Should You Choose Ablation or Medication for Arrhythmia Management?

Electrocautery or medication?

During a health check-up, arrhythmia was discovered.
In the first 24-hour Holter monitor test, there were over 10,000 irregular beats recorded daily.
The doctor diagnosed it as benign ventricular premature contractions and recommended catheter ablation.
Concerned about the surgery, I opted for medication, taking Meletin 100 mg twice daily.
I have been on this medication since 2021.
Follow-up tests, including nuclear imaging and MRI, indicated that there are no issues with blood flow or the heart's vessels.
However, the results from subsequent 24-hour Holter monitors have been inconsistent, with counts ranging from 5 to 1,500, and even reaching 10,000 beats on a particularly busy day during an event.
I can clearly identify when the irregularities occur; sometimes they last for one to two hours and are uncomfortable, while at other times, I feel nothing and skip a dose.
Currently, my other health conditions include high cholesterol (total 203, LDL 153) without medication, and blood pressure fluctuating between 107 and 130, also without medication.
I would like to ask:
1.
Should I consider catheter ablation? I am concerned about the pain during the procedure (as it cannot be done under anesthesia) and the success rate, given that my condition seems persistent.
Is it possible to continue managing it with medication and coexist peacefully with it?
2.
A doctor mentioned that it might improve after age 60.
Why is that? Is there a chance of stopping medication and achieving natural recovery? Or could uncontrolled arrhythmia lead to heart failure?
3.
I enjoy exercising.
Does physical activity (such as jogging, hiking, cycling, and weight training) help improve my condition? Currently, I have noticed that adjusting my lifestyle to reduce stress, avoiding stimulants, managing my emotions, and maintaining a regular sleep schedule has been somewhat beneficial.

Janny, 50~59 year old female. Ask Date: 2022/08/16

Dr. He Dongjin reply Cardiology

Hello, it seems you want a permanent solution.
If you're worried about developing heart failure in the long run, then radiofrequency ablation isn't that scary.
The pain is comparable to an injection.
Is it persistent? In fact, the success rate is higher; previous success rates have been over 90%.
You should consider whether to manage your condition with medication and coexist with it.
Essentially, that means maintaining the current state, so it depends on whether you are satisfied with the status quo.
You probably aren't satisfied, which is why you're asking me.
Will it get better after 60? I don't know.
If it does, then just hold on for three more years.
I don't believe that exercise helps improve the situation? Exercise can stabilize the autonomic nervous system.
It depends on whether you want to undergo radiofrequency ablation every few hours to resolve the issue, avoid stimulants, or live a life of strict self-discipline without anger, stimulation, or emotional fluctuations.
We are human, and I think the latter is harder to achieve.
Please consider your options carefully; both paths are viable.
It’s up to your choice.
Changhua Hospital cares about you.

Reply Date: 2022/08/16

More Info

When it comes to managing arrhythmias, particularly when considering the options of ablation versus medication, there are several factors to weigh carefully. Your situation, characterized by frequent premature ventricular contractions (PVCs) and a history of medication use, presents a common dilemma faced by many patients.

1. Should You Consider Ablation?
Ablation is a procedure that aims to destroy the small areas of heart tissue that are causing abnormal electrical signals. It is often recommended for patients who experience significant symptoms from arrhythmias or for those whose arrhythmias are not well controlled with medication. Given that you have experienced episodes of irregular heartbeats that can last for hours, and considering the frequency of your PVCs, ablation could be a viable option.
However, your concerns about the procedure are valid. Ablation can be uncomfortable, and while it is typically performed under sedation, the level of anesthesia can vary. The success rates for ablation are generally high, especially for certain types of arrhythmias, but individual outcomes can vary based on the specific characteristics of your arrhythmia and your overall health.

2. Can You Manage with Medication?
Continuing with medication, such as Meletin (which is a beta-blocker), is a common approach, especially if the arrhythmia is deemed benign and not causing significant symptoms or complications. Many patients successfully manage their arrhythmias with medication alone. However, it is crucial to have regular follow-ups with your healthcare provider to monitor your condition and adjust your medication as needed.
Your observation that your arrhythmia episodes vary in frequency and intensity is also important. It suggests that while the medication may help, it may not completely eliminate the PVCs. Lifestyle modifications, such as reducing stress, avoiding stimulants, and maintaining a healthy sleep schedule, can also play a significant role in managing your symptoms.

3. Aging and Arrhythmias
The comment about arrhythmias potentially improving with age is not uncommon. Some studies suggest that certain types of arrhythmias may become less frequent as people age, possibly due to changes in heart tissue and electrical conduction. However, this is not guaranteed, and it is essential to continue monitoring your heart health. Stopping medication without consulting your doctor could lead to a resurgence of symptoms or complications, including the risk of heart failure if the arrhythmias are significant.

4. The Role of Exercise
Exercise can be beneficial for heart health and may help reduce the frequency of arrhythmias for some individuals. Regular physical activity can improve cardiovascular fitness, help manage weight, and reduce stress—all factors that can influence heart rhythm. However, it is essential to engage in exercise that feels comfortable for you and to avoid overexertion, especially during episodes of arrhythmia. Consulting with a healthcare provider about an appropriate exercise regimen is advisable.

Conclusion
In summary, the decision between ablation and medication should be made collaboratively with your healthcare provider, considering your symptoms, lifestyle, and preferences. If your PVCs are causing significant discomfort or impacting your quality of life, discussing the possibility of ablation may be worthwhile. On the other hand, if you find that medication and lifestyle changes are manageable, continuing with this approach is also valid. Regular follow-ups and open communication with your healthcare provider are key to effectively managing your arrhythmia and ensuring your heart health.

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