LVOT Bigeminy with NSVT/PSVT

Thank you for posting this interesting question, @paula3166. First of all, I'm so glad to hear that you have an appointment at Mayo Clinic. Mayo has a reputation for being exceptionally good at hard-to-treat problems.

While we wait for other members to respond to your concern about left-sided heart ablation, I'm wondering if you could share a bit more information about yourself as you are comfortable doing so. You mention that you have no known heart or blood pressure issues. Is there any family history of heart problems? What meds have been tried to correct this problem?

I would like to tag some members who have had heart rhythm problems and see if they can offer some support for you at this time, @predictable, @thankful, @danab, @mayofeb2020 @scottij .

No one in my family had this particular issue others had high blood pressure and my mom died of Congestive heart failure but she had Parkinson’s.

My blood pressure is and has always been low 100/60 and is that way as we speak. The ectopic arrhythmia was first noted in my 30’s and I am currently 55. The last two years it is symptomatic and I have frequent near fainting episodes with pulse dropping into the 30’s. Original ablation was done in RVOT because that is where they originally thought the signal problem was coming from. However during that procedure as they were mapping they started to believe it was high on left side near valves. After the ablation I had new arrhythmia’s begin NSVT and PSVT. Recently a pattern which was not originally seen has emerged on exercise recovery and I can have either Bigeminy or the tachycardia. Last echo showed left ventricle wall remodeling and my ejection fraction was down 5%. Local cardiologist no longer felt he was able to handle my case and referred me.

They tried flecanide but I was allergic and the other beta blockers lowered my already bradycardia and hypotension too much and I could not stay awake.

I used to feel the palpitations and it just felt like a blip and after 20 minutes they resolved. These days those episodes feel different like my heart is tired and struggling. I am hoping the MRI will show something that local cardiologist was unable to define. I have two to three episodes of the low dips a day. I have about one to two episodes of tachycardia a week.

I probably should mention my ejection fraction is at 55% down from 60% a year and a half ago. I am borderline they have described to me that the LV issues are believed to be the result of the arrhythmia causing heart muscle over working.

Here is an example of my arrhythmia from my watch the pattern is not consistent it used to be the exact same every time but after the ablation in June 2020 it is no longer consistent they vary and this is one of 6 patterns

@paula3166 Hi Paula, I am not familiar with Bigeminy But have had sustained VT for about 10 years so im failure with arrhythmias as I had them frequently. I want ed to set your mind at ease until I had a chance to be more in-depth and ill follow up a bit later. But the fact that yours are not sustained sounds like a better place to be as mine usually required either pacing by a pacemaker or a mild shock by my internal defibulator. I can go into more detain when I have some time but be assured that Mayo is the best place to get a through eval. As a not my EF at it's lowest was 5% and only got up to the 45% range with time ablations and medication so 55% is a pretty good place. I'll get back to you this evening.
Have a Blessed Day
Dana

I assumed not too many have what I have the Bigeminy is similar to a sustained Tachy as it can cause the heart to stop. That is my understanding. An episode can last as long as 3 hours. My tachy is very short but new.

@hopeful33250, paula3166- Greetings! I'm not sure if I can help much in your situation Paula. Until my HA back in 5/2014 I never had any heart issues. My cholesterol has been a bit high and I've been on statins even before my HA. I have been exercising regularly for many years, doing 45 minutes of cardio and 30 minutes of strength training 3x a week. Even the day of my HA, I had just arrived home from exercising. I view all of this as somewhat of a fluke, but it got my attention and has caused me to consider everything I eat and how I exercise. I have dropped my overall Cholesterol to 137, LDL down to 52, HDL to 38 and my Triglycerides down to 124
My experience with Mayo in Scottsdale, AZ. was excellent! I would definetely plan on going there again for any 2nd opinions that I may need in the future. Jim@thankful

Thank you for your reply most people have a-fib or sick sinus rhythms mine is being called Multi focal ectopic or something like that an the instability is what started the new tachy. I guess I will know more when I go in April I am just worried because everything I have read states that left ventricular ablation has a 50% stroke risk. If I don’t fix it my heart could become unstable and stop and if I do fix it I have a high stroke risk. Pacemaker was not an option. I just was hoping someone had that kind of ablation but I know the reason I was referred to Rochester MN Mayo was the risks and danger of what is happening. Feel damned if I do damned if I don’t at this point. I had no structural heart disease when diagnosed but the arrhythmia is wearing out the left ventricle. The cause is very unknown and one of the first tests at Mayo is an MRI to look at the heart for abnormalities. Just really scary, I know the patterns and issues were not common to the local cardiologist. I have faith in Mayo I am just worried probably normal.

Hi @paula3166,

Yes, you are right. Your concern/worry is very normal. Most of us would feel the same way if we were in your shoes. An MRI of the heart is considered a great way to look at the heart. Here is a very short video from Mayo that might help you see what information a cardiac MRI provides to you and your doctor.

https://www.mayoclinic.org/diseases-conditions/ventricular-tachycardia/multimedia/cardiac-mri-animation/vid-20260426. If you have not had this done previously, it may provide some more information.

Do you know the name of the doctor at Mayo who will be overseeing your care?

Welcome to Mayo Connect @paula3166. I wish I could be helpful to you, but your complication of symptoms is not in my experience. A-fib has been my problem, but not to the extent that my medical team has recommended either cardioversion or ablation -- so far, at least. We just identified a blockage in my heart's Right Bundle Branch, but it will be a few weeks before we will know whether it needs treatment. For now, you are in the excellent hands of Teresa @hopeful33250, and if she concludes that I can be of help on any part of your current challenge, I will eagerly respond. Best wishes for your ablation next month. Martin