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My cardiac ablation at the end of September 2020 immediately stopped the fast beat sequence (SVT, or supra-ventricular tachycardia) that was happening, but no early ventricular beats (PVCs) occurred during the entire procedure. My latest EKGs show sinus rhythm with junctional escapes and some early atrial beats (PACs), but no PVCs. I’m still making adjustments for my thyroid, cholesterol, and blood pressure; also my glucose has been higher lately, along with about a 15-pound weight gain since July.
After my 30-day follow-up visit, my electrophysiologist started me on Flecainide 50 mg twice daily, which is a “sodium channel blocker”; after a month I think I’m more normal most of the time and at least my irregular beats are not really noticeable any more. I also have a 3-month follow-up with my cardiologist soon so I’ll see what he says.
My latest thyroid test shows that it’s still low on 50 mcg levothyroxine. At least my TSH dropped from 65 down to 12, but that’s still high, which indicates that my actual thyroid is low (but “less low”). So my endocrinologist wants me to take 2 tablets on Saturday and Sunday, and just 1 Monday-Friday; this would be average about 63/day over a week rather than increasing my dose up to 75 because the last time they did that my thyroid went too high. So I will check it again in 6 weeks.
My last metabolic panel showed a high potassium (5.6), aod they had me do another one 2 days later but it was still high (5.7). So the cardiologist wants me to stop my lisinopril 50 mg, and start taking amlodipine 5 mg for high blood pressure instead, and then check my potassium levels again in about 3 days.
Several months ago my Crestor was increased from 10 to 40 mg to aggressively get my cholesterol and LDL down (because of my recently-discovered coronary artery disease – high calcification in 3 arteries). This latest lab saw a huge decline in cholesterol to 107 and LDL to 31. Because I have been having hip aches and stiffness since my Crestor has increased, they suggested to try cutting the pills in half for a while to see if that improves my hips, and it does seem to help already. They figured there was now more room to relax the statin dosage without causing the cholesterol to rise much.
And my endocrinologist is increasing my Tresiba fast-acting insulin at bedtime from 9 to 10 units, and changing my carb ratio from 12 to 10 grams per unit of Novolog at dinner (like it is for breakfast and lunch). Of course, the Thanksgiving holiday and leftovers didn’t help much, and I’ve probably had more snacks that I should. So I just need to double-down and really get my glucose levels back in-range again like I had done for a while earlier this year. It’s always a constant struggle.
So we’ll see how these changes work.
My cardiac ablation procedure last Friday morning was successful. I think I now have a normal sinus rhythm again without all the early beats or fast heart rate sequences I had for recent months. That’s what the doctor told my wife when he visited her while I was in recovery. At least I’m not constantly aware of irregular heart rhythms like I was before, so it seems like it’s getting back to a regular pattern where you usually don’t notice your heart most of the time.
I was scheduled at 7:30 am as the first patient of the day in the Texas Cardiac Arrythmia Institute at St. David’s Medical Center main hospital in Austin. We had to arrive at 5:15 am, and it’s almost an hour’s drive from our home, so we needed to wake up at 3:45 am. At least there’s not much traffic at that time. My wife came with me since I was allowed only one guest. I had received a negative COVID-19 test just 2 days before my outpatient procedure.
It took somewhat longer than they expected because some of the areas they need to zap were very close to the main electrical pathway through the heart, so they had to be especially careful not to affect that at all. It actually took about 3 1/2 hours, when they initially thought it might be 1 1/2 to 2 hours. However, I’m glad they took the more time to be extra careful and get it done right; I was out during that part of the procedure anyway.
Initially, they weren’t seeing many PVCs (early ventricular beats), like I usually had when I was wearing the Zio monitor (about 13%), but there were tons of PAC (early atrial beats) happening in triplets (3 in a row). They gave me adrenaline through my IV line to get my heart revved up so it would be easier to catch them and identify the spots that needs to be fixed.
My doctor had warned me that at times my heart would be racing with somebody else driving. He said it might feel like having 3 cups of coffee all at once, and I felt more and more jittery until it felt like I was actually bouncing off the table. It really got going, at least 115 bpm that I remembered hearing them tell me. I was awake throughout the electrical mapping part of the procedure before they put me out during the ablation phase when fixing the problem spots.
To perform this heart procedure, they needed to insert electrode catheters via the large femoral thigh vein in my groin up inside my heart to do the electrical mapping for the electrophysiology study and ablation to disable the misbehaving heart cells that triggered the arrhymias. They used an Abbott Perclose ProGlide suture-mediated closure (SMC) system to seal it off and stop any bleeding with a quicker recovery time so I was able to go home that afternoon.
That evening I noticed that I had a fever of 101, and the discharge instructions said to contact the doctor is it was over 100. I talked to the on-call electrophysiologist, and he thought it was probably just a “stress reaction” and to take 2 Tylenol, which did the trick and brought it down.
Also my blood glucose kept going up, until it was over 600. which is my meter’s measurement limit. That’s getting in the scary-high range, so I contacted the on-call endocrinologist to get some advice. Besides drinking lots of water to help dilute and flush my blood, she had me take a correction insulin dose to get it down. I then checked it periodically throughout the night to make sure it was going down, which it did (slowly).
