Ventricular Premature Contractions: Treatment Options and Next Steps

Ventricular premature contraction (VPC)

I received the BNT vaccine on October 14, and on October 18, I was hospitalized due to arrhythmia.
After being discharged, I still experience chest pain, tightness, and dizziness.
During my hospitalization, I underwent a 24-hour Holter monitor test, which showed ventricular arrhythmia with over 1,000 beats in a day.
I switched medications twice, but there was no improvement.
Later, I visited the cardiology department at Taichung Veterans General Hospital, where another 24-hour Holter monitor test revealed over 2,000 beats in a day.
The doctor suggested trying medication, and if that doesn't work, we may consider catheter ablation.

I would like to ask if, after catheter ablation, I still experience arrhythmia, would I need to have a pacemaker implanted? Or can a pacemaker directly resolve my issue with premature ventricular contractions? If the ablation procedure fails, what would be the next steps in management?

Ms. Hsieh, 20~29 year old female. Ask Date: 2021/11/11

Dr. He Dongjin reply Cardiology

Hello, having over 1,000 to 2,000 beats per day should be within an observable range.
It's advisable to start medication and monitor the situation.
Personally, I believe that using a sledgehammer to crack a nut is unnecessary; it shouldn't come to needing ablation.
If the ablation fails, you would just return to the current state.
There is no need for an implantable cardioverter-defibrillator (ICD) as it does not address the issue of premature ventricular contractions (PVCs).
For now, take it easy and coexist peacefully with it.
Best wishes from Changhua Hospital.

Reply Date: 2021/11/11

More Info

Ventricular premature contractions (VPCs), also known as premature ventricular contractions (PVCs), are common cardiac arrhythmias characterized by early heartbeats originating from the ventricles. They can occur in healthy individuals and may not always indicate a serious underlying condition. However, when they are frequent or symptomatic, as in your case, they can lead to discomfort, palpitations, and even more serious complications.

Based on your description, it appears that you experienced a significant increase in VPCs following your BNT vaccination, which led to hospitalization. The fact that you had over 1,000 VPCs in a day during your first hospitalization and over 2,000 during your follow-up at Taichung Veterans General Hospital suggests that your condition is indeed concerning and warrants careful management.

Treatment Options
1. Medication: The first line of treatment for symptomatic VPCs often involves antiarrhythmic medications. It seems you have already tried two different medications without improvement. Common medications include beta-blockers, calcium channel blockers, or other antiarrhythmic drugs like flecainide or sotalol. If these medications do not alleviate your symptoms, further evaluation is necessary.

2. Electrophysiological Study and Catheter Ablation: If medication fails to control your symptoms, catheter ablation may be considered. This procedure involves threading catheters through blood vessels to the heart to identify and destroy the tissue responsible for the abnormal electrical signals. Ablation can be highly effective for VPCs, especially if they are frequent and symptomatic.

3. Pacemaker or Implantable Cardioverter-Defibrillator (ICD): If catheter ablation is unsuccessful or if your VPCs are associated with more serious arrhythmias, your cardiologist may recommend the implantation of a pacemaker or an ICD. A pacemaker can help regulate heart rhythms, while an ICD can deliver shocks to restore normal rhythm in case of life-threatening arrhythmias.

Next Steps
- Post-Ablation Monitoring: If you undergo catheter ablation, close monitoring will be essential. Your cardiologist will likely schedule follow-up appointments to assess the effectiveness of the procedure and monitor for any recurrence of VPCs.

- Lifestyle Modifications: In addition to medical treatment, lifestyle changes can help manage symptoms. This includes reducing caffeine and alcohol intake, managing stress, and ensuring adequate sleep.

- Regular Follow-ups: Continuous follow-up with your cardiologist is crucial. They may recommend periodic Holter monitoring (24-hour ECG) to assess the frequency of VPCs and evaluate the effectiveness of treatment.

Considerations Regarding Device Implantation
If catheter ablation does not resolve your symptoms, the decision to implant a pacemaker or ICD will depend on several factors, including the frequency of VPCs, the presence of other arrhythmias, and your overall cardiac health. While a pacemaker can help manage heart rhythm, it does not directly eliminate VPCs. Instead, it can provide a more stable heart rate and prevent symptoms associated with bradycardia (slow heart rate).

Conclusion
In summary, while VPCs can be bothersome, there are several treatment options available. The path forward will depend on your response to medications and the results of any further testing. It is essential to maintain open communication with your cardiologist about your symptoms and treatment options. If you have concerns about the effectiveness of your current treatment plan, do not hesitate to seek a second opinion or discuss alternative therapies with your healthcare provider.

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