Ventricular Premature Contractions: Questions and Insights

Questions regarding premature ventricular contractions?

Medical Summary: Approximately 10 years ago, I was diagnosed with premature ventricular contractions (PVCs).
I began medication around 2018 to manage the condition (Dronedarone + Bisoprolol), but my symptoms remained variable.
In May 2020, I experienced around 16,000 irregular heartbeats in one day, leading to a catheter ablation procedure in June of the same year.
Following the procedure, while still on the same medications, a 24-hour Holter monitor showed a reduction to over 1,200 PVCs.
The physician indicated that the surgery was very successful, and I gradually reduced my medication to one Bisoprolol daily.
However, the frequency of PVCs later increased to between 6,000 and 19,000.
The physician explained that although the ablation was performed, PVCs may not be completely eliminated; it helped to ablate the abnormal ectopic foci, but some patients may require multiple procedures for optimal results.
Additionally, the physician noted that while the frequency of PVCs remains, the "drive" has decreased compared to before the ablation (I am unsure if "drive" is the correct term; does it refer to a reduction in the force of the irregular beats?).
Currently, I am taking two doses of Metoprolol daily.
The physician also prescribed Xanax for my occasional anxiety, which I primarily take for insomnia.

Regarding symptoms, I frequently experienced dizziness before the ablation, sometimes lasting nearly a day, but this sensation has almost disappeared post-procedure.
I had an echocardiogram done a year and a half ago, which showed a left ventricular ejection fraction (LVEF) of 57%, and the physician stated that the echocardiogram results were normal.
In terms of diet, I follow the physician's advice to drink only mild tea (like green tea), avoid coffee and alcohol, and maintain a regular sleep schedule from around 10 PM to 7 or 8 AM without staying up late.
Main Questions:
1.
Are the ectopic foci for the abnormal discharges fixed? For instance, if the procedure identifies points A, B, and C, but points E, F, and G are not active at that time, does this mean multiple ablations may be necessary for complete resolution?
2.
I have a tendency towards anxiety and often seek medical attention for minor health issues (e.g., I worry excessively about small oral wounds and have consulted several dentists who confirmed there was no issue, or I mistakenly identify normal bone structures as tumors after self-examination, etc., with all results ultimately being normal).
My family believes I may have obsessive-compulsive tendencies.
Could my anxiety potentially affect my autonomic nervous system and trigger arrhythmias? (I also have gastroesophageal reflux disease, and my gastroenterologist suggested that autonomic instability might be affecting the function of the lower esophageal sphincter, and I am currently undergoing medication treatment for this.)
3.
Does habitual mouth breathing (due to long-term nasal allergies) affect my heart rhythm?
4.
Could persistent PVCs lead to heart failure and pose a life-threatening risk?
5.
What recommendations might the physician have regarding my condition? Thank you for your patience in reading this, and I appreciate your help!

Tim, 30~39 year old female. Ask Date: 2023/03/31

Dr. He Dongjin reply Cardiology

Hello, anxiety may affect the autonomic nervous system and gastroesophageal reflux, which can trigger arrhythmias.
Breathing through the mouth typically does not impact heart rate.
Persistent ventricular premature contractions (VPCs) are unlikely to lead to heart failure or pose a life-threatening risk.
It is advisable to seek a second opinion at another medical center to explore management options.
Changhua Hospital cares about your well-being.

Reply Date: 2023/03/31

More Info

Ventricular premature contractions (VPCs) are a common type of arrhythmia characterized by early heartbeats originating from the ventricles. Your history of VPCs, treatment with antiarrhythmic medications, and catheter ablation (electrophysiological study) indicate that you have been actively managing this condition. Let's address your questions and concerns based on the information provided.

1. Are the abnormal discharge points fixed?
VPCs can arise from various ectopic foci within the ventricles, and these points may not be fixed. During an electrophysiological study, the physician identifies and ablates the sites that are responsible for the abnormal electrical activity. However, if other ectopic foci exist that were not detected during the procedure, they can continue to cause VPCs. This is why some patients may require multiple ablation procedures. The variability in the sites of ectopic activity can lead to fluctuations in the frequency of VPCs over time.

2. Can anxiety affect the autonomic nervous system and induce arrhythmias?
Yes, anxiety can significantly impact the autonomic nervous system, which regulates heart rate and rhythm. Stress and anxiety can lead to increased sympathetic nervous system activity, potentially triggering or exacerbating arrhythmias, including VPCs. Your history of anxiety and its physical manifestations, such as gastrointestinal issues, may contribute to your overall symptomatology. It is essential to manage anxiety effectively, as it can have both psychological and physiological effects on your heart health.

3. Does mouth breathing affect heart rate?
Mouth breathing, especially if related to chronic allergies or nasal obstruction, can lead to changes in oxygenation and carbon dioxide levels in the blood. This can potentially influence heart rate and rhythm. Chronic nasal congestion can also contribute to sleep disturbances, which may further exacerbate anxiety and stress levels. Addressing the underlying causes of your nasal issues may help improve your overall respiratory function and potentially reduce any related cardiovascular symptoms.

4. Can persistent VPCs lead to heart failure?
In general, isolated VPCs in healthy individuals are not typically associated with an increased risk of heart failure. However, if VPCs are frequent and associated with underlying heart disease or reduced left ventricular function (as indicated by your LVEF of 57%), they could contribute to further cardiac dysfunction over time. Continuous monitoring and management of your heart health are crucial, especially if you experience symptoms like dizziness or fatigue.

5. What recommendations might your physician have?
Your physician may suggest several strategies to manage your condition effectively:
- Regular Follow-ups: Continue to have regular check-ups with your cardiologist to monitor your heart function and VPC frequency.

- Medication Management: Discuss the possibility of adjusting your antiarrhythmic medications if VPCs persist or increase in frequency.

- Anxiety Management: Consider cognitive-behavioral therapy (CBT) or other forms of therapy to help manage anxiety. Mindfulness and relaxation techniques may also be beneficial.

- Lifestyle Modifications: Maintain a heart-healthy lifestyle, including a balanced diet, regular exercise, and adequate sleep. Avoiding stimulants such as caffeine and nicotine is also advisable.

- Addressing Allergies: Consult with an allergist to manage your nasal allergies effectively, which may improve your breathing and overall comfort.

In conclusion, while VPCs can be concerning, they are often manageable with appropriate medical care and lifestyle adjustments. It is essential to maintain open communication with your healthcare providers and report any new or worsening symptoms promptly. Your proactive approach to your health is commendable, and with continued care and attention, you can work towards better management of your condition.

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