PVC

Pre-operative condition

In 2007, I was diagnosed with Premature Ventricular Contractions (PVC) a form of cardiac dysrhythmia which warrants medical investigation of the heart's electrical conduction system.

My symptoms in September 2010 included:

Tightness in my chest that comes and goes
Shortness of breath after low intensity movement
Occasional perceptions that my heart has stopped

Ironic I should develop a heart condition, as I:

Exercise regularly
Eat healthy foods
Maintain a healthy weight
Don't smoke
I have normal blood pressure, cholesterol and no diabetes.

Animated descriptions:

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 felt only after consuming alcohol, but none of the above symptoms.

2008:

Hand-held sonic heart monitor shows PVC worsening when turning over in bed, and especially when laying on my right side. Decrease alcohol from one drink/day to half that. Still consuming 2 cups of coffee/day, since 1990.

2009:

Further ECG studies quantifies the worsening PVC.

29-Jun-2010:

An echocardiography shows my otherwise-healthy heart, but now getting more bothersome symptoms. Dr. Sarraf prescribes daily half-dose of Metoporolol and refers me to Dr. Ji for an electrophysiology study (EPS) and catheter ablation, as worsening PVC's might 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 which was dormant until recently. He recommends an electrophysiology study, and a cardiac ablation to cure the problem.

Aug-2010:

PVC are nearly continuous (thousands daily) and without provocation (alcohol, caffeine, or stress). Although disruptive, I continue exercising without cardiac limitation, and 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 Left and Right sides of my heart
No leaking of blood through valves (valvular regurgitation)
Cardiac output
Ejection fraction

16-Sep-2010:

Dr. Sarraf reviews 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 70% of minimum healthy level (mine:110 vs. normal>150). Will the amount of any blood-thinner, during surgery be adjusted for my situation?
Answer: Possibility of bleeding will be watched. But at 100,000, usually it's 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 electroan-atomic 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. Sen Ji, MD, PhD, Electrophysioligist, KP LAMC, (323)783-5850

Dr. Nigel Gupta, MD, FACC, Director, CCEP Lab, KP LAMC, (323)783-5850

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

Dr. Rofman, my PCP at Kaiser Torrance, (800)780-1230

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.