Ventricular tachycardia and ablation for PVCs

[Prince123456]

Hi

I’m due to see my EP in June to discuss catheter ablation for ventricular tachycardia and PVCs.

Has anyone had a VT ablation or An ablation just for PVCs ?

[Jfelder]

I have not but I have researched pretty extensively. I have on the order of about 4000 PVC/PAC a day and runs of VT. Most of the runs of VT are relatively short, but about 3-4 times a year it will go up on the order of around a few hours until I take some kind of beta blocker or it goes away on its own. I am also a long time endurance athlete..so riding my road bike for 3-5 hours a pop a few times a week is pretty typical for me. After speaking with a number of cardiologists (EP's) the challenge seems to be that it is very difficult to get your heart to go into VT (and have enough PVC's) while under sedation. If they cannot get your heart to go into VT they cant narrow down where its coming from and ablate successfully. The same seems to be the case for PVC's as well. In short I just have to manage the symptoms unless things get progressively worse. I would love to hear more about your particular situation and how it goes with the Dr. Good luck!

[Prince123456 in reply to Jfelder]

Hi

They know my PVCs are coming from the left ventricle so they are convinced once the catheters are in place they can induce them with medicine I think they use adrenaline to trigger them off. I will keep you posted 👍

[R2958 in reply to Prince123456]

I had an attempted ablation earlier this year for svt and they could not induce it with adrenaline. The EP admitted I should have been told to not take my medication. I will likely be going in for another attempt soon. Im hopeful that my skipped beats will go away with a successful ablation. Hope for the best outcome, Prince, but be prepared for it being a possibility of not working so you don't get down emotionally. And like me, you could likely try again anyway. Best of luck, and update us when you can here.

[Prince123456 in reply to R2958]

Sorry it didn’t work for you first time, I cannot believe you wasn’t told to stop meds before your ablation that’s very careless, my EP said I will be awake for mine more chance of triggering the VT off when I’m awake. How did they diagnose it was SVT I personally know 2 people who have had successful ablations for svt my good friend used to blackout when the svt was triggered always by exercise.

[R2958 in reply to Prince123456]

My SVT was diagnosed, well confirmed really, by an event that was captured by a holter monitor my primary had ordered for me. I was awake during my 1st ablation attempt and recalled I only got to hear 4 or 5 songs they were playing in the lab before they gave up. They asked after 15 minutes or so how I was feeling and I said my chest was kinda sore, so they called it. Blackout, wow, thats scary! My incidents have always been tied to indigestion and/or dehydration and possibly low blood pressure. Almost never has one occurred due to stress or a "panic attack". I have to ask my new EP if adrenaline is the only way to trigger in the Cath lab,,,

[MikeThePike in reply to R2958]

I'm sorry but can you please explain why they stopped it? Was it because you were in pain or because they could not induce or find the PVC?

[R2958 in reply to MikeThePike]

They never really said, but I'm sure it was because they couldn't induce it. My cardiologist told me later, if they can't induce within 15 to 20 minutes they stop. That EP, incidentally, has 26 years experience and thousands of ablation performed.

[MikeThePike in reply to Prince123456]

Worked for Tony Blair! He had one when he was about 50 back in 2004. My suggestion is find the guy who performed his ablation. The success of an ablation is more down to the skill and experience of the EP than anything else. They all seem to use the same equipment and 3D mapping software but they don't all have the same experience. In the US they have massive hospitals and ablation centers performing thousands of them every month. Those EPs get a LOT more practice and experience than our NHS EPs. Its important to find an ablation EP who has many years of experience and has performed HUNDREDS of them. Not just a few dozen. I think those elite EPs may be hard to find in a small country like the UK.

[Prince123456 in reply to MikeThePike]

Hi m8. Tony Blair had an ablation for SVT totally different scenario to VT

[Prince123456]

Can I ask which hospital did you have the ablation ?

