High burden PVCs

I wish I could allay your fears about ablation. I'll try, and I have had two of them, both by the same gentleman doctor. I know of a person who runs the affibers.org forums who has had at least six ablations. He was desperate and sought out Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin. That was his last ablation. He still runs the show at affibers, answers tons of questions, and has been free of arrhythmia ever since being signed off by Natale. I hear good things about Dr. Pasquale Santangeli at Cleveland Clinic.

Ablations are something like getting a colonoscopy, except there's no bowel prep. The process is largely the same, except you get a trans-esophageal echocardiogram tube put down your esophagus, and not up your bum. Then, they make a small incision in your bikini waxed area, literally, and feed a small, thin, but long, tube up the vein and into your right atrium where all the body's spent blood empties into the heart. From there, they pierce the septum between that atrium and the one next to it, both atop the two large pumps, the ventricles. When in the left atrium, they probe and find where unwanted extra signals are entering the endothelium, the lining of the atria. The atria are not enervated, not like your big muscles. Instead the signal to make them contract runs along their inner surface, it being endothelial tissue. The signal issues from the 'sino-atrial node' in the right atrium and travels to the other atrium, causing both to beat. In the case of atrial fibrillation, or tachycardia, those nodes' signals get confounded by different pathways that the heart develops.

Probably the worst part of an arrhythmia, besides how they intrude on our body's normal sensations, is the anxiety and their intrusiveness, especially into good rest. Those run in what engineers call a 'reinforcing loop', which just makes them so debilitating. In the right hands, tachycardias, arrythmias, and PACs can be cut off from impacting both the heart's normal rhythm and one's well-being. This puts the onus on the patient to do the correct type of sleuthing to find to whom they can travel reasonable and be seen in good time, but who also will quite probably stem the dysrhythmia in question.

You want a middle-aged EP, electrophysiologist, who has performed 1500-2000 ablations, who does at least six to ten each week, and who, when asked, will claim that their success rate for an index ablation (first ablation) runs at 75% or higher. I didn't have to ask mine; he told me when we first met. It doesn't sound like a great record of success, but that is the running average across the industry. This means some EPs have worse rates of success, while others enjoy a much better reputation. Natale and Santangeli are two examples of the latter, There are other really expert and highly skilled EPs in the USA, but I don't know of them.

Knowledge is power. Learn! Find out what kind of success two or three EPs estimate THEY have of ridding you of PVCs. Learn why it's tricky to treat PVCs versus PACs or AF. Then, do a risk analysis on yourself. Can you stand the burden, and the enlargement of the vessels involved, and maybe the eventual heart failure/heart insufficiency? What do trusted friends say when you ask them to do some reading and advise you?

Thank you so much for taking the time to explain this to me I just do too much google searching and see all the negative things that people have to say so. It scared me. Some people said it made them worse and I surely don’t need them to be worse, but thank you so much. I hope you have a wonderful day.

Thinking it through a bit, almost all of the people who post on feedback and review sites, or who come to medical sites, are seeking help, occasionally AFTER failed interventions that seemed like a great idea to their care providers. Those whose interventions succeed fly.....literally...to their favorite pastimes, hobbies, friends with whom relationships were deteriorating because of the impact of the health problems, and so on. We never hear from them. Instead, we hear from the desperate, the confused, the unlearned, and the angry.

As I said earlier, 75% of all index ablations succeed, despite the variances imposed on the exchange between the patient, as an individual case with all sorts of other worries and conditions, and the electrophysiologist whose life can impose itself in undesired ways, or who simply doesn't quite have the experience to overcome the odd glitch while he/she is investigating your case and trying to ablate you successfully. It's not a great statistic, but it isn't gloomy, either. For second and third attempts at stemming AF, the rate climbs to 80%+, which by itself is encouraging, or ought to be. Same two people, same team of operators, same heart. Or not if you get handed off out of necessity or for your own imposed reasons. The point is, you should get your AF controlled, and then managed effectively by whatever means while it is still 'young', BEFORE it changes to persistent and then permanent AF, both of which are much trickier to beat into submission.

My reasoning was that, the drugs, according to my reading, were ultimately going to fail. So was my heart if I couldn't control it thereafter. Ablation is a mechanical means to blocking the secondary and tertiary electrical foci that force the atrium to add extra beats....but out of sync with the two ventricles beating below it. If you put a stockade of scar tissue around the focus, or re-entrant as it is often called, the signal can't pass over the scar tissue. It's blockec...stockaded. Your heart is still electrically disordered, still sending the same unwanted signals to the same re-entrant, but it can't spread out from there across the endothelial lining and cause the extra beast...er...beats. To me, that's going to be the best fix...not that it IS a fix, but it's the next best thing. No spreading signals, no extra beats. Bliss.

@pamconley67
Are you seeing a EP? If not make a appointment with them and asked your questions. Do you have access to a major provider (Mayo, Cleveland Clinic, etc.) with experience in doing ablations?

I had an ablation done several years ago on RV. The PVC from that RV stop immediately. I do still have PVCs from LV but none from RV. My EP is the Director of Electrophysiology and Pace Clinic at Mayo Jacksonville. I could not have a more world reknown EP. Other caridologist from other places I lived knew him, had taken his seminars, and read his books.

So a big thing is to have trust in your EP and that he or she is doing the right thing for you. I assume you have had the holter monitor checks. Are your PVCs coming from many areas or just one?

You mentioned anxiety and depression. Have your medical providers advised you that these can add to your PVCs? Medication for anxiety and depression are out there and may help but discuss with your EP. Also lifestyle changes and doing activities and hobbies that you like to do to reduce your anxiety and depression.

Just know that most ablation are done without any complications and many help at least temporarily or like me no recurrence after many years. You mentioned your test revealed a healthly heart. That is great news. Most PVCs come after a heart attack, infections, and other causes.

I wish I could say I had a healthly heart but I do not. That is something to be positive about. I have heart failure that was determined to have been cause by a viral infection that got into my heart and caused major issues with my electrical system. My HF got worse and worse and now have a ICD/Pacemaker (since 2006).

Thank you for responding. I’m sorry you are in poor health, I will pray for you !!
My first cardiologist recommended an ep I got a second opinion he died my wanna go that route still trying to find meds that I can tolerate. It’s so frustrating trying to get to the source, I live in a small town in Ky not sure how good the EP are there . My insurance is through the state so there’s that lol!! I have tried diet and exercise , no caffeine, gonna stop dairy see if that helps and also I’m on Zoloft have been for 21 years I’m just an anxious worry wart , I wish I wasn’t and knew how to stop . Anyway I do appreciate your concern and comments. I hope things get better for you ☺️

Dr John Mandrola is in Louisville, Ky. He is a world renowned EP. He has written many books and has a blog for other EP doctors on Afib. He performed 2 ablations on me over 20 years ago… so he is very experienced. He had Afib himself. If you are close enough to see him.. make an appointment with him and he will explain all your symptoms, answer your questions and explain the best treatments for your particular situation. We moved multiple times over the last 20 years and whenever the new EP sees his name, we usually spend the rest of my visit discussing him.,,,, because of his blog (?) on twitter.

He has a book on a broken heart.

Yes Louisville is only 2 or so hours away . I will definitely see about getting an appointment with him ! Thank you so much 😊

I always wrote down my questions, cuz he is very interesting when he tells you how things go, that I would forget to ask him some things.
Good Luck with your health!