Woo hoo my heart went back in sinus rhythm and I’m headed home!
Cardiac Ablation for Intermittent Arrhythmia
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This message will share information about my treatment for Premature Ventricular Contractions (PVCs). I hope this is useful for others.
I had a full sternotomy for mitral valve repair and installation of a mechanical aortic On-X valve. This was at Mayo on Sep 14, 2023. Mechanically everything healed fine. I had an excellent surgeon who did everything right. But scar tissue always forms around the incisions, and scar tissue sometimes doesn't transmit the heart's electrical signals correctly. Initially, my heart's electrical system was working fine. I felt fine, my cardiovascular system was improving, my strength was improving. and the cardiac rehab team said I looked great - but some electrical problems were beginning to show up.
About 10 weeks after surgery, my electrophysiologist ordered a Holter monitor 14 day test. This showed that I had 10% PVC loading, which means 10% of my heartbeats were PVCs. This is higher than we want, but not an immediate crisis. Since I was still recovering from surgery we decided to keep me on metoprolol and follow up in 6 months. In May 2024 we did another Holter monitor test for 7 days; this showed 22% PVC loading. My electrophysiologist said 22% loading will seriously damage my heart over time, so he suggested we try an approach other than metoprolol.
He offered 2 options: a drug called Sotalol, or a cardiac ablation.
Sotalol is a beta blocker which also acts on potassium channels. For many people it effectively treats abnormal heart rhythms; some 300,000 people take Sotalol in the USA. However, Sotalol can have some nasty side effects, including occasional dangerous changes to heart rhythms. For this reason a Sotalol prescription is started during a 3 day hospital stay so the patient can be monitored. Perhaps a 70% chance Sotalol will fix my problem, perhaps a 10% chance of an annoying side effect such as slow heart rate, low blood pressure, dizziness, vomiting, etc. There is also perhaps a 1% chance of a major heart rhythm issue during those 3 days in the hospital.
If a patient considers Sotalol's side effects too problematic, or if Sotalol doesn't solve the intended problem, the patient can (carefully under doctor's supervision) be weaned off Sotalol with no long term effects. Of course, the patient would then still have their original problem to deal with.
Cardiac ablation is an outpatient procedure that kills the heart cells which are transmitting the problematic electrical signals in the heart. Perhaps a 70% chance it fixes a patient's problem, and a small chance the patient leaves the hospital with a pacemaker.
I chose Cardiac Ablation surgery because I feared Sotalol might cause a really bad heart rhythm issue.
On Nov 6, 2024 I had a cardiac ablation at the University of Iowa. Surgery was fine, and my recovery was smooth. 3 weeks later we did another 7 day Holter monitor test, which showed I still had 11% PVC loading. This is on the edge of requiring intervention. So my electrophysiologist offered 3 options: monitor my condition with periodic tests; another ablation; or the drug Sotalol.
I still want to live a long life, so I felt we should continue trying to fix my problem. A 2nd ablation would use alcohol to kill more heart tissue, which may kill more tissue than we want. I also learned that Sotalol is pretty safe once you are established on it.
2 weeks ago I checked in at the University of Iowa hospital to start taking Sotalol. The FDA approved procedure for starting Sotalol is to take your first 5 doses in the hospital while wearing a 6 lead monitor continuously for those 3 days. Sotalol is taken every 12 hours; its half life is around 12 hours. They also do an EKG 2 hours after each Sotalol dose.
My only side effect of Sotalol is a slow pulse. I am in the upper 40s each morning. When exercising my pulse will only go up to around 100; before Sotalol I could get my pulse up to 125.
My Kardia Mobile ECG monitor shows that most of the PVCs are gone. In May we'll do another Holter monitor 7 day test. I'll see my cardiologist and my electrophysiologist in June. I am hopeful that my PVC loading will be low enough to avoid further intervention.
I had a full sternotomy for mitral valve repair and installation of a mechanical aortic On-X valve. This was at Mayo on Sep 14, 2023. Mechanically everything healed fine. I had an excellent surgeon who did everything right. But scar tissue always forms around the incisions, and scar tissue sometimes doesn't transmit the heart's electrical signals correctly. Initially, my heart's electrical system was working fine. I felt fine, my cardiovascular system was improving, my strength was improving. and the cardiac rehab team said I looked great - but some electrical problems were beginning to show up.
About 10 weeks after surgery, my electrophysiologist ordered a Holter monitor 14 day test. This showed that I had 10% PVC loading, which means 10% of my heartbeats were PVCs. This is higher than we want, but not an immediate crisis. Since I was still recovering from surgery we decided to keep me on metoprolol and follow up in 6 months. In May 2024 we did another Holter monitor test for 7 days; this showed 22% PVC loading. My electrophysiologist said 22% loading will seriously damage my heart over time, so he suggested we try an approach other than metoprolol.
He offered 2 options: a drug called Sotalol, or a cardiac ablation.
Sotalol is a beta blocker which also acts on potassium channels. For many people it effectively treats abnormal heart rhythms; some 300,000 people take Sotalol in the USA. However, Sotalol can have some nasty side effects, including occasional dangerous changes to heart rhythms. For this reason a Sotalol prescription is started during a 3 day hospital stay so the patient can be monitored. Perhaps a 70% chance Sotalol will fix my problem, perhaps a 10% chance of an annoying side effect such as slow heart rate, low blood pressure, dizziness, vomiting, etc. There is also perhaps a 1% chance of a major heart rhythm issue during those 3 days in the hospital.
If a patient considers Sotalol's side effects too problematic, or if Sotalol doesn't solve the intended problem, the patient can (carefully under doctor's supervision) be weaned off Sotalol with no long term effects. Of course, the patient would then still have their original problem to deal with.
Cardiac ablation is an outpatient procedure that kills the heart cells which are transmitting the problematic electrical signals in the heart. Perhaps a 70% chance it fixes a patient's problem, and a small chance the patient leaves the hospital with a pacemaker.
I chose Cardiac Ablation surgery because I feared Sotalol might cause a really bad heart rhythm issue.
On Nov 6, 2024 I had a cardiac ablation at the University of Iowa. Surgery was fine, and my recovery was smooth. 3 weeks later we did another 7 day Holter monitor test, which showed I still had 11% PVC loading. This is on the edge of requiring intervention. So my electrophysiologist offered 3 options: monitor my condition with periodic tests; another ablation; or the drug Sotalol.
I still want to live a long life, so I felt we should continue trying to fix my problem. A 2nd ablation would use alcohol to kill more heart tissue, which may kill more tissue than we want. I also learned that Sotalol is pretty safe once you are established on it.
2 weeks ago I checked in at the University of Iowa hospital to start taking Sotalol. The FDA approved procedure for starting Sotalol is to take your first 5 doses in the hospital while wearing a 6 lead monitor continuously for those 3 days. Sotalol is taken every 12 hours; its half life is around 12 hours. They also do an EKG 2 hours after each Sotalol dose.
My only side effect of Sotalol is a slow pulse. I am in the upper 40s each morning. When exercising my pulse will only go up to around 100; before Sotalol I could get my pulse up to 125.
My Kardia Mobile ECG monitor shows that most of the PVCs are gone. In May we'll do another Holter monitor 7 day test. I'll see my cardiologist and my electrophysiologist in June. I am hopeful that my PVC loading will be low enough to avoid further intervention.
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