I had disconnected my Dexcom G6 CGM before my procedure because I was concerned that the electro-magnets, X-ray imaging, etc. might affect my transmitter. I put it back on Saturday with a new sensor, but primarily relied on fingersticks over the weekend while it was calibrated to get back on track.
I was tired over the weekend, but I’m feeling good now. I am very glad to have this procedure done and behind me, and that it worked out well. I’ve gone for walks the past several days, and everything seems to be healing nicely (with the expected bruising near the access site).
I understand that it’s normal to still have some irregular rhythms for several weeks while healing from the heart irritation and inflammation; several small spots in my heart were actually damaged (on purpose) to eliminate the arrhythmias from those locations. I have a follow-up visit at the end of this month to get all the details about the electrophysiology study and ablation procedure, as well as check my ECG at that time.
I thought I would provide some information about my recent irregular heart rhythms, multiple tests, and scheduled cardiac ablation procedure this week. I have included screenshots from my heart monitor results, as well as video about Texas Cardiac Arrhythmia Institute at the end. Besides telling you what’s going on with me, I thought it might be interesting or helpful to others as well (even though it’s somewhat long).
Heartbeats normally occur between 60 and 100 per minute; it’s tachycardia when higher, and bradycardia if lower. My regular (sinus) heart rate averaged 57 beats per minutes (bpm), which is slightly below normal, with minimum 39 early morning and maximum 109. I understand it tends to be slower during sleep.
I have frequent premature contractions, or early beats, from both ventricle (PVC) and atria (PAC) that disrupt the regular sinus rhythm. This irregular heart beat is known as an arrhythmia. Also, there are fast heart rate episodes called supra-ventricular tachycardia (SVT) that I’m having with a maximum 156 bpm.
My maximum normal sinus rate was 109 bpm, with PVCs present.
My minimum sinus rhythm was 39 bpm; PVCs occurred when slow or fast.
In some cases, there were both types of early beats (PAC & PVC) even when slower.
I am also definitely having premature heart beats, which are called “ectopic” by cardiologists. There are two types depending on which heart chamber is the source (atrium/upper or ventricle/lower), and I have both.
For a few months now, I have been having heart rhythm issues with frequent premature ventricular contractions (PVCs), which are extra early heart beats between the normal regular rhythm (known as sinus beats). So after a normal beat, another quickly follows and then there’s a long pause before the next regular sinus interval that’s stronger than usual because more blood fills the chamber than normal that must be pushed out. So it’s like “regular (sinus) beat … early (PVC) beat … long pause … Boom (next regular beat – louder and stronger)”.
This shows normal sinus rhythm interrupted by early beats (PAC & PVC) that are followed by a pause (skipping the next regular sinus beat). These early beats are then followed by a longer pause, so they feel like a skipped beat (“palpitations” or “flutter”).
Most occurred as isolated events, and both are frequent, with PVCs twice as often as PACs. Notice the extra beat between the regular sinus beat intervals; there were two different ECG pattern shapes detected, but one was dominant and the other fairly rare.
PVCs often occur in repeating patterns. Some occasionally happen in pairs (or “couplets”) as two consecutive PVCs.
However, there were a few with three in a row (“triplets”).
When every other beat is a PVC, it’s known as “bigeminy”, and my longest was 8 minutes.
It’s “trigeminy” when every third beat is a PVC, and my longest sequence lasted 3 1/2 minutes.
A fast heart rate is called “tachycardia”. I had 86 intermittent (or “paroxysmal”) supraventricular tachycardia (SVT) episodes with at least 4 in a row that occurred in the atria/upper chamber (“above ventricle”). During those periods, my average heart rate was 124 bpm with a maximum of 156. However, I had no ventricular tachycardia with 4 or more, which can become dangerous.
I knew I had occasional PVCs from when I wore a Holter heart monitor for a week several years ago. At that time, I think they might have detected about 6 PVCs over the entire week that I wore it, whereas now they happened pretty much all the time; now there were 38,166 early PVCs over 84 hours, or almost 8 per minute. That earlier test also showed I have a mitral valve prolapse, where the flaps don’t quite close all the way and there is slight leakage between the ventricle and atria chamber.
Here’s a summary of my frequent PVCs, which occurred both day and night.
Initially my endocrinologist found I had low thyroid so they started me on 50 mcg levothyroxine. However when I was tested the next time, it then showed that it was then quite high, so I guess that dose was too much. She had me skip it one day a week, effectively making it about 43 mcg. The following time it was still slightly high, so she switched me to only 25 mcg, which then stabilized my thyroid in the low normal range where I am now.
For a while I noticed shortness of breath, even just taking neighborhood walks, as well as swollen feet, ankles and lower legs. Also was feeling generally jittery too. At first I had thought it might have been due to the higher thyroid level, but those symptoms have disappeared more recently. So I’m not quite sure what caused that, but possibly it might have been associated with the irregular rhythms.
I had been concerned that I might have congestive heart failure (like my mother), so my cardiologist ordered a BNP Pro test to check for fluid overload, electrolytes etc, but they were all great. So I definitely do no have heart failure.
