Frequent Ventricular Premature Contractions After Catheter Ablation

Frequent premature ventricular contractions (PVCs)

Hello Doctor, I would like to ask about my condition.
In March of this year, I underwent catheter ablation for PSVT, and since the procedure, I have not experienced any PSVT episodes.
However, I have occasionally felt a strong heartbeat or palpitations after the procedure, which I did not experience before the ablation.
I consulted my attending physician, who mentioned that this is a temporary phenomenon post-surgery and that it would gradually return to normal.
Initially, the frequency of these palpitations was low, occurring only 2-3 times a month.
However, since a particular day in September when I engaged in sexual activity and possibly became overly excited, I have been experiencing these palpitations daily.
I later returned to my attending physician for a 24-hour Holter monitor, which diagnosed me with frequent premature ventricular contractions (approximately 2800 VPCs per day).
The doctor prescribed Mexiletine, but after a week with no improvement, the medication was changed to Amiodarone.
After nearly a month on Amiodarone, I still experience frequent premature ventricular contractions with limited improvement.

I would like to ask:
1.
For my condition of frequent premature ventricular contractions, is it sufficient to continue medication for management, or should I undergo further electrophysiological studies for diagnosis and treatment? (I am concerned that undergoing another catheter procedure may lead to other arrhythmias.)
2.
Additionally, I have had an echocardiogram that showed normal results with only mild mitral and tricuspid valve prolapse.
Is there a need for me to undergo a cardiac CT scan? Thank you!

ntwu, 40~49 year old female. Ask Date: 2011/11/11

Dr. He Dongjin reply Cardiology

Hello, based on your description, you are currently troubled by frequent premature ventricular contractions (PVCs).
In fact, if there is no continuous rhythm such as ventricular tachycardia occurring, this type of arrhythmia should not pose a life-threatening risk; it is merely bothersome.
Therefore, is it necessary to take such drastic measures? You seem to be a bit impatient.
The half-life of the aforementioned medication is quite long, and if you believe it is ineffective after just one week without allowing it to fully take effect, switching medications and opting for catheter-based electrophysiological studies for diagnosis may not be necessary.
It would be more appropriate to first try simpler medications to manage the symptoms, such as Inderal.
Changhua Hospital is concerned about you.

Reply Date: 2011/11/11

More Info

Frequent ventricular premature contractions (VPCs) after catheter ablation can be concerning, especially when they manifest as palpitations or a sensation of the heart "skipping" beats. Your experience following the PSVT (paroxysmal supraventricular tachycardia) ablation is not uncommon, as the heart can undergo various changes post-procedure. Let’s break down your concerns and questions.

1. Management of Frequent VPCs: It is essential to understand that VPCs are common and can occur in healthy individuals as well as those with underlying heart conditions. After catheter ablation, the heart may take time to heal, and the presence of VPCs can be a part of this healing process. The fact that your VPCs were diagnosed through a 24-hour Holter monitor indicates that they are being monitored appropriately.
In many cases, if VPCs are infrequent and not associated with significant symptoms or structural heart disease, they may not require aggressive treatment. However, since your VPCs have become frequent (2800 per day), it is reasonable to consider further evaluation. The medications you have been prescribed, such as Mexiletine and Amiodarone (Cordarone), are antiarrhythmic agents that can help manage VPCs. If these medications have not provided relief, it may be beneficial to discuss with your cardiologist the possibility of further electrophysiological studies (EPS). An EPS can help identify the origin of the VPCs and determine if there is a specific area that can be targeted for ablation, especially if the VPCs are symptomatic or affecting your quality of life.

2. Need for Additional Imaging: Your previous echocardiogram showed normal results with only mild mitral and tricuspid valve prolapse. This is reassuring, as significant structural heart disease is often a cause of frequent VPCs. A cardiac CT scan may not be necessary unless there are specific concerns about coronary artery disease or other structural abnormalities that were not evaluated in the echocardiogram. If your cardiologist believes that your symptoms are primarily due to the VPCs and not related to any underlying structural issues, they may recommend continuing with medication management and monitoring rather than additional imaging.

In conclusion, while it is common to experience VPCs after an ablation procedure, the frequency and symptoms you describe warrant careful monitoring and possibly further evaluation. It is crucial to maintain open communication with your cardiologist regarding your symptoms and treatment options. If your symptoms persist or worsen, or if you have concerns about the effectiveness of your current medications, do not hesitate to seek a second opinion or further evaluation. Your heart health is paramount, and addressing these concerns proactively is essential for your overall well-being.

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