Managing Ventricular Premature Contractions: Medication and Symptoms

Ventricular premature contraction (VPC)

Hello Doctor, I started taking "Dronedarone" in December 2020 due to "ventricular premature contractions" and continued until May when I felt no significant symptoms, so I stopped the medication as per your instructions.
However, during the medication period, I often felt short of breath and occasionally had a dry cough at night, which would last about four to five coughs before stopping.
After discontinuing the medication, I no longer experienced shortness of breath or dry cough.

Recently, starting in March 2022, I began to have poor sleep quality, high stress, and significant mood swings, and I started experiencing skipped heartbeats, approximately 100 times a day.
By mid-April, it suddenly worsened, and I immediately sought medical attention and underwent a 24-hour Holter monitor, where the doctor reported detecting "3000" VPCs.
I resumed taking "Dronedarone" in mid-April, and after about 10 days, I saw significant improvement, with fewer than 20 skipped beats per day by mid-May.

During this time, I experienced some shortness of breath again, but less frequent dry cough.
At my follow-up appointment, I mentioned this to my doctor, who advised me to change my dosage from two pills a day, one at a time, to two pills a day, one and a half at a time, but I still find myself easily short of breath.
I am now a bit concerned that the shortness of breath might be caused by "Dronedarone" leading to "pulmonary fibrosis." Should I ask my doctor to switch to another antiarrhythmic medication? Additionally, considering the recurrence of symptoms, would it be better to consider catheter ablation for a more permanent solution? Thank you for taking the time to address my concerns amidst your busy schedule.
Thank you!

Jeff, 40~49 year old female. Ask Date: 2022/05/15

Dr. He Dongjin reply Cardiology

Hello, if your condition stabilizes, it may be possible to reduce the dosage to once a day at 0.5, or even every two days at 0.5.
Alternatively, you could ask your physician to adjust your medication to a beta-blocker.
As for the electrocautery, I have reservations about it; at this stage, it seems a bit excessive.
Changhua Hospital cares about you.

Reply Date: 2022/05/15

More Info

Managing ventricular premature contractions (VPCs) can be a complex process, especially when considering the various medications and their potential side effects. In your case, it appears that you have been experiencing VPCs since December 2020 and have been treated with Dronedarone (臟得樂). It is important to understand both the medication's role and the symptoms you are experiencing.

VPCs are common and often benign, but they can be bothersome and may lead to anxiety or concerns about underlying heart disease. In many cases, lifestyle modifications, such as reducing caffeine intake, managing stress, and ensuring adequate sleep, can help alleviate symptoms. However, when symptoms are persistent or bothersome, medications like Dronedarone may be prescribed to help manage the condition.

You mentioned that during your initial treatment with Dronedarone, you experienced shortness of breath and occasional dry cough, which resolved after stopping the medication. It is important to note that Dronedarone can have side effects, including respiratory symptoms, which may be exacerbated by underlying conditions such as asthma or chronic obstructive pulmonary disease (COPD). If you are experiencing shortness of breath again after resuming the medication, it is essential to discuss this with your healthcare provider. They may consider evaluating your lung function or exploring other potential causes for your symptoms.

Regarding your concern about pulmonary fibrosis, while Dronedarone is associated with some pulmonary side effects, the risk of developing pulmonary fibrosis is relatively low. However, if you have a history of respiratory issues or if your symptoms persist, your doctor may want to investigate further, possibly considering alternative antiarrhythmic medications that may have a more favorable side effect profile for you.

As for the recurrence of your VPCs, it is not uncommon for patients to experience fluctuations in their symptoms. Stress, anxiety, and changes in lifestyle can all contribute to the frequency and severity of VPCs. If your symptoms are well-controlled with Dronedarone and you are experiencing fewer than 20 VPCs per day, this is generally considered a positive outcome. However, if you continue to have significant symptoms or if your VPCs increase in frequency, it may be worth discussing the option of catheter ablation (電燒) with your cardiologist. This procedure can be effective in treating VPCs and may provide a more permanent solution for some patients.

In summary, it is crucial to maintain open communication with your healthcare provider regarding your symptoms and any side effects you experience from medications. If you are concerned about the side effects of Dronedarone or if your symptoms worsen, do not hesitate to reach out to your doctor for further evaluation and possible adjustments to your treatment plan. They can help determine the best course of action, whether that involves changing medications, further testing, or considering procedural options like catheter ablation. Your health and well-being are paramount, and your healthcare team is there to support you in managing your condition effectively.

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