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What Causes PVCs While Exercising?
Question: Dear Dr Sharka,
It's XXXXX again, needing advice and reassurance that I am not in grave danger. Last week, at the gym, I had a bout of bad PVCs (captured on heart monitor, not felt) and was scared and saw my EP the next day. He was able to see PVCs on an EKG and has decided to do the ablation next week. In fact, it will be on Monday, in just two days. EP felt sure that the location was safe (RVOT) and that as my PVCs were happening quite regularly he could get the single focus. He said he will map the PVC location before he inserts any catheter so that there is no risk to me if he is unable to find or induce my PVCS.
I know you think this is premature and too risky, but I feel so scared having these PVCS which I can't even feel. I feel like in 6 months between holters, PVCS could increase so much, I become sick again. In May 2014 my PVCS started and by July, I was having issues feeling comfortable lying flat, although at the time I didn't know that was a symptom. Of course that was 60% PVC burden, not 3%, but it happened very quickly. I just want them to be gone.
EP assured me that it would be ok. He said there will be no edema and no heart weakening. I know this is assuming there are no complications but I know he is an excellent doctor so I feel I will most likely be ok. Do you agree that if the procedure goes smoothly, with no complications, I won't suffer any temporary (or permanent) lowering of EF? I cannot help but remember the early days of my illness when so much was made of my EF and I know I am obsessed but l am so scared of becoming sick again.
I've attached the two echoes I've had since my new PVCS started. It's only over a few months but is it good evidence that my PVCS aren't hurting me? Is there any chance that in the month since that echo, my heart function has declined?
I must get better and stronger mentally if I am to do work in Cambodia. I am still convinced that sitting still after drinking is what is keeping me out of heart failure.
Thank you so much, Dr Iliri. I hope you are having a fine weekend.
XXXXX
It's XXXXX again, needing advice and reassurance that I am not in grave danger. Last week, at the gym, I had a bout of bad PVCs (captured on heart monitor, not felt) and was scared and saw my EP the next day. He was able to see PVCs on an EKG and has decided to do the ablation next week. In fact, it will be on Monday, in just two days. EP felt sure that the location was safe (RVOT) and that as my PVCs were happening quite regularly he could get the single focus. He said he will map the PVC location before he inserts any catheter so that there is no risk to me if he is unable to find or induce my PVCS.
I know you think this is premature and too risky, but I feel so scared having these PVCS which I can't even feel. I feel like in 6 months between holters, PVCS could increase so much, I become sick again. In May 2014 my PVCS started and by July, I was having issues feeling comfortable lying flat, although at the time I didn't know that was a symptom. Of course that was 60% PVC burden, not 3%, but it happened very quickly. I just want them to be gone.
EP assured me that it would be ok. He said there will be no edema and no heart weakening. I know this is assuming there are no complications but I know he is an excellent doctor so I feel I will most likely be ok. Do you agree that if the procedure goes smoothly, with no complications, I won't suffer any temporary (or permanent) lowering of EF? I cannot help but remember the early days of my illness when so much was made of my EF and I know I am obsessed but l am so scared of becoming sick again.
I've attached the two echoes I've had since my new PVCS started. It's only over a few months but is it good evidence that my PVCS aren't hurting me? Is there any chance that in the month since that echo, my heart function has declined?
I must get better and stronger mentally if I am to do work in Cambodia. I am still convinced that sitting still after drinking is what is keeping me out of heart failure.
Thank you so much, Dr Iliri. I hope you are having a fine weekend.
XXXXX
Brief Answer:
Your cardiac performance is not going to decrease from potential ablation.
Detailed Answer:
Dear XXXXX,
I know that the arrhythmia issue is getting too much concern to you and this is a normal reaction after experiencing the serious threatening heart condition two years ago.
Regarding your PVCs, I could say that RVOT origin denotes usually a benign sort of ectopic beats.
RVOT PVCs may be quite suitable for catheter ablation treatment, if it is necessary.
But, they generally don’t adversely affect long-term prognosis even if left completely untreated (excellent long-term survival).
You actually know my opinion regarding 3% burden of PVCs. They can’t interfere with your overall cardiac performance and could not decrease your LVEF over time.
