PVCs Ugh!

Not quite 3 weeks post op with a new Medtronic Claria MRI Quad CRTD and AV Node ablation.  32 years on my St. Jude mitral valve, I know a lot about heart valve replacements.  I know next to nothing about pacemaker/ICD's and am trying to learn.

I have Grade B heart failure after 7 years of a-fib that wasn't well controlled by meds.  My EF is now 32-34%.  I have no outward signs of heart failure.  The reason for the AV Node ablation was so I could be taken off of diltiazem which was used to "try" and control my a-fib, but is really contra-indicated for HF.  I am also on 200mg of metoprolol XL, 12.5 of losartan and 10 mg jardiance.  I was taken off the diltiazem right after the AV Node ablation.  My cardio hopes to add one more HF drug, but my BP is low to begin with, let alone with the metop and losartan.

Here's my question/concern.  I feel I'm having lots of PVC's.  The past few days it feels like anywhere from 1 every 5 beats to 1 every 2.  I'm doing my best to try and ignore them, but it's a little discouraging because I feel I had less noticable arrhythmia before the AV Node ablation.

My rate is set at 80 bpm and my cardio wants to work it down to 70.  My 1st (and only) in-office interrogation, 1 week post op, showed the pacemaker doing 90% of the beats.  I feel as if this last week, it would be somewhat less with PVC's overexcelling.  I don't have another in-office interrogation until 10/19.  Am I to understand that the MyCareLink device will download the daily information each night?  So is my device nurse getting the info on my PVC's?

Suggestions, comments welcome.  From searching this club, I see that PVCs seem to be "a thing" for many, just wondering what's normal and what's not.

Blessings,

Karlynn

3 Comments

ECG / EKG

by Penguin - 2023-09-27 04:31:12

Hi Karylynn

The advice above from Marybird is thorough and makes sense IMO. 

The ablation may be the cause of a more disturbed heart rhythm currently and you may have to be patient through this period of disruption.  I know that's hard!  PVCs can be evidenced on the device's EKG.  If they are really bothering you a lot ring the clinic during a daytime / weekday episode of PVCs and organise a remote transmission via MyCareLink to confirm the cause of your symptoms. At least then you will have confirmation of PVC as the cause of symptoms - or not.  

As Marybird says devices can be programmed with alerts to let the EP / techs know when PVCs exceed a pre-determined %.  If this happens an alert will show up in your records.  My PM also lists the number of PVCs and so did my previous PM. I haven't had a Medtronic device. 

Edited: Just noticed the CRT-D. 

Best Wishes

 

 

Ectopic beats

by Gemita - 2023-09-27 09:28:48

Karlynn, I see you have received lots of helpful suggestions already, but here are a few more.

I also have a Medtronic pacemaker.   Pacemaker internal ECG storage is generally reserved for important events like ventricular and atrial tachy arrhythmias, but our downloads will give our technicians/EPs, especially in your case with an CRT-D, a lot more useful information.  For example my total “PVC runs (2-4 beats) or PVC single beats” per hour are recorded which shows the overall % PVC burden for a period of monitoring.  Since PVCs can develop into NSVT (non sustained ventricular tachycardia), they need to keep a watch on them for your own comfort and safety. 

Unfortunately with heart failure, arrhythmias are more likely to occur and that includes “irregular” ectopic beats which can make us feel awful.  Hopefully your heart will recover with treatment changes/improvements, especially with your CRT device, but this may take several months to show a benefit.

As far as I know and as I have already mentioned when answering your previous post, the lower rate setting is usually set higher for a few months (to 80 bpm/90 bpm) immediately following an AV Node ablation.  Ventricular arrhythmias can occur following this procedure but setting the pacemaker at a “higher” lower rate limit is usually sufficient to prevent this complication.  I wouldn't be in a hurry to lower it!

I am optimistic after reading your comments “I have Grade B heart failure after 7 years of a-fib that wasn't well controlled by meds.  My EF is now 32-34%.  I have no outward signs of heart failure” that your ejection fraction will improve with cardiac resynchronization therapy if your heart failure is due mainly to AF.  AF now will be confined to the atria, leaving your ventricles to steadily pace you so this should improve your symptoms overall.

I can understand you are discouraged following your AV Node ablation to be feeling worse than before your procedure, but this too I feel will settle/pass with healing.  My heart and arrhythmias were worse initially before they got better so we do need to be patient and to stay positive because etcopics thrive when we are stressed.

Since you now have a CRT-D, I feel sure you will be monitored nightly.  Keep an eye on your meds too and perhaps ask to have these reviewed occasionally, to see whether you need to stay on them all and at the dosage prescribed?  With CRT support you may not need so much medication in the future to treat your heart failure.  For example, I note you are on Jardiance.  It is an anti-diabetic medication used for glucose control but it has become the new wonder med for heart failure apparently for symptomatic patients.

I wish you every success with pacing and hope your rhythm disturbances settle quickly.

Many thanks!

by Gramzo - 2023-09-27 10:36:57

I am so humbled that you all took great care and time to respond.  You are giving the exact information I am looking for!

Blessings,

Karlynn

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