Ventricular Bigeminy and Bradycardia, SVE, PVC and AF. Appointment today. Advice please.

[Lynnsj63]

Hi, I have A. Fib and have had 2 ablations. I get occasional runs of AF still, SVE and PVC but ablations have helped tremendously. Most recently I have had weeks and weeks of ventricular bigeminy along with the pvc and sve and a lot bradycardia. I've not had ventricular bigeminy before, sent my kardia trace to consultant and he has called me in for an appointment. I have felt exhausted and lightheaded with these spells, my heart rate is 42 to 55 when I am so fatigued. It's hard to keep functioning. I expect I am going to be reassured and told it is all ok. Any advice on this please and any questions I should ask. Shall I ask can repeated bouts of this happening put a burden on the heart? Unsure of what to ask. Thanks for any advice. Take care everyone. x

[Cliff_G]

Sounds a bit like my situation after I had an ablation, 15 years NSR, then an aortic dissection, where the open heart surgery brought my AF back. It affected me badly, as for you. Bigeminy is relatively common in conjunction with PVCs, I'm not sure why. I have wondered when I've also had bradycardia mixed in with it all what the heck has been going on.

In the end I've had another small ablation but have been told that the PVCs etc I am left with after can't be ablated and that I only have medications as future options. So far (and only 3 weeks) a combination of 100 mg/day of Flecainide and 60 mg of Diltiazem has me going in the right direction. My EP also responded to my query about Ranolazine for PVCs by saying it was now being used by several of his colleagues for such reasons, so that's a future option too. There's some quite good evidence that Ranolazine helps with ectopics.

As to questions to ask, you could try asking exactly what is happening and why, and how any medications actually work, but it can get quite technical quite quickly. I suppose one non-technical question is what % chance does this proposed treatment, be it meds or further ablation, have to help me? I have found ChatGPT is currently a lot better than it used to be and has answered these sorts of questions quite clearly, though you always need to be a bit wary of what it's saying and corroborate it from elsewhere.

Best of luck

[Lynnsj63 in reply to Cliff_G]

Ahh thanks very much for your helpful reply Cliff. I too have been told there is no more ablation options for me also. I can't tolerate any higher bisoprolol than what I am on. I will see about any other meds to try and break the runs of these when they go on for weeks and weeks.I haven't heard of chatgp, I'll have a look. Thanks. Stay well. Fiona

[Cliff_G in reply to Lynnsj63]

I can't take bisoprolol or any other beta blockers due to asthma, so my EP has me on Diltiazem. Pretty much no side effects on that, at least for me, and fairly effective.

Yes, ChatGPT is (one of) the Artificial Intelligence web site(s) where you can ask questions and get answers. It's pretty good for general questions, and has improved a lot at the latest update, though it has been known to make things up, hence the advice to check what it tells you.

I was originally disallowed Flecainide after my AD, as I had a "heart attack"* with it. But since then, things have become a little more nuanced and provided your heart's blood supply and pumping is good (which mine is) then it can be considered again. It helped to keep me in rhythm with minimal ectopics for 15 years after my first ablation.

(* it was moot as to whether it really was, as the AD had actually done most of the blocking off of the coronaries)

[Ppiman]

Your account sounds similar to my own but you seem are getting worse symptoms. Bad luck. I also have insomnia so never know what is causing the fatigue but I cope well enough.

I'm waiting for a second ablation at Leicester on the NHS waiting list. I wonder if you'll be offered another? I think it's a possibility. The ectopics I get daily are like mini-AF to look on the ECG traces but can feel worse than when full AF starts. Some are labelled PVC on the ECG device but mostly are atrial or just labelled as "arrhythmia" (I don't use a Kardia these days).

I also, like you, have bradycardia with a daily rate showing on my Apple Watch often 40-120bpm or so. It likely comes from my bundle block (LBBB) - you don't mention that? Do you have it, also? I am beginning to think the slow beat might cause more problems than I realised - some light headedness and a "distant" feeling at times. I have begun to wonder, too, if it doesn't affect the gastric system causing indigestion and even the IBS I get (I see you have that, too). A pacemaker has been mentioned as one possibility. That hardly fills me with glee, but there we are.

Life could be much worse, of course, When I was younger and saw all the older folk looking relaxed and at peace with life... I never realised they were all hiding the truth and putting on a brave face!

Steve

[Sweetmelody]

Hello Lynnsj63,

My suggestion? Ask about a pacemaker. And a Watchman.

Together those two additions to my heart’s welfare have given me my life back.

I went through four years of drugs, 2 ablations, 9 cardioversions—afib, aflutter, atrial tachycardia, drug-induced bradycardia, PAC’s.

Now, a month after my pacemaker and AV node ablation, I’m feeling like myself again and making gains every day—including warm toes! I guess my circulation is working better. (-:

I saw no option left but a pacemaker. It works for me. I’m sleeping better than ever and have my oomph back, and my joy.

I’m waiting to report my experience on this forum until I’m sure of the results as I continue to heal. But in the meantime, I thought I’d share my suggestions with you to explore with your provider.

A single lead pacemaker doesn’t end afib, but it renders it extraneous to the proper functioning of your ventricles and your heartbeat. My atria can go ahead and misfire at will, but my bpm stays steady. The are other options than a single lead. Lots to explore. Good luck!

I’ll just say I’m thrilled to be done with afib hanging over my head every minute of the day. My only drug now is baby aspirin. What a relief!