Your last cardiac ultrasound reports reveal a perfectly normal cardiac structure and function.
I am quite sure that the same normal pattern is going to be present in the future cardiac echoes after one, two or many years.
My personal professional opinion goes in favor of just wait and monitor your heart rhythm periodically.
I believe that cardiac ablation even though technically quite feasible and safe, has no clear indication for the moment and would not change any important clues on your clinical symptomatology and cardiac performance. Cardiac ablation probably could be considered premature.
But, from the other side, I also believe that cardiac ablation when performed by highly experienced hands offers beneficial results in eradicating an arrhythmogenic focus, though it could not give absolute assurance in regards of long-term relapses.
Generally speaking, ablation of unifocal RVOT PVCs is almost quite safe and highly successful.
If your EP doctor believes he could perfectly localize the arrhythmia focus, then the procedure success rate is expected to be higher.
Though as I said above, I am not sure that a cardiac ablation at this moment would offer any remarkable beneficial effect, it could be an alternative option.
Finally, I am glad to confirm you that cardiac performance revealed by your last echo reports is normal and you are on very good clinical conditions. It is not going to decline for any actual reasons.
So, you should not be afraid of fluids (water and others) intake and do not have to restrict your daily physical activity meanwhile.
Dear XXXX,
You just need to relax!
Nothing dangerous seems to be happening to you.
Please, let me know how you are going to proceed with your EP doctor decision.
I remain at your disposal for any further support and discussion.
Remember you are in good shape and nothing is going to change.
Wishing you a pleasant weekend!
Kind regards,
Dr. Iliri
Your cardiac performance is not going to decrease from potential ablation.
Detailed Answer:
Dear XXXXX,
I know that the arrhythmia issue is getting too much concern to you and this is a normal reaction after experiencing the serious threatening heart condition two years ago.
Regarding your PVCs, I could say that RVOT origin denotes usually a benign sort of ectopic beats.
RVOT PVCs may be quite suitable for catheter ablation treatment, if it is necessary.
But, they generally don’t adversely affect long-term prognosis even if left completely untreated (excellent long-term survival).
You actually know my opinion regarding 3% burden of PVCs. They can’t interfere with your overall cardiac performance and could not decrease your LVEF over time.
Your last cardiac ultrasound reports reveal a perfectly normal cardiac structure and function.
I am quite sure that the same normal pattern is going to be present in the future cardiac echoes after one, two or many years.
My personal professional opinion goes in favor of just wait and monitor your heart rhythm periodically.
I believe that cardiac ablation even though technically quite feasible and safe, has no clear indication for the moment and would not change any important clues on your clinical symptomatology and cardiac performance. Cardiac ablation probably could be considered premature.
But, from the other side, I also believe that cardiac ablation when performed by highly experienced hands offers beneficial results in eradicating an arrhythmogenic focus, though it could not give absolute assurance in regards of long-term relapses.
Generally speaking, ablation of unifocal RVOT PVCs is almost quite safe and highly successful.
If your EP doctor believes he could perfectly localize the arrhythmia focus, then the procedure success rate is expected to be higher.
Though as I said above, I am not sure that a cardiac ablation at this moment would offer any remarkable beneficial effect, it could be an alternative option.
Finally, I am glad to confirm you that cardiac performance revealed by your last echo reports is normal and you are on very good clinical conditions. It is not going to decline for any actual reasons.
So, you should not be afraid of fluids (water and others) intake and do not have to restrict your daily physical activity meanwhile.
Dear XXXX,
You just need to relax!
Nothing dangerous seems to be happening to you.
Please, let me know how you are going to proceed with your EP doctor decision.
I remain at your disposal for any further support and discussion.
Remember you are in good shape and nothing is going to change.
Wishing you a pleasant weekend!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
I have decided to do the PVC ablation. I know you, as well as my primary cardiologist, believe it is premature but as I dont know what level made me sick before, so I am very uneasy about having these PVCS.
The first time, my PVCs were also unifocal RVOT but the 60% burden made them malignant. But ablation had me at 0% PVCs for nearly two years.
I was so traumatized the first time, that I barely remember the procedure. And though my cardio disagreed, my EP did think ablation could cure me. EF went from 20 to 60 in 3 1/2 weeks. I wish I could not have ablation again but I dont feel these (could they be interpolated and less strong for that reason?)
