18757197 tn?1467648980

PVCs, magnesium, beta blocker and ablation

I'm a 23 year old male and I have been diagnosed of PVCs (Monomorphic Right Ventricular Outflow Tract). I wore a Holter monitor last October and had about 10k PVCs with one pair. Also did MRI with an left EF of 53% with a very slight increase in left mass, but a structurally fine heart. Stress test with no PVCs while running. BP, 120/80.

After, in Febraury, I wore a Holter again and was found with 7k PVCs with 40 pairs. Also did a echocardiogram again with an EF of 55%. I have been told that my PVCs mostly occur while sleeping or resting.

I had no symptoms before all these started, after I was found with this I feel very anxious. I have read a lot and I have found that my type of PVC can be easily removed with ablation. I really just want to do it and forget about it, but meanwhile my cardiologist has started me with 2.5mg of bisoprolol for 6 months,  and I'm not a fan of medication and I fear for possible side effects. I have read the bisoprolol slows down the heart, but my rate is already quite low while resting, 40s-50s, I fear that it can stop if I take that. That's whi I have done research and  read a lot about magnesium helping with PVCs,  there is even a clinical study done in Brazil where it showed a significant reduction of PVCs of all patients (http://www.scielo.br/scielo.php?pid=S0066-782X2012000600002&script=sci_arttext&tlng=en).

That's why in the last 3 weeks I have started taking Magnesium malate about 260mg a day. I have seen a improvement of PVCs in the first 3 weeks but this last week I felt them comming back again with great frequency. I must say also that this last week week has been a stressful one.

What do you think? Should I keep taking magnesium or change it to magnesium glycinate? Should I start taking bisoprolol too or only mag is fine? Should I exercise normally too? Can I convince my cardiologist to consider me for ablation?

Additionally, I have a surgery to correct my nose, and my anesthesiologist has told me check with my cardiologist if it is fine to undergo the surgery with general anesthesia. Do you think I will have no problem?

Thank you very much, I know they are a lots of questions but I would be very greatful if someone can help me.

2 Responses
995271 tn?1463924259
My PVCs have always changed over the years.  I've had very high loads in the 7k per day range and very low.  Mine originate in the RVOT as-well.  It sounds almost exactly like yours.

I also had an MRI.  I'm 100% Italian so I am 4x more at risk for something called ARVD which was ruled out.

My EP talked me out of an ablation and glad he did because they do keep changing.

You also mention that yours are more prone to happen when your heart rate is lower.    When PVCs correlate with a lower rate I've always read and understood that a treatment that would lower your rate would be a bad idea.  In other words I would NOT take a beta blocker.  

Mine ALWAYS got worse while on Beta Blockers or calcium channel blockers.

Read up more on "enhanced automaticity".  That's what I think was happening with mine.  I also feel very strongly it was related to something called "vagal tone", also called many other things.  Understanding CNS tone is very complex.

I'm now 48.  No ablation yet.  There has been no change to the muscle of my heart in all those years.  I do 3 or 4 days vigorous (fairly intense) cardio per week (rowing and running).

I used to take a lot of Magnesium GLycinate which at the time I swore helped but who knows. they always kept changing too much to make a solid conclusion.  

The BB won't stop your heart.

I had a a big surgery back in 2013 while having a lot of PVCs.  I was scared.  I didn't throw a single PVC while under general.    I was fine!  I have a theory about this that gets back to vagal tone.  General anesthesia (certain types) does suppress vagal tone and so this is why I think I was less likely to get them.  If you have a clear EKG (which I'm sure you do), you'll be cleared for the anesthesia and believe it or not, you won't get any PVCs.  Your heart muscle is healthy, it's just twitchy.
Thank you very much itdood, your answers helped me a lot, its glad to see somebody else with silimar a similar condition sharing thoughts. I will investigate more on the vagal tone.

As I thought, BB probably won't help me, so I will keep no taking it as I am currently asymptomatic. I will consider with my cardiologist the ablation. I have found this interesting article regarting RVOT arrythmia. http://content.onlinejacc.org/article.aspx?articleid=1136503#bib22

It shows that very high frequency of RVOT as the cause of decrease of left EV, which can be safely amended with ablation. May be in our cases, the frequency of these beat are not enough to cause a relevant impact of left ventricular function, nevertheless I believe it's importat to keep in mind that it these beats can cause myocardiopahy in the longer run if left un treated. Tha good thing if that after succesful ablation, the EV improves greatly and recovers its normal state.
12492606 tn?1459874033
itdood, with regards to "My EP talked me out of an ablation and glad he did because they do keep changing. "  Can you please elaborate about his reasoning and also explain the changes?  TIA
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