[R2958]

An update for me, after a consult with another EP and my cardiologist I'm starting beta blockers for control of ectopics and seeing how it goes, no second "study" as they call it (ablation attempt in my terms), just managing symptoms for now. My first try was at TMC in Tucson, but the team was from a couple different places or practices.

[Prince123456 in reply to R2958]

Hi. I hope they work for you. I originally started on Verapamil but they didn’t work at all I then started on Bisoprolol and they didn’t work made me feel very tired so I stopped them I then started on Nebivolol which are a more cardio selective medicine but again they didn’t work either, I’m now on 50mg of Flecainide twice daily been on these for the last few months along with the Nebivolol they seem to be working for now. If I was you if the beta blockers don’t work ask to trial flecainide. One medicine I wouldn’t touch is Amiodorone the side effects are scary. I have another consultation in July with my EP but if the flecainide works I don’t think I’m going to go through with an ablation.

[R2958]

The one in starting is called metoprolol and it's a small extended release dose. Doc says it will help with the ectopic beats, which are really my main problem now. Tho the docs claim they aren't "a problem" just noticeable. Thanks for the heads up on the other meds. If you've found a combo that works, id go with it for a while. They say ablation is low risk, but why take any risk if you don't need to? It's all about quality of life they told me in regards to svt, mine anyway, and it was sucking so I went for it. Didn't work, that's life, going forward. What's funny is latest EP I saw even said during his explanations to me, that ablation isn't an exact science, sometimes some "witchcraft" involved getting someone into tachycardia and fixing it?! Lol, wonder why I didn't get a great feeling from him🤔😄

[Prince123456 in reply to R2958]

It took my friend 3 attempts before he got his SVT successfully ablated the first 2 ablations he was put to sleep and they failed to trigger the Svt but on the 3rd attempt he was left awake and the Svt triggered so they managed to carry out the ablation and he has been svt free for the last 9 years. My advice to you would be if the beta blockers don’t work ask to be put on flecainide it’s not a beta blocker it’s an Antiarrhythmic drug.

[MikeThePike in reply to Prince123456]

I read a story on a UK forum about a 23 yo woman who had six unsuccessful ablations. I don't focus on the fact that they were unsuccessful but on her incredible determination and bravery in trying to find a cure. I think I would prefer ablation to drugs any day. Remember, the drugs they prescribe for PVC suppression were not designed for that purpose. At least ablation specifically targets PVCs. I think you just need an experienced and confident ablation team who know what they are doing.

[R2958]

Ok, thanks, I will keep that in mind. I appreciate the input. Good luck on your meeting and update us here with any changes.

[BC82]

Hi,

I had an ablation at the end of Feb this year for VT which originates from the right ventricular outflow track.

I was sedated and they were able to induce the VT with adrenaline and ablate what they needed. They said it was highly successful as they couldn’t induce the VT again after the ablation.

However! Three weeks after the ablation I felt worse than ever, 1 or 2 short runs of VT and lots of PVCs. I was warned this could happen and is very common as they have messed around with your heart and it needs time to create scar tissue/heal and settle.

I contacted my consultant and sent through a recording from my heart monitor of the frequency of my PVCs and he suggested we try again as it could be coming from the left side as well.

So two months after the first ablation I went for a second one. I came off my meds 3 days before as planned and experienced lots of PVCs (which I find so uncomfortable and debilitating). However when I got into the lab all psyched and ready to go again, my PVCs disappeared, they tried 3 different meds to induce them but nothing!!

About an hour after the returning to the ward, the PVCs were back…so unbelievably annoyed and disappointed!

I was discharged back on Flecainide (which is the only thing that works for me having tried Bisoprolol and Verapamil) and have a 24 holter booked for June and a 3 month follow up with the consultant to talk about what happens next.

The consultant has said they won’t try again unless I have more than a 20% burden of PVCs and although I don’t get many at all on Flec, I don’t want to be on meds for the rest of my life. I also find I’m quiet tired and can feel pressure in my chest some times so I’m not sure the Flec should be my long term solution.

So my long story short!!! My VT has been ‘cured’ (although I’m not doing anything really physical right now to test that) but I experience PVCs a lot without medication.

