Pre-operative condition

In 2007, I learned I have a worsening heart condition called Premature Ventricular Contractions (PVC) a type of cardiac dysrhythmia that warrants medical investigation of the heart's electrical conduction system.  

As of September 2010, my symptoms include:
  • tightness in my chest that comes and goes
  • shortness of breath after low intensity movement
  • occasional frightening perceptions that my heart has stopped
It's ironic I should develop a heart condition because I: 
  • Exercise regularly
  • Eat healthy foods
  • Maintain a healthy weight
  • Don't smoke
  • I have normal blood pressure, cholesterol and no diabetes.
Informative animated descriptions:
Succinct overview of the problem and proposed solution: 

The electrical system of the heart controls each heartbeat. Electrical impulses generated by special tissue (nodes)  travel set pathways through the heart causing the muscle to contract, or “beat”. When abnormal electrical signals interfere with the normal flow of impulses, an irregular heartbeat occurs.

Cardiac ablation is a procedure used to correct irregular heartbeats by destroying the tissue that creates the abnormal electrical signals. A catheter is threaded into the heart and the tip is guided to the area producing abnormal electrical signals. The catheter then emits a pulse of high-energy electricity that destroys the abnormal tissue and corrects the irregular heartbeat.

Timeline of my situation:

pre-2008:
Palpatations are only felt after consuming alcohol, but they don't cause the symptoms above.

2008
Handheld sonic heart monitor shows PVC worsening when turning over in bed, and especially when laying on my right side.  I transition from averaging one drink/day to half that, trying to isolate the cause.  Still drinking about 2 cups of coffee/day, which I've done since the 1990. 

2009
Further ECG studies quantify the worsening PVC.  

29-Jun-2010:  
An echocardiography shows otherwise-healthy heart, but I start noticing the above bothersome symptoms.  Dr. Sarraf prescribes daily half-dose of Metoporolol and refers me to Dr. Ji to consider an electrophysiology study (EPS) and catheter ablation, as the worsening PVC's could lead to heart failure, or worse, Ventrical Tachycardia, which could lead to sudden cardiac arrest. 

July 2010
I eliminate alcohol completely, and switch to decaf.  Recent electrocardiographs (ECG) show the condition worsening, despite the absence of triggers such as stress, alcohol, caffeine, or coronary disease.  

29-Jul-2010
Dr. Sen Ji believes the condition is caused by malfunctioning heart tissue that I was born with, but that was dormant until adulthood.  He recommends an electrophysiology study, and a cardiac ablation to cure the problem.

Aug-2010
PVC occur almost continuously (thousands per day) and without provocation (alcohol, caffeine, or stress).  Although disruptive/annoying, I continue exercising without cardiac limitation (in other words, I don't feel winded after biking 60 minutes and swimming 30 minutes).  

10-Sep-2010
Start full-time Holter monitor to report symptoms to Dr. Sarraf who recommends ceasing Metoporol and continuing with planned surgery.

15-Sep-2010
Dr. Sarraf finds:
  • No net advantage for me in switching to Verapamil or any other agent
  • An investigatory angiogram would be 
    risky, and is 
    not 
    recommended.
  • Same urgency level for the scheduled catheter ablation
Since I'm not winded during exercise, Dr. Sarraf confirms my heart is normal re:
  • Communications between L & R sides of my heartz
  • No leaking of blood through valves (valvular regurgitation)
  • Cardiac output
  • Ejection fraction
16-Sep-2010
Phone call with Dr. Sarraf to review latest PVC data and finds nothing life-threatening.  Continues to recommend ablation.

21-Sep-2010
Q&A with Dr. Ji: 

Question 1. My platelet count is about 70% of minimum healthy level (mine:110 vs. normal>150). Will the amount of any blood-thinner on Thursday be adjusted for my situation?
A
nswer
: Possibility of bleeding will be very closed watched. But at 100,000, usually it is not an issue. Blood thinner if needed, will be adjusted.

Question 
2. Should I undergo general anaesthesia vs. local+sedation?
Answer: Local + sedation.

Question 
3. Is there any advantage in a 3D electroanatomic mapping, to reduce radiation time? Is there an alternate Kaiser facility for catheter ablation which avoids fluoroscopy? I'd like to minimize the fluoroscopy time, to lessen risk of developing a future cancer.
A: 3-D mapping will be used. It helps reduce radiation. But no facility in the country can avoid it completely.

On reviewing the benefits/risks, Dr. Ji responds with: 

"Benefits include the cure of the tachycardia with a successful rate of >80%. Risks are 1-2%, including, but not limited to, the following: bleeding, pain, vascular trauma, cardiac perforation requiring pericardiocentesis, incessant tachycardia requiring cardioversion, complete heart block, requiring implantation of pacemaker, and a remote possibility of death."

23-Sep-2010:
EPS and catheter ablation by Dr. Ji is postponed.

30-Sep-2010:
Meeting with Dr. Ji to review procedure and platelet count.

07-Oct-2010:
EPS and catheter ablation is performed by Dr. Gupta, Dr. Ostrum, a PA, and two nurses in a catheter laboratory.  

Physicians:
Dr. Guilda Sarraf, Cardiologist at Kaiser Torrance(310)517-3264

Post-op condition
Week 1: heart sensitive to movement, slightly painful. PVC's <1%
Week 2: Trouble sleeping due to recurring PVC's <3%
Week 3: Mild exercise. PVC's <3%
Week 6: Cardiologist Dr. Sarraf who prescribed Metoporolol
2012: Seeing cardiologist Dr. Wu in Santa Monica for pre-VT symtoms which are increasing
2012: Dr. Wu switched me from Metoporolol to Diltiazem at 120mg/day to try to address pre-VT symtoms
Jan 2013: Dr. Wu increased my dosage of Diltiazem from 120mg/day to 180mg/day 
Apr 2013: Dr. Wu asks me to decrease my weight from 235 to 210 pounds.
Apr 2014: Currently 220 pounds, with daily 240mg dosage of Diltiazem helping.

Family: 

Maurene and Grant Nelson, 626-355-7774
Denise Reiser, 310-266-4076
Kristine Reiser, (626) 399-2168
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