I received a sheet at Dr's office but it was for AF ablation. It said you could have symptoms of CHF post procedure. I hope
That is not the case for PVC ablation. I'm very scared. I am having the surgery very early in the morning tomorrow.
EP will be mapping PVCs before he inserts any catheters so there is no risk to me if he cant find. I pray he can find and ablate.
As long as the procedure itself doesnt cause lowering of EF or edema, I can accept the risks of complications given my dr is very experienced and head of the EP lab. I dont have routine echo followup scheduled since my heart isnt weak now, but if there are no complications, do you think I need one? I feel so scared that I will feel weak and short of breath and sick.
Thank you so much, Dr Iliri. I will write you as soon as I am able to, once I am out of surgery.
Thank you so much,
XXXXX
I have decided to do the PVC ablation. I know you, as well as my primary cardiologist, believe it is premature but as I dont know what level made me sick before, so I am very uneasy about having these PVCS.
The first time, my PVCs were also unifocal RVOT but the 60% burden made them malignant. But ablation had me at 0% PVCs for nearly two years.
I was so traumatized the first time, that I barely remember the procedure. And though my cardio disagreed, my EP did think ablation could cure me. EF went from 20 to 60 in 3 1/2 weeks. I wish I could not have ablation again but I dont feel these (could they be interpolated and less strong for that reason?)
I received a sheet at Dr's office but it was for AF ablation. It said you could have symptoms of CHF post procedure. I hope
That is not the case for PVC ablation. I'm very scared. I am having the surgery very early in the morning tomorrow.
EP will be mapping PVCs before he inserts any catheters so there is no risk to me if he cant find. I pray he can find and ablate.
As long as the procedure itself doesnt cause lowering of EF or edema, I can accept the risks of complications given my dr is very experienced and head of the EP lab. I dont have routine echo followup scheduled since my heart isnt weak now, but if there are no complications, do you think I need one? I feel so scared that I will feel weak and short of breath and sick.
Thank you so much, Dr Iliri. I will write you as soon as I am able to, once I am out of surgery.
Thank you so much,
XXXXX
Brief Answer:
I hope everything will proceed to the best possible way!
Detailed Answer:
Dear XXXXX,
I would like to assure you that ablation of an arrhythmogenic focus, in RVOT is considered just a routine procedure in the hands of an experienced EP cardiologist.
So, you shouldn't be afraid of any dangerous complications such as EF impairment or systemic congestion (peripheral edema).
Also, it is not necessary to recheck your cardiac performance by a new cardiac ultrasound as you had normal ones recently.
Though I believe that a successful cardiac ablation may eradicate an actual arrhythmogenic focus.
But, I am not sure if new rare PVCs will not reoccur in a distant future.
It is very important to increase the chances of a successful procedure when the operator optimism is high, especially when he is an experienced doctor.
I hope everything will proceed to the best possible way and the arrhythmia issue will not be a source of anxiety any more.
Please let me know about everything!
Wishing all the best,
Dr. Iliri
I hope everything will proceed to the best possible way!
Detailed Answer:
Dear XXXXX,
I would like to assure you that ablation of an arrhythmogenic focus, in RVOT is considered just a routine procedure in the hands of an experienced EP cardiologist.
So, you shouldn't be afraid of any dangerous complications such as EF impairment or systemic congestion (peripheral edema).
Also, it is not necessary to recheck your cardiac performance by a new cardiac ultrasound as you had normal ones recently.
Though I believe that a successful cardiac ablation may eradicate an actual arrhythmogenic focus.
But, I am not sure if new rare PVCs will not reoccur in a distant future.
It is very important to increase the chances of a successful procedure when the operator optimism is high, especially when he is an experienced doctor.
I hope everything will proceed to the best possible way and the arrhythmia issue will not be a source of anxiety any more.
Please let me know about everything!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Yesterday I had a succesful PVC ablation. I was back home yesterday evening.
In the holding area, I was having frequent PVCs, including bigeminy. When my EP arrived he still wasnt sure he would be able to get the focus and said we may not know until follow up holter because my PVCs could stop temporarily in the lab after ablation.