From what I’ve read it can be hard to pinpoint/ablate VT and/or PVCs if they don’t show up in the lab. The ECGs are obviously just a guide. Having said that, there’s supposed to be a 90% success rate for this type of ablation so there is hope!

I hope you feel ok and can function on your meds for now.

By the way, the actual procedure itself was totally manageable, the recovery was a bit rough but I would not hesitate to go again if they offer it.

Best wishes

[Prince123456 in reply to BC82]

Hey thanks for your message. I started with PVCs in September 2019 they appeared from out of nowhere but I do recall feeling very unwell a few months before they started I felt extremely tired I used to wake up in the middle of the night dripping with sweat I have had all the tests done CT / Angiogram / echocardiogram / I’ve even had a pet scan My ejection fraction is 60 % left and 65 % right ventricle so my heart is pumping good and it’s structurally normal. My PVCs and the runs of none sustained VT have never been induced by exercise I’ve lost count of how many exercise stress tests I’ve had and not once did they trigger. My PVCs are multifocal and are coming from the left ventricle. For now the Flecainide is working very well it’s stopped 90% of the PVCs.

What dose of Flecainide are you taking ?

Have you had all the tests and scans done ?

Did they offer you an ICD implant ?

[BC82]

Like you mine came out of nowhere, I was an active 39 year old with a healthy diet! I’ve had tests (echo, mri, stress test etc.) and thankfully I’ve been told I have a structurally normal heart which I’m very grateful for. During my stress test my heart rate got to 180ish before I had a short run of VT.

I take 100mg of Flec in the AM and 50mg in the PM and it’s the only one that’s stopped my PVCs so again I’m grateful that something has eased the burden.

Again like you, I felt tired and drained before it all kicked off and now wonder if it was going on longer without me knowing.

No one has mentioned an implant only ablation and/or meds.

I’ve recently been looking into taking a magnesium supplement as it seems to help a lot of people and there are small studies that show it can reduce pvcs. Im going to give it time on Flec before adding anything else into the mix.

Im glad flecainide is working for you too, PVCs are so horrible and debilitating even if they are not dangerous.

Again like you, I don’t know what triggers mine. I’ve stopped drinking caffeine and alcohol and I’ve increased my water, fruit and veg intake and tried to limit any stress or worry.

So you don’t know what triggers yours?

[Prince123456 in reply to BC82]

Hi. I have no idea what triggers mine and like you I was healthy I was a body builder at the time when they started always in the gym and I already had a very healthy diet I’ve never drank Coffee in my life and only ever had the odd drink of tea so food a drink definitely wasn’t anything to do with PVCs. I rarely drink alcohol and if I do it doesn’t set them off or make them worse. I started taking Magnesium Citrate before I started on Flecainide but it didn’t help at all.

Yes the PVCs are very debilitating they have absolutely ruined my life for the past 3 years

the only time I was at piece was when I was asleep because I wasn’t feeling them.

Im so thankful the Flecainide seems to be working for me I take 50mg in the morning with 10mg of Nebivolol and another 50mg in the evening.

My EP mentioned another medication called Amiodorone but I had already researched about Amiodorone and told him under no circumstances would i take it due to the extreme side effects.

I forgot to mention that when I had my MRI scan it showed up what they described has late enhancement on my left ventricle which at the time they thought was cardiac sarcoidosis but they soon ruled that out when I had the PET SCAN because it didn’t show up any inflammation so they don’t know what caused the scarring they say possibly was caused by a

virus I might of had at some point.

I have another appointment in June with my EP he’s called Dr Chris Pepper he works from LGI which is Leeds General Infirmary he’s been absolutely fantastic he’s been honest and said he would rather try to avoid an ablation but has a last resort if medicine didn’t work he would attempt one but its going to be very difficult because they are multi focal coming from at least 5 different places of my heart.

Fingers crossed the Flecainide continues to work. I will keep you posted when I’ve had my consultation in June.