Lots of PVC’s after CRT-P placement

Doc says if metaprolol does not quell pvc’s, may need ablation, early ablation, that is. If PM sees pvc, it does not fire. He wants 100% pacing. If pacing falls below 90%, 80%, due to premature LV contractions it is very much a concern, as ventricles are not in sync. I think, if beta-blocker slows down heart rate sufficiently, PM should get in first and díctate pacing rhythm. If not, the contractions of left ventricle need to be disabled. No doubt that means total dependence on device.

My cardiologist is the best!


5 Comments

PVCs

by AgentX86 - 2019-05-26 00:35:49

All of the above makes sense.  What is your PVC burden now? 

I too have PVCs (bigeminy) but at its worst, was only an hour or so a day.  It wasn't enough to get my cardiologist or EP excited but it didn't feel good at all.  My EP raised my heart rate to 80bpm to discourage the PVCs and that helped some.  I still have it set at 50bpm at night so I can sleep, so still wake up with bigeminy at times.  It has been getting better, so perhaps yours will get better with time, too.  I'm on metoprolol but that didn't help.  I've cut back on it because it makes me sleepy (falling asleep in a meeting with your boss isn't cool). 

It sounds like you're dependent anyway?  I've been dependent since I got my PM (AV node ablation).  It's not a big deal. You'll still have the normal rhythm and escape rhythms to fall back on (I don't have a fall-back).  Or maybe I misunderstood your concern?

 

Lots of pvc’s still, after crt-p

by Jereems - 2019-05-26 03:07:02

Thank you for reply, Agent X86. I don’t have a number. Strangely, I don’t feel them. With me it’s a silent sickness. But a troubling one. A sort of generalized system failure, where I am vaguely aware something is wrong??

Escape rhythm: I’m not well up on this. I assumed that proposed ablation was designed to kill the “volunteer” beats originating in LV, so that PM reign supreme. My device is 3-lead, addressing first, bradycardia, then also the volunteer out-of-sync beats of ventricles, I think. In the past, I was aware of dysynchronized chambers only after exercise, so I discontinued exercise; better a weak heart than a heart fighting itself. Never mentioned it to a doctor until symptoms became critical. 

PVC treatment

by Selwyn - 2019-05-26 07:34:15

May be worth trying Verapramil?

 See : https://www.ncbi.nlm.nih.gov/pubmed/22528707

 

Thank you Selwyn

by Jereems - 2019-05-26 10:20:16

I am grateful for your input. I read that article. So, there are options, and besides, pvc’s sometimes disappear on their own. 

Already, 4th day, I experience relief of congestion for which I am very grateful. 

Tests show low RBC and Sodium, but this may be attributable to diet changes. Doc has not commented yet. Overall I am very grateful. 

Bradycardiac mode DDDR: W4TR01 Percepta quad

by Jereems - 2019-05-26 23:41:22

I think that means his options are maximized, so he can program it to his heart’s content?? Ablation surely means AV Node ablation. This should quench the escape rhythms, so that ventricles “listen up” and depolarize when and only when told by PM, and no longer depolarize until they are told. Yeah, that is what resynchronization is about.

I don’t have a figure for pvc burden, but I get 1111-1111-11-11-, or 11-11- simply. So variable. Sometimes 70 bpm, then 49 or 50 shows on bp monitor. Doc sets cutoff rate 70-130 bpm. The ekg monitor at hospital (after placement) showed rolling hills, nothing like the p-qrs pattern we like and recognize. 

It’s kinda amazing talking to your Doctor about his homeland as he’s threading wires along the corridors of your heart!

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