Once in the EP lab during mapping, dr said PVCS were frequent enough and consistent enough that he would know if he got the focus. He mapped right side first and they couldn't find the focus but he said he knew where it was. So he went in through artery and went to left side where he found the focus very close to my aorta. After three burns, PVCS stopped and were not inducible. They didn't re-appear in recovery or in 5 hours of telemetry while lying flat. I hope they are gone forever.
Today I feel fine and catheter insertion site is not swollen or painful. Chest feels fine and I feel generally normal. I am to not exercise for two weeks and rest as much as I can for a week.
Of course I have questions now which make me anxious again already. When I got home, I noticed my weight was up and I was barely urinating although I was drinking constantly. Late night, the water began to flush out and all was normal by morning. Could this be because of all the saline solution I was given (drip and catheter) and the fentanyl? I was also given high doses of heparin because of artery.
All during pre-op and surgery, my pulse ox was 100 steadily. Even after surgery at first it was 100. After about 15 minutes in recovery it began to drop- going from 97-100, mostly staying at 98. I know that's normal but it was a change as it had been 100 all day. I read opiates can make pulse ox drop. Could it be the fentanyl I was given at end of surgery be what caused the drop?
Because of the focus being near the aorta, I was given a 3D echo right after ablation, right on EP lab table. Was told everything looked great, no pericardial effusion, heart size perfect, EF still 60-70. Should I stop worrying that ablation could damage my heart? I have been so worried that I could end up weaker not better.
In all, it was highly successful and hopefully the PVCS stay away. I hope my anxiety starts to lessen soon.
Yesterday I had a succesful PVC ablation. I was back home yesterday evening.
In the holding area, I was having frequent PVCs, including bigeminy. When my EP arrived he still wasnt sure he would be able to get the focus and said we may not know until follow up holter because my PVCs could stop temporarily in the lab after ablation.
Once in the EP lab during mapping, dr said PVCS were frequent enough and consistent enough that he would know if he got the focus. He mapped right side first and they couldn't find the focus but he said he knew where it was. So he went in through artery and went to left side where he found the focus very close to my aorta. After three burns, PVCS stopped and were not inducible. They didn't re-appear in recovery or in 5 hours of telemetry while lying flat. I hope they are gone forever.
Today I feel fine and catheter insertion site is not swollen or painful. Chest feels fine and I feel generally normal. I am to not exercise for two weeks and rest as much as I can for a week.
Of course I have questions now which make me anxious again already. When I got home, I noticed my weight was up and I was barely urinating although I was drinking constantly. Late night, the water began to flush out and all was normal by morning. Could this be because of all the saline solution I was given (drip and catheter) and the fentanyl? I was also given high doses of heparin because of artery.
All during pre-op and surgery, my pulse ox was 100 steadily. Even after surgery at first it was 100. After about 15 minutes in recovery it began to drop- going from 97-100, mostly staying at 98. I know that's normal but it was a change as it had been 100 all day. I read opiates can make pulse ox drop. Could it be the fentanyl I was given at end of surgery be what caused the drop?
Because of the focus being near the aorta, I was given a 3D echo right after ablation, right on EP lab table. Was told everything looked great, no pericardial effusion, heart size perfect, EF still 60-70. Should I stop worrying that ablation could damage my heart? I have been so worried that I could end up weaker not better.
In all, it was highly successful and hopefully the PVCS stay away. I hope my anxiety starts to lessen soon.
Brief Answer:
Everything seems to be OK!
Detailed Answer:
Dear XXXXX,
I am glad to confirm ( based on your description of the procedure and final ultrasound results) that everything seems to have gone in the best way.
You shouldn't worry about the temporary weight increase, because it was related to the saline.
Even with your heart rhythm, these are normal changes after the procedure.
Do everything seems to be OK!
I hope everything will be OK in the future too!
You should start to think less of your arrhythmia, because it is all gone now. So push away anxiety!
I remain at your disposal for any other questions, if you need to discuss about it.
Wishing a nice recovery,
Dr.Iliri
Everything seems to be OK!
Detailed Answer:
Dear XXXXX,
I am glad to confirm ( based on your description of the procedure and final ultrasound results) that everything seems to have gone in the best way.
