Ventricular Premature Contractions: Treatment Options and Insights

Premature Ventricular Contractions (PVCs) Issues

Hello, Director! Last April, I inquired about VPC-related issues.
Three years ago, I underwent a catheter ablation (initially through a vein, but switched to an artery midway).
However, my arrhythmia returned afterward.
The previous physician mentioned that my condition might require two ablation procedures to resolve, but I am hesitant (mainly concerned that if the first procedure didn't work, the second might also lead to recurrence).
You suggested that I seek a second opinion at a medical center, so I visited a nearby medical center (also in Taipei).
This physician, who specializes in electrophysiology, conducted some tests: a 24-hour Holter monitor showed approximately 15,000 VPCs, an echocardiogram indicated an LVEF of about 51-52% with no other issues, and my ProBNP levels were normal.
The second physician indicated that the recurrence after the previous ablation might be due to the abnormal discharge points being deeper and more challenging to ablate, raising concerns about potential damage to the heart, which could explain why it wasn't fully addressed.
He suggested that if I am hesitant about a repeat ablation, I could start medication for management (currently taking one dose of rhythm control medication in the morning and evening, plus half a dose of antiarrhythmic medication on Mondays, Wednesdays, and Fridays).
Regarding symptoms, while the frequency remains significant, they are milder compared to before the ablation; I used to experience dizziness throughout the day, which has improved, but I can still feel occasional missed beats.

I would like to ask you:
1.
If I still have arrhythmia issues now, is there room to adjust the medication dosage upwards?
2.
Given that I have undergone ablation and am on long-term medication but still experience arrhythmia, and although the symptoms are not prominent, I feel quite discouraged.
Is my condition considered serious? Is it feasible to manage it with medication and coexist peacefully with it?
3.
The physician mentioned that I have no other heart issues and that I am simply predisposed to VPCs.
I am puzzled as to why this is the case and find it frustrating.
I have also consulted a psychiatrist, but the situation seems similar.
I would like to know if my predisposition to arrhythmias is unique or if others experience similar issues.

I apologize for the mixed questions.
Thank you for your response, and I wish you a Happy New Year!

Tim, 30~39 year old female. Ask Date: 2024/02/05

Dr. He Dongjin reply Cardiology

Hello, to be honest, you are prone to VPCs, but they may cause you increased anxiety.
I would suggest actively addressing this, possibly with another round of catheter ablation or increasing your medication dosage.
I recommend seeking a third opinion from another medical center in the northern region to find what makes you feel comfortable and at ease.
Take care, and Changhua Hospital is here for you.

Reply Date: 2024/02/05

More Info

Dear Patient,
Thank you for your detailed inquiry regarding your experience with Ventricular Premature Contractions (VPCs). It’s understandable to feel concerned about your condition, especially after undergoing a procedure like catheter ablation and still experiencing symptoms. Let’s address your questions one by one.

1. Medication Adjustment: The current regimen you are on, which includes antiarrhythmic medications, can indeed be adjusted based on your symptoms and the frequency of VPCs. If you are still experiencing a significant number of VPCs (15,000 in 24 hours is quite a high count), it may be worth discussing with your cardiologist the possibility of increasing the dosage or adding another medication. However, any changes should be made cautiously and under the guidance of your healthcare provider, as they will consider your overall health, the side effects of medications, and how well you are tolerating your current treatment.

2. Severity of Your Condition: While it can be disheartening to continue experiencing VPCs despite treatment, the severity of your condition is not solely determined by the number of VPCs but also by their impact on your quality of life and heart function. Given that your symptoms have improved (less frequent dizziness and palpitations), it suggests that the current treatment is having a positive effect. Many patients live with VPCs and manage them effectively with medication. It is entirely possible to coexist with VPCs, especially if they are not causing significant symptoms or complications. Regular follow-ups with your cardiologist are essential to monitor your condition and adjust treatment as necessary.

3. Understanding Your Condition: It is not uncommon for individuals to have a predisposition to VPCs or other arrhythmias. Factors such as genetics, lifestyle, stress, and even certain medical conditions can contribute to the development of VPCs. Many people experience similar issues, and while it may feel isolating, you are not alone in this. It’s important to continue exploring the underlying causes with your healthcare team, including lifestyle modifications, stress management techniques, and possibly further evaluations to rule out any other contributing factors.

In summary, while your situation may feel challenging, it is manageable. Continuing to work closely with your cardiologist, adhering to your medication regimen, and considering lifestyle changes can help you lead a fulfilling life despite the presence of VPCs. If you feel uncertain about your treatment plan or the effectiveness of your current medications, seeking a second opinion from another cardiologist or electrophysiologist can provide additional insights and options.

Please remember that your health and well-being are paramount, and it’s essential to communicate openly with your healthcare team about your concerns and experiences. Wishing you a happy and healthy new year!
Best regards,
Doctor Q&A Teams

Similar Q&A

Managing Frequent Ventricular Premature Contractions: Options Beyond Medication

Hello Doctor, many years ago during my military service, I was diagnosed with premature ventricular contractions (PVCs). At that time, I consulted a doctor who said it was fine as long as I didn't feel any discomfort. However, due to work requirements, I have to undergo both...

Dr. He Dongjin reply Cardiology
Hello, there are three solutions for premature ventricular contractions (PVCs): 1. Observation and coexistence; 2. Medication; 3. Catheter ablation. Since I haven't seen the electrocardiogram (ECG), it's difficult to provide specific recommendations. I suggest obtaining...

Managing Premature Ventricular Contractions: Treatment Options and Advice

I have been experiencing premature ventricular contractions (PVCs) for a long time, occasionally leading to irregular heartbeats. I am unsure if there are medications available to maintain a normal heart rhythm or if there are other treatment options that could resolve this issue...

Dr. Lin Jixiong reply Cardiology
Hello: Ventricular premature contractions are a common arrhythmia. It is recommended to discuss the pharmacological treatment of arrhythmias with a cardiologist. Dr. Lin Chi-Hsiung.

Understanding Ventricular Premature Contractions: Expert Opinions and Treatment Options

Hello Dr. He: I have experienced palpitations and chest tightness for a while, and this year they have become more frequent. Additionally, I have asthma and a compromised immune system (frequent allergies and urticaria). I have consulted three doctors and would like to know which...

Dr. He Dongjin reply Cardiology
Hello, your episodes seem to be more frequent. We should determine the treatment based on your symptoms. Since you have experienced palpitations and chest tightness more frequently this year, it may not be appropriate to completely disregard treatment with medication. If your sym...

Understanding Premature Ventricular Contractions: Causes and Treatment Options

Hello, Doctor. At the end of last year, I felt uncomfortable due to palpitations, and a cardiologist performed an echocardiogram and a 24-hour Holter monitor test. The doctor said the echocardiogram showed no issues, but the 24-hour Holter monitor indicated early contractions, an...

Dr. He Dongjin reply Cardiology
Hello, the echocardiogram showed no issues. The occasional VPCs over 24 hours are still within a reasonable and acceptable range. At your age, approaching menopause, you may experience more palpitations. The medication is intended to help stabilize your autonomic nervous system a...