Complex Arrhythmias: Insights on VT/VF Management - Cardiology

Complex arrhythmias and VT/VF

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Hello Doctor: I have a history of mitral valve prolapse, ventricular premature contractions (VPC), ventricular tachycardia (VT), ventricular fibrillation (VF), and heart failure, but no other chronic diseases.
● 2009 / 2013: I experienced temporary fainting during activities like exercise and hiking, which was likely VT.
● 2014 / 2016: I had possible VT, feeling a heavy sensation in my heart for a few seconds before it returned to normal without fainting; during this period, I underwent examinations in the cardiology department at Hospital A, but aside from mitral valve prolapse, no other issues were found, and I was prescribed only Dronedarone.
● 2017: (1) One evening, I suddenly collapsed (the details were relayed by my family), my face turned dark, and my family performed CPR and called an ambulance.
Three doses of epinephrine were ineffective, and I experienced recurrent VT/VF with multiple defibrillation attempts.
By the time I reached Hospital B, I was in out-of-hospital cardiac arrest (OHCA) and was resuscitated after several hours, then sent to the ICU and placed on ECMO for three days.
I was in a coma for about eight days and spent a total of 22 days in the ICU before being transferred to a regular ward after having an ICD implanted, where I stayed for another eight days before discharge.
(2) The physician initially planned to perform catheter ablation, but after some delay, the doctor at Hospital B stated, "Your episode frequency is not that high, so ablation is unlikely.
If you go into the operating room, everyone will have to wait for you to have an episode, and we don't know how long that will take," so the ablation was not performed.
(3) My medications at that time included Dronedarone, Amiodarone, and Bisoprolol (which has since been discontinued).
● 2018-2020: My condition stabilized, with no VT/VF episodes, and the frequency of VPCs remained tolerable.
I had follow-up appointments every three months and an ICD check every six months.
● 2021: (1) I discovered that Dronedarone caused hypothyroidism.
The physician at Hospital B assessed my previous condition as stable and discontinued the medication.
However, three months after stopping, I experienced eight short episodes of VT without defibrillation.
Two months later, VT/VF recurred, resulting in three shocks from the ICD and hospitalization for treatment, which only involved resuming Dronedarone without any special interventions.
(2) After discharge, VPCs became very frequent, and due to the shocks, I became extremely anxious.
Whenever the frequency of VPCs increased, I worried about the possibility of VT/VF and receiving shocks again.
(3) I consulted at Hospital C, where my medications included Dronedarone, Amiodarone, Bisoprolol, Sotalol, and Entresto (which was discontinued due to urinary tract infection side effects), and I was also taking Entresto.
(4) At Hospital C, after evaluations including ultrasound and MRI, I was told, "Your condition is complex arrhythmia, and ablation is not suitable.
Even if ablation were performed, VPCs would not decrease" (previously, the cause assessed by Hospital B was "myocardial damage").
I had hoped that ablation could resolve the crisis of VPC/VT/VF, but that hope was dashed.
● 2022: (1) I had check-ups every three months at Hospital C, where I experienced one episode of slow VT (160-170 bpm) lasting one minute, but I felt no discomfort and did not receive a shock from the ICD.
(2) My medications at that time included Dronedarone, Amiodarone, Bisoprolol, Sotalol, SGLT2 inhibitors, and Entresto (I continued to follow up on my thyroid condition at Hospital A).
(3) In my most recent echocardiogram, my left ventricular ejection fraction (LVEF) was only 38%, and there was no cardiac enlargement; I occasionally experience shortness of breath, but the symptoms seem atypical and irregular, with no hallmark symptoms like orthopnea, nocturnal dyspnea, or edema.
(4) VPCs are paroxysmal, with faster heart rates in the evening to midnight (often accompanied by strong palpitations), occurring more frequently, seemingly unrelated to weather, diet, or exercise, making it hard to identify patterns.
Once the first episode occurs, it can last from several minutes to hours, continuing for days to weeks, with an estimated daily count of VPCs in the thousands; during calm periods, it may last from days to weeks, with about a hundred VPCs daily.
Due to my sensitivity and anxiety, the missed beats from VPCs (especially when frequent) are very uncomfortable for me.
(5) In the most recent ICD check, there were over 20,000 VPCs in the past three months, concentrated during the active periods; additionally, about 20-30% of the rhythms were assisted by the ICD's pacing function.
※ Based on the above medical history, I would like to ask the doctor a few questions: (1) Are there truly situations where ablation is completely unsuitable? If I were to undergo it, would the results be poor? (2) When VPCs occur frequently, is the only option to take medication and wait passively? I cannot find any way to alleviate the situation, and the medications do not always work, causing me significant distress.
(3) Is it possible to understand why my heart rate is slow in the morning (50 bpm, assisted by ICD pacing) and faster in the afternoon (70-80 bpm)? (4) Given my condition, are the risks of any anesthesia or surgery extremely high? (5) Will the ICD run out of battery in 7-8 years, and is there a type that can be wirelessly charged? Otherwise, I would need surgery periodically.
Additionally, are there ICDs that can connect to the internet to alert hospitals of abnormal rhythms and notify patients for follow-up? I would greatly appreciate any response from the doctor! Despite taking my medications on time and attending follow-ups for five years, my condition has gradually worsened; I feel very hopeless about my life.

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WK, 40~49 year old female. Ask Date: 2022/12/23