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PVC nightmare

Heart Rhythm Conditions | Last Active: 10 minutes ago | Replies (33)

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Profile picture for chickenfarmer @chickenfarmer

After an ablation, many patients experience a "blanking period" of increased arrythmias. That was ceratinly my experience in 2017. For me it was 2 mos and after that arrythmia free until 2021 when I started having some short spells coupled with almost continuous PVCs/PACs. in 2024 EP said I shouldnt worry about PVC/PAC as they're common with most all folks even those who never had afib. But my incidence of PVC/PAC got to almost 20-30% of all beats and it was affecting my quality of life with what I dubbed 'Afib lite' symptoms. He offered to put me on Multaq an antiarrythmia drug but I deferred because of the side effects. He also mentioned that I should increase my Thyroid Stimulating Hormone (TSH) which I did and the arrythmias went away.

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Replies to "After an ablation, many patients experience a "blanking period" of increased arrythmias. That was ceratinly my..."

@chickenfarmer Your story is a perfect example of a one-size-doesn't-fitz-all for cardiac arrhythmias and how they behave in the months and years after an apparently failed, or an apparently successful ablation. For the heavy majority, if an ablation works, the patient can expect some minor glitches in the first two-six weeks, and then the heart should calm. After that, the Holter at about the 12 week mark should show maybe the odd PAC or PVC, but nothing more. Then, like you, some people's hearts seem crazy for the entire blanking period, but clean themselves up AFTER the Holter....which dutifully shows a lot of ectopy. Then, months, years later, they realize they have been in blissful NSR for months, years!

As very general rules:

a. AF begets AF. Once it takes hold, it likes its own company and wants to take up residence permanently. It works toward that. That's why aggressive management, by you changing stuff, or with the help of an expert, is important....before any permanent changes;
b The literature does say that, during the blanking period, some minor ectopy should be expected, and to not blow a gasket if it happens. Further, you WANT the ectopy blips to happen early in the blanking period. This, remember, is in the literature I have personally read. What does not portend well is if the early part of the blanking period, say the first six weeks, are clear and you begin to relax and to breathe, but then ectopy begins to happen in Week Seven or Week Eight...that does not bode well for a successful ablation....generally...and chickenfarmer is proof that it's only a general rule; and
c. It is quite common for an ablation to successfully curb AF, but within a few weeks flutter or PACs take its place. I am sort of an example of that, although my first ablation didn't work because I was in the local ICU inside of six whole days....and shortly placed on amiodarone to kick my chaotic rhythm into NSR. It worked, too. The PACs showed up later, during the 18 hour Holter.