30,000+ PVCs

Yikes!

by AgentX86 - 2020-06-18 21:47:28

30K PVCs in 24 hours is amazing. That''s something like one out of three heartbeats is a PVC. I've had bigminy (every other PVC) a few times for an hour at a time and wouldn't wish that on anyone.  ...and you say you didn't feel it? Wow!

I have a lot of questions for you (and I would of my EP, too)

Was your ablation for PVCs?  i.e. a ventricular ablation? Or was this an ablation for Afib/Aflutter?  In what way did it fail?

Do you know exactly why you're getting the pacemaker?  That is, what specifically is the pacemaker going to do for you. 

What is your heart rate?  I assume it's elevated (hence the metoprolol).

Brilinta is an anti-platelet drug, which is a little stranve.  Perhaps answers to the above questions would explain the Brilinta but most are on warfarin or some sort of Xa inhibitor.

Back to your question.  It's completely understandable that you're worried.  You should sit down with your EP and ask questions until you understand exactly what he's going to do to you and more importantly for you.  You may need to do a crash course into your situation to get a handle on it. 

There is a good chance that someone here can  help you understand what's going on but we need more information too.  I think I can speak for others here - we'll do what we can to help you understand and cope.

The pacemaker, itself, isn't a big issue.  99% of pacemaker implants are a big nothing (I equate it to oral surgery, though that's a bit of an overstatement).  The other stuff I don't understand and don't understand what a PM will do.

30,000+ PVCs

by newhorizons - 2020-06-18 22:41:27

The Ablation was to reduce occurance # of PVCs / bigiminy. HR currently varies from mid 40s to upper 80s. History though of low HR in low 40s mostly. Brilinta to prevent micro TIAs, as I have a history of those. I also had a medical breakthrough surgery for its time of  two stents (one unmedicated and then another medicated) in my right corotid artery behind the right ear in the brain in 2005 and again in 2006. Was on Liptor until last stent put in heart. Survived the widow-maker blockage and 4 other blockages due to very high number of cardiac collateral arteries bypassing all blockages and delivering near normal bloodflow to the heart. No sustained heart muscle damage yet. Apparently heriditary as my great Aunt lived with a history of 20+ heart attacks from the 1940s to 1990s, passing away at age 93.

Anyway, the EP will attempt another ablation, but likely will have to put in the PM as the PVCs are also coming from very near the heart's natural pacemaker and now total, I am told, near 36,000 daily.

Any ideas?

New Horizons

That's more information

by AgentX86 - 2020-06-18 23:05:30

But still confusing.

The heart's "natural pacemaker" is in the right atrium and, of course, PVCs are a ventricular event.  Are they not PACs (premature atrial contractions) or perhaps Afib/flutter?

I have a lot of that history.  I had four blocked arteries (all close to or at 100%) with the collateral arteries taking up the slack.  At the same time as my CABG, I had a full Cox Maze to try to fix my Afib, and an Atriclip put on the LAA to reduce the stroke risk.  The Maze fixed the Afib but left me in permanent flutter (not a good trade) .  Like you, my heart rate varied from 40 (sometimes in the 30s) ao the 80s when in flutter (drugs not working).

I was supposed to have my carotids stented three years ago.  The CTA showed >70% blockage.  When they did the catheterization they found it was only 20% so didn't (couldn't) stent it.  Since the CATA was so far off they didn't even look at the other side.

I understand the TIA issue but not so much the Brilanta.  I'm not a doctor so my queston was more for my benefit.  I'm not questioning your doctor.

Anyway, I had three failed ablations for atypical Aflutter.  After that, they found asystoles up to eight seconds so a pacemaker was needed immediately.  My EP had been talking about an AV ablation to get rid of the symptoms of flutter (gave up trying to stop it).  Since I needed the pacemaker anyway, the AV ablation wasn't a huge step.

Like you, I've had a lot of maintenance done.  ;-)  If found the pacemaker process to be a big nothing.  I was back at work the day after I was released from the hospital and walking, though not as far as normal, immediately.  I felt better instantly, almost a high.  That lasted a couple of months and only came down from that to "normal".  I can do anything I want to do.  With all you've had done, this will be a walk in the park.  BTDT.

Ectopics queen

by Gemita - 2020-06-19 05:43:27

Dear NewHorizons,

If you are the Ectopics King, I have to be the Queen of them !!  I had them both in the upper and lower chambers (PACs and PVCs) and they led to all my arrhythmias that I am now the proud owner of, most notably AF, Flutter and non sustained VT.

I have not had an ablation and am glad I haven't, choosing instead to go down the route of pacemaker and maintaining a higher heart rate up to a comfortable 70 bpm night and day which has helped tremendously to eradicate my skipped little beats !!  

My EP initially told me that I had predominantly bradycardia induced arrhythmias and how right he was in my particularly case.  Betablockers like Metoprolol may not help because they will lower heart rate too much causing more arrhythmias in vulnerable folks like us, but I would definitely recommend a pacemaker might help you.  I have tachy/brady syndrome so I do need to take a low dose betablocker (Bisoprolol) to calm any tachycardia (with a very rapid ventricular response) and this is working very well for me at the moment.  

My pacemaker otherwise is helping to outpace my rogue beats and doing a superb job.  I still get arrhythmias but they are causing fewer problems.  I am a happier patient in all respects heartwise and I hope it will soon be the same for you too

Back from EP Doc Visit

by newhorizons - 2020-06-19 17:07:00

As Agent X86 and Gemita alluded too, there was a lot of information all at once, so still have more questions to ask the EP. But, he did answer a few of my inquiries. I do definetly experience PVCs, and no PACs, nor Afib/flutter events. I have no seizure or heart attack history to date.Today's EKG showed a somewhat noteable decrease in PVCs, now at 1 in every 6 beats, rather than every 3 beats and even every 2 beats during previous times. HR on 12.5mg of Losarten and 50mg Metoprolol is at 79. BP is in normal range. Diagnostic plan: Attempt a 2nd ablation to eliminate or significantly reduce electrical charges very near the heart's natural pacemaker 'wire', as it were, which trigger the avalanch of my PVCs. He noted it is quite unusual for it to be in Left Chamber, rather than right. If ablation does not reduce enough PVC production, a St. Jude PM that is MRI compatible, dual upper and lower chamber set of leads, possibly a third in right chamber, will be implanted during surgery. EF is good. Remain on Brilinta, which replaced Lipitor for me 18 months back, to counter any micro TIAs that could occur. The EP was also hopeful that the secondaty ablation might be more effective. He estimated a 30-40% chance of having to do a PM implantation. (Vegas anyone? Lotto time maybe..ha!) He assured me I would likely recover relatively quickly, a few weeks of discomfort, adjustments, wear a sling only for sleep, pain meds as needed, and hopefully (there's that word again), no significant surprises.

That is the latest Gazillion PVCs Soap Opera Update.

I am immensely grateful for the responses and assistance in trying to learn and understand this major life event for me, which like many I have read about here, seems like entering a space-time galaxy worm hole. I have been faced with many significant challenges in life, but am very grateful to be alive.

New Horizons

That’s a lot of PVCs

by Pinkit94 - 2020-06-22 14:50:42

30,000PVCs is a lot, even if you don't feel them! I would go and get a second opinion. People with that many PVCs are at an increased risk for developing heart failure.