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PAC/PVCs post VT ablation
Hi, question regarding PACs and PVCs after an ablation. Five months ago, I had an ablation for ventricular tachycardia after a VT storm. Previously, I had been diagnosed with afib five years ago, ablated. and was asymptomatic for about 2 1/2 years. Over a year and a half ago, went into ventricular tachycardia, but my previous EP thought it was A flutter and ablated me for that a few months later. Right after that, I went into another round of ventricular tachycardia, back to the hospital where they put in an ICD. This February went into a VT storm and ended up getting the ablation that I probably needed to begin with. It was an endocardial/epicardial ablation as I have scarring on both the inside and outside of the cardiac tissue. Previously, I had been on sotalol, which I seemed to tolerate well, but apparently had stopped working. Post ablation, they put me on amiodarone for three months, discontinued that two months ago, prior to an NIPS test a month later. Although I had PVCs after the ablation and prior to the test, they seemed to be relatively minor and of no concern to my doctor’s team. Felt great after the NIPS test, but a couple weeks afterwards started experiencing PAC‘s, which keep me up at night. They tell me that they are generally not harmful, but sent me a Zio monitor, which I am wearing now to assess the burden. Although I feel them less acutely than I seemed to have before, my Kardia Mobile device shows that the ectopic beats are still very much present, and in my opinion, seem to be increasing. I’m nearing the six month post ablation period which as I understand, should be the end of the so-called “blanking” period. I’m curious as to whether anyone else has experienced PVCs andPACs this far out from an ablation.
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Hi. and welcome.
PACs are benign until their burden moves past the 3% mark, and even then a graphic representation showing rising morbidity only increases its pitch a bit. It's when it hits the 8-10% mark that it becomes a serious problem and you should be ablated.............if.........you're a candidate.
The blanking period is normally 10 weeks, maybe 12 in some cases and with some EPs. The Holter assessment after an ablation for AF shows PACs surprisingly often....it's quite common....and flutter is as common. Flutter is easy to fix, PACs a bit more problematic. But both are common, and in the right hands, a really skilled and experienced EP who does complex ablations, they can be fixed.
Also, the literature shows that ectopy in the first few weeks after an ablation has a better prognosis than ectopy that suddenly begins to appear after Week 6 or so, and you had been clear of any AF/PACs/AFL until then.
Finally, some cases take much longer than the blanking period to resolve. Patients report ectopy for weeks out, and then the ectopy slow and disappears, maybe by the sixth month. Or, their post-ablation HR will be running pretty consistently at 85-90 BPM, and do that for several months, but then it begins to resolve and by the first anniversary they're back down to 75 or less.
So, we all have a puzzling journey to take on this one. If you're having an obvious increase in ectopy with each passing week (try to keep meticulous records so that the increase is obvious to your caregivers), then you might wish to seek help. Maybe even another EP.
@robert21
What a very clear post of your heart health.
I too had PVCs originating from both inside and outside of the heart. I did have an ablation on June 4th on the inside to correct a PVC source on LV. I was told it did work but the two on the outside tissues of the heart could not be done from inside the heart and per my EP would wait to see if needed to be ablated.
I am on Amiodarone 200 MG once a day now due to previous shocks. You mentioned having a NIPS test. Could you explain what that is? I was on Amiodarone 10 years ago after 5 ICD shocks in 24 hours. I stayed on it for many months but aske to be taken off. My EP agreed and we slowly came off the drug. I did not have any side affects from it with all the follow up tests for years. I was told since no side affects last time he many keep me on a low dose.
On time after ablations for heart to calm down (it was damaged during ablations) I was told 608 weeks for heart to calm down. And this is a statistically number not an individual number. We are all different and what the time frame for one for heart to settle down will not be the same for another and that means a shorter time or a longer time for heart to settle down from being ablated.
The ablation on me LV did work in reduction my PVCs. But I still have two other areas that are generating them so still getting them but are not like every other beat that I was having with the internal PVC from LV.
Six months out is quite a time for heart not to have settled down. What have your EP or cardiologist say about other areas creating PVCs. PVCs are quite common and increase with age. They can stop or new ones come up. I would asked for a Holter monitor to see if you are having new areas of PVCs.
Have you discussed with your EP about supplements? My EP recommended (and a common recommendation) to take 400 mg of magnesium that can help reduce PVCs. Won't hurt to asked about it and could help or not but worth a try.