You shouldn't worry about the temporary weight increase, because it was related to the saline.
Even with your heart rhythm, these are normal changes after the procedure.
Do everything seems to be OK!
I hope everything will be OK in the future too!
You should start to think less of your arrhythmia, because it is all gone now. So push away anxiety!
I remain at your disposal for any other questions, if you need to discuss about it.
Wishing a nice recovery,
Dr.Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear dr iliri,
What about pulse ox? Do you think it was based on fentanyl? It had been 100 steadily then 97-98-99 about 15 minutes into recovery after I got out of lab.
So the post ablation echo would have shown if there was any problem or if EF would decline? I worry now that something happened when I got into recovery which may have had bad effects and caused the lower pulse ox.
As long as my catheter entry point is ok, do you think that means my artery is ok? Afraid of arterial damage as I keep reading about it. I dont have swelling or bleeding or pain.
Post ablation, In hospital, no pvcs but I have felt maybe one or two in pulse since then. I know PVCS may not be zero, and one day new focus may open or other things can happen but isnt zero PVCs in 7 hours at hospital good evidence that for short term this was successful and I am only having very rare PVC? Worried maybe it wasnt successful but EP was very comfident the spot was destroyed.
Now after resting I must gain confidence about being able to be fully active and heart function and renal function doesnt change. I cannot keep living in this crazy way where I keep sitting with my feet up when I drink. You told me posture has nothing to do with renal function and I must keep remembering that.
Thank you Dr Iliri, for all your help
What about pulse ox? Do you think it was based on fentanyl? It had been 100 steadily then 97-98-99 about 15 minutes into recovery after I got out of lab.
So the post ablation echo would have shown if there was any problem or if EF would decline? I worry now that something happened when I got into recovery which may have had bad effects and caused the lower pulse ox.
As long as my catheter entry point is ok, do you think that means my artery is ok? Afraid of arterial damage as I keep reading about it. I dont have swelling or bleeding or pain.
Post ablation, In hospital, no pvcs but I have felt maybe one or two in pulse since then. I know PVCS may not be zero, and one day new focus may open or other things can happen but isnt zero PVCs in 7 hours at hospital good evidence that for short term this was successful and I am only having very rare PVC? Worried maybe it wasnt successful but EP was very comfident the spot was destroyed.
Now after resting I must gain confidence about being able to be fully active and heart function and renal function doesnt change. I cannot keep living in this crazy way where I keep sitting with my feet up when I drink. You told me posture has nothing to do with renal function and I must keep remembering that.
Thank you Dr Iliri, for all your help
Brief Answer:
My opinion as follows:
Detailed Answer:
Dear XXXX,
Changes in pulse oxymetry are quite normal. They can be related to the changes in the respiratory stages and happen in every healthy person. They are not related to fentanyl or any cardiac causes. In fact they do not have any clinical significance. So relax and don't worry about it.
Regarding some ectopic heart beats, they are quite normal after cardiac ablation. They can also occur in every normal persons. So, try not to notice them. They are not indicating anything abnormal.
As you feel perfectly normal, there is no fever, the catheter entry point is OK, there is nothing to worry about.
You can stay as you like as your heart and kidney function are not depending from your body position.
So, try to live a normal life and act normally. There are no limitations to physical activity for you!
So, try to remain calm and think about beautiful things.
Everything seems to be OK! You should just try to be more faithful!
I am always here if you need to discuss again about anything!
Regards,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Dear XXXX,
Changes in pulse oxymetry are quite normal. They can be related to the changes in the respiratory stages and happen in every healthy person. They are not related to fentanyl or any cardiac causes. In fact they do not have any clinical significance. So relax and don't worry about it.
Regarding some ectopic heart beats, they are quite normal after cardiac ablation. They can also occur in every normal persons. So, try not to notice them. They are not indicating anything abnormal.
As you feel perfectly normal, there is no fever, the catheter entry point is OK, there is nothing to worry about.
You can stay as you like as your heart and kidney function are not depending from your body position.
So, try to live a normal life and act normally. There are no limitations to physical activity for you!
So, try to remain calm and think about beautiful things.
Everything seems to be OK! You should just try to be more faithful!
I am always here if you need to discuss again about anything!
Regards,
Dr. Iliri
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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