PVC nightmare

I also had some horrific episodes mostly late afternoon or evening. ( think may have been torsades ). When I tried to capture with my Apple Watch, it would start and stop for HOURS. When I tried to explain to cardio/ electrophysiologist, they suspected Brugada syndrome. I have since had an ablation, no alcohol, taking magnesium at night and stopped all anti-arrhythmics( side effects were bad for me). Good luck. I recommend a diary of food, sugar and what you are doing at the time of the “event” . You may see a pattern.

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.

@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.

To get more knowledgeable about my condition I read a lot and got involved with stopafibdotorg
run by a remarkable person Melanie True Hill. I attended a couple of conferences in DAllas which hi lited some experts, In one of the talks the expert showed a chart - afib reoccurrence after ablation and the mean was 5 yrs. So I guess i sorta fit the curve.

@chickenfarmer Regrettably, this is true; most ablation success stories have an ending. For some, it's soon after the Holter assessment where one is given the all-clear, and some lucky sods get ten years or more, and they even die of something entirely unrelated to their cardiac history. As you must know, and I certainly do, even one full year free of the dreaded symptoms and anxiety makes a single day in the cath lab and recovery worth it. It's far better than letting 'er rip and then possibly coming up against mitral valve prolapse or heart failure, which the literature says are two possible outcomes of unmanageable AF.

In case you missed my commnet on another thread, I was in much the same state as you in 2024 - PVcs and PACs at ahigh level - 20 to 30% of beats and feeling Afib symptoms My EP gave me the same message - PACs and PVCs are no big issue, everyone has them. Well not to the level I had. So he offered to put me on Multaq an antiarrythmic drug. But I'm opposed to antiarryhthmics because of side effects and the fact they are famous for losing their effectiveness with time. He also offered another ablation. First one in 2017. Then in passing he recommended that I raise my TSH level (Thyroid Stimulating Hormone) as my TSh was less than 1.0. (I take levothyroxine daily as my cancerous thyroid was surgically removed 35yrs ago). it tooks a few weeks for the TSH to increase but after it reached about 5.0, the PAC/PVCs went away. I repeated the test and same result. then I visited Dr Google and found there is a recognized link between hyperthyroidism and arrythmias. By the way if you don't have a smartwatch that can record your heart rhythm, you're flying blind. Holter monitors are OK but inconvenient and temporary - watches are better. I've owned both Samsung Galaxy as well as Iwatch. I've also used a device from Kardia but I prefer the Iwatch. There's also at least one implantable devcie - Medtronic Link which can record 24/7 for several years. More expensive and needs medical folks to install but appears to be the best solution for someone wishing for continuous monitoring - I have no experiene with Link. The Iwatch is reported to be highly accurate in Identifying Afib/Flutter however it fails to differentiate between PVC/PAC and Afib so in 2024 my watch was continually reporting that I was in AFib which prompted my EP visit only for him to say that the watch was wrong, (There's an online service, QALY, that for a fee will interpret your smart watch traces. ) My experience may be separate from mine but if you haven't chased this rabbit hole yet im recommend doing so. I also recommend "The AFIB Cure" by Bunch and Day which has many lifestyle change recommendations to reduce arrythmias.

Sounds awful and I’m praying for you. This sounds crazy but how do you know you’re having a PVC. I’ve been diagnosed during surgery only by the anesthesiologist upon awakening. So I don’t know the feeling. I have mild AFib/LBBB and finally determined when I have those (sometimes).

I had an ablation and at the same time they turned my pacemaker down from 80 bpm to 60 bpm, so I'm not sure which helped more in reducing the PVC's from 20% to < 1%. Good luck and you do need to be your own advocate.

@gloaming "It is common for two new arrhythmias, PACs and flutter, to take the place of AF after an ablation. Dismayingly common to those EPs who feel they've successfully, and conscientiously, nipped your AF when they send you away from the cath lab"

Exactly my experience. My EP keeps apologizing whenever i show him traces of arrythmia.

kpryor, I didn't see anywhere in your posts that you had been tested for sleep apnea. Since I sense that you are overweight this is particularly important to chase down as obesity is correlated with sleep apnea. The relationship between sleep apnea and AFIB is well documented. your EP should know this.