Post-Ablation Sleep Issues in Patients with Ventricular Premature Contractions

Sleep issues after radiofrequency ablation for premature ventricular contractions?

Hello Dr.
He, I apologize for bothering you again.
I have issues with premature ventricular contractions (PVCs).
I underwent catheter ablation in June 2020, and post-procedure, I had 24-hour Holter monitoring in August 2020 and January 2021, which showed a decrease in PVC frequency (pre-procedure counts were approximately 16,000 to 20,000, while the post-procedure counts were 1,200 and 1,900, respectively).
My attending physician indicated that there was improvement.
Regarding medication, I was on Dronedarone and Bisoprolol, which has now been reduced to one dose of Bisoprolol per day.
Recently, I had another 24-hour Holter monitoring, but here's the issue: I maintain a normal daily routine (going to bed around 10-11 PM and waking up around 7-8 AM).
On the day of the monitoring, I did not experience any particular discomfort, but that night, I was worried about the device and the wires affecting my sleeping position, and I was also concerned about the test results.
This led to a restless night with poor sleep quality, tossing and turning, and I probably only slept about half of what I usually do.
Could this potentially cause my PVC counts to spike back up to 10,000 or 20,000? Is my usual sleep duration considered acceptable? I typically go to bed early and wake up early, and it was only on the day of the test that I experienced this issue, which makes me feel like I had a perfect game until the bottom of the ninth inning, only to be hit with a home run.
The doctor has scheduled a follow-up in three months, in December, so I wanted to consult you about this.
Thank you!

Sam, 30~39 year old female. Ask Date: 2021/09/29

Dr. He Dongjin reply Cardiology

Hello, it's common to overthink things.
Premature ventricular contractions (PVCs) are generally benign.
It's natural for their frequency to fluctuate with life stressors, sleep, and anxiety.
It's best to coexist peacefully with them.
If you experience an increase, you can consider taking heart health supplements again.
Don't worry, and take care.
Changhua Hospital is here for you.

Reply Date: 2021/09/29

More Info

Post-ablation sleep issues, particularly in patients with ventricular premature contractions (VPCs), can be a complex topic that intertwines physiological, psychological, and lifestyle factors. Your experience following the ablation procedure for VPCs, including the subsequent changes in your heart rhythm and sleep disturbances, is not uncommon.
Firstly, it’s important to understand that sleep is a critical component of overall health, and disturbances in sleep can have significant effects on cardiovascular health. After your ablation in June 2020, the reduction in VPCs from 16,000-20,000 to 1,200 and 1,900 is a positive outcome, indicating that the procedure was effective. However, the anxiety and discomfort associated with wearing a Holter monitor during your recent 24-hour ECG can certainly impact your sleep quality.
Sleep disturbances can arise from several factors, including anxiety about health, discomfort from medical devices, and changes in routine. The worry about damaging the monitor or the wires can lead to a heightened state of alertness, making it difficult to relax and fall into a deep sleep. This is compounded by the psychological stress of monitoring your heart condition, which can create a cycle of anxiety that further disrupts sleep.

Regarding your question about whether poor sleep on the night of the test could lead to a resurgence of VPCs, it is plausible. Sleep deprivation can increase sympathetic nervous system activity, which may exacerbate arrhythmias. While one night of poor sleep is unlikely to cause a dramatic increase in VPCs back to pre-ablation levels, chronic sleep issues can contribute to ongoing cardiovascular problems.
Your regular sleep schedule of going to bed around 10-11 PM and waking up at 7-8 AM is generally considered healthy, as it aligns with the recommended 7-9 hours of sleep for adults. However, the quality of that sleep is just as important as the quantity. If you find yourself waking frequently or unable to achieve restful sleep, it may be beneficial to explore relaxation techniques before bed, such as deep breathing exercises, meditation, or gentle stretching. These practices can help reduce anxiety and promote a more restful state conducive to sleep.

In terms of your feelings of having a "perfect game" until the last inning, it’s essential to recognize that setbacks in health management are common and do not negate the progress you have made. It’s normal to feel frustrated or anxious about fluctuations in your health, but it’s crucial to maintain a long-term perspective.
If you continue to experience sleep disturbances or increased anxiety about your heart condition, consider discussing these issues with your healthcare provider. They may recommend a referral to a sleep specialist or a mental health professional who can help address anxiety and its impact on your sleep. Additionally, they can provide further guidance on managing your VPCs and overall heart health.

In summary, while your sleep issues on the night of the Holter monitor test are understandable and likely influenced by anxiety and discomfort, maintaining a regular sleep schedule and addressing any underlying anxiety can help improve your sleep quality. Keep in mind that health management is a journey, and it’s essential to be kind to yourself as you navigate these challenges.

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