← Return to How do you determine PVC burden?

Discussion

How do you determine PVC burden?

Heart Rhythm Conditions | Last Active: Oct 14 9:15pm | Replies (15)

Comment receiving replies
@gloaming

Your burden is high. What makes it very important to treat is:

a. How it makes you feel, how symptomatic you are, how intrusive the PACs are, and if they interfere with your quality of life severely, or even detrimentally, as YOU define it....not the EP; and
b. What your overall condition, age, co-morbidity risk and burden, and cardiac condition are.

It is true that most EPs are averse to intruding on the heart just for PACS. You can live forever with PACs, just as you can with intermittent, or paroxysmal, AF. However, any dysrhythmia is eventually a problem, usually because they tend to morph or to progress, and they usually ARE associated with other co-morbidities, or they encourage their onset. Nasty in a way, and worth considering.

I have read recent research that even a 2% burden of PACs is associated with higher morbidity. That should not be surprising because any dysrhythmia is a sign of an electrically disordered myocardium.

Depending on your body weight, about 300mg of Flecainide a day is about the max you'd want to HAVE TO take...ideally. Like metoprolol, there is published literature saying 200mg a day is the upper prescribing limit before you have to look at other remedies, but then the same article said that if one is in heart failure that the upper limit is 400mg PO. Well, ummm....that's exactly twice, or 100% more than the max recommended dosage for those in flutter or AF. What gives!? They're guidelines with lots of room for discretion by the prescribing physician, if not all that highly favoured by insurance industries that might have to pay in a law suit.
So, back to Flecainide, if your body weight is over 80kg or so, (175 lbs) [I need to verify, but it's close], then you can take up to 300 mg PO, but those under that weight, especially most women, should be taking less....always what is prescribed, though.

Lastly, it could be that your EP wants to hammer your heart into calmness, into submission post-ablation. Maybe he feels the PACS are a typical post-op sign of an irritable heart. So, he's sure he's doing you a solid, if you know what I mean. In my inexpert opinion and from readings, Amiodarone is often the drug of choice when a cranky heart acts up immediately after an ablative procedure for arrhythmia. But, I'm not paid and nobody asks me...probably a great thing. 😀

Jump to this post


Replies to "Your burden is high. What makes it very important to treat is: a. How it makes..."

I appreciate your thoughtful response. I have come to accept ( As a believer in Christianity) that if anything happens to me I'll be in a better place. This has helped tremendously with the fear, so now what i deal with is anger and frustration when they happen...more like a fly buzzing around constantly annoying me. Ideally i don't want to have to rely on medicine to function but at this junction I have no choice...