inflammation and therefore could be pro arrhythmic for two or three days but not at three weeks.

I still had my fourth booster however requested Novavax as a precaution.

I had Covid in December and managed Ok. Had antivirals day 1 and no long covid symptoms.

I will proceed with a fifth booster in six months when recommended.

Cheers

[FindingCaradoc]

I have occasional spells of palpitations .ectopics and I have been told by two EPs that they are of no concern

[Ppiman]

Can you give the source of your evidence that ectopic beats can be dangerous, please? I thought that I had read deeply and widely on this, and I have not been able to come to such a conclusion.

At a personal level, if your cardiac MRI came back as "normal", then I would stop worrying much at all, since that is a gold standard way of inspecting changes to the heart muscle. Whether an ablation is required is an individual matter, since we all differ in the cause of our various arrhythmias but I would seriously question the different treatment options suggested to you for NHS and private care, as that seems strange and not quite right.

Steve

[Kittyca in reply to Ppiman]

Thank you for your answer Ppiman, I have read and was told that PVCs are ok if they are below 10000. What’s more in about 2-5 years time they may harm heart muscle and be the cause of other heart problems. So, warning sign is an amount 10000.

That’s why my question is : ablate or not. EP has promised to sort out two problems at one go : AF and PVCs.

Can’t decide

[Ppiman in reply to Kittyca]

Aha - I’d ignored the frequency of the ectopic beats. Sorry. One problem with ablating them, as I understand it, is that they often originate in varying and numerous areas of the heart.

Steve

[listerines in reply to Ppiman]

Not at all trying to be inflammatory here, but the more I search up recent peer reviewed medical journal articles re:Consequences of Frequent Premature Atrial Contractions or Premature Ventricular contractions

The more I am inclined to be skeptical about my EP and Afib Clinic's stance that ectopics are benign.

Of course, some minor episodes of palpitations here and there unlikely to be of any significance. But those with regular bouts of ectopics seem to have a greater likelihood of negative outcomes (mortality and morbidity)

I wish Frequent and/ or regular ectopics were given more attention from the health care system

[Ppiman in reply to listerines]

I think you might well be right but it seems to depend on where the ectopic beats form (their "locus"). Most frequently, the cause seems to be benign (from what I have been told and read), but not always. I think the echo / MRI / ECG gives the cardiologist the information they need on this - but likely only up to a point. It's only an anecdote, but I was once seen by a cardiologist who told me that he had thousands of ectopics a day more than I was having and he was quite happy with them and that he expected to live a long life!

Steve

[philologus]

Lots of ectopics can be very stressful and cause you to worry what damage they are doing.

I went through this when I had a Holter and found that I was having 30,000 -40,000 a day.

I was offered an ablation because my poor ticker was getting so many 'rogue' signals that it didn't know when to do what.

This caused my ejection fraction to drop below 20 and I was told that I had Heart Failure at level four.

I decided against the ablation and tried other, more natural things, to reduce the ectopics.

I am now classed as having 'mild' HF and have been able to stop or greatly reduce the medication I was taking.

I haven't had any of the vaccines but I have had Covid and currently have Long Covid and this has caused the ectopics to start again. - but not as bad as previously. My Kardia says that (roughly) every fifth beat is an ectopic and I'm OK with that. I had a Holter for a day and am awaiting the results.

My conclusion is that a low number of ectopics is not going to cause me to fall off my perch, but a huge burden should not be ignored as it just might.

[Kittyca in reply to philologus]

Thank you Philologus,

May I ask why you decided against ablation. And which medication you took to fight ectopics

[Peacefulneedshelp]

I listen to a podcast with Dr. McCullogh who is a cardiologist and researcher and he has repeatedly warned that these spike proteins in the vaccines are causing inflammation of the heart. Covid was bad enough and it keeps mutating faster then they can keep up with vaccines.

[philologus]

An ablation sounded the same to me as it did to you, damage and scarring inside my ticker, and that just didn't appeal to me at all. I know enough about electricity to know that if it doesn't get through one way it will try to find another it has to go somewhere. My ectopics and subsequent HF were caused by me taking Tramadol for two years without being monitored by my GP. I stopped taking Tramadol and started looking into other ways of dealing with having too many electrical impulses and found that Earthing myself regularly helped and I researched the use of Iodine on the advice of someone on this forum. It worked for me but realise that might not be the case for others.