I had an appointment to see my cardiologist (Dr Michael Grad) in July. I feel confident that he really know what’s he doing; he’s Director of Cardiology at St David’s Round Rock Medical Center. He confirmed that I definitely have frequent PVCs. He heard several just listening on his stethoscope and also on the office EKG. He recommended several tests for me to get:
My last cholesterol test was slightly elevated so the cardiologist wants to be more aggressive about getting that down as a preventative measure with my coronary artery disease. So he raised my Crestor statin (generic Rosuvastatin) from 10 to 40 mg.
They had me take my blood pressure at home each day to determine if they might need to increase my Lisinopril BP medication from 20 to 40 mg. However, my readings for about a month indicate that it is really good so there is no need to change the dose. Sometimes my blood pressure monitor indicates a slower pulse; however that might be off because it can’t really be detected properly with the frequent PVCs.
Also my latest thyroid test was back in low normal range, so I will continue the 25 mcg levothyroxine dose.
I have a calcium score of 5,200 that indicates very significant calcification in my coronary arteries (anything over 400 is considered “significant”). There are 3 coronary arteries with plaque build-up on the walls. I don’t know how long it’s been there because I never did one of these tests before. However, it’s not affecting the blood flow yet. My cardiologist said it’s substantial, maybe about 40-50%, but doesn’t require intervention with something like stents (or bypass) until it gets over 70%.
The echo cardiogram was really good! Ventricle walls were normal and not enlarged or stiff. I still had mild mitral valve leakage, but that’s not really a problem (and fairly typical with older age).
This chemically-induced stress test (no treadmill) was normal with NO blockages! My heart had a “good squeeze”, showing a 69% ejection fraction, which indicates that most of the blood was pumped out on each contraction. Since I do have plaque calcification, we just need to focus on preventative risk factors like keeping cholesterol and blood pressure down.
I wore a Zio heart monitor from iRhythm Technologies for 3 days. This small monitor had electrode wings that was simply applied to my chest above my heart with adhesive backing. I had to shave first, then prep the skin with an abrader to rough the skin a little, and clean with alcohol swab for good contact.
There was a button to click on the monitor, and an iPhone app to log any symptoms (that syncs with the data), like irregular beat, pounding, etc. The entries included date/time, symptom, duration, and activity (what I was doing). For me, it was pretty much all the time so I primarily recorded an entry once a day, rather than every time I noticed something. I mailed it back to San Diego after the 3 days, they analyzed the data, and sent a detailed report to my cardiologist with the results.
This was much better that my previous Holter monitor experience since there were no multiple electrode attachments and wires to a transmitter device hanging from my neck and associated smart phone to transmit data to a central location in Chicago for processing.
The results from about 3 days with the heart monitor were very interesting! My cardiologist provided this summary.
My cardiologist had recommended that I see an “electrical” heart doctor known as a cardiac electrophysiologist, who specializes in irregular heart rhythms (or arrhythmias). They receive several additional years of training beyond what a normal cardiologist receives. I saw Dr. David Tschopp, who was outstanding. He’s with a Texas Cardiac Arrythmia group associated with St David’s Medical Center and Austin Heart Hospital.
He reviewed my Zio heart monitor results to investigate any underlying cause for the frequent PVCs that might need fixing, and discussed his recommendations with me. He summarized my condition as follows.
He said that I need ablation for the PVC, PAC & SVT, but that I do not have Atrial fibrillation (or A-fib), which actually occurs in the pulmonary vein coming into the heart (atria) with fresh (oxygenated) blood from the lungs. At least my sinus rhythm (regular beat) is good with no “pause”, and no ventricular tachycardia (which is dangerous).
The premature ventricular contractions (PVCs) all seem to be coming the same place, and he can fix that with a cardiac ablation. I also discovered that I have premature atrial contractions (PACs) too, so I have extra beats in both chambers.
This shows some single early atrial beats (PAC), identified as a supraventricular ectopic (SVE).
Sometimes they occur in pairs between regular sinus rhythm intervals like shown here.
I also have supraventricular tachycardia (SVT), or fast heart rate episodes in the upper (atrial) chamber, possibly triggered by the PVCs. He showed me quite a few times where it appeared it might have been triggered following the PVCs, where suddenly it was “off to the races” for a short period.
Here’s a summary of those SVT episodes, which averaged about 124 bpm, and occurred throughout the day.
My maximum heart rate during an SVT run was 156 bpm; it averaged 140 bpm with 63 beats over a 30-second interval. It appears this might have been triggered by the PVC couplet just before.
This shows my longest SVT sequence lasted about 48 seconds with 99 beats averaging 125 bpm. Here again it looks like a pair of PVCs might have kicked it off.
Here you can see some early beats, and then I’m “off to the races” with an SVT episode sequence of fast heart rate up to 150 bpm for a while, back to normal rhythm, and then more early beats at the end.
Several patterns (on different days) were triggered by the monitor that looked rather chaotic, abnormal, and somewhat scary.
I’m not really sure what was going with these, but they included multiple frequent PACs and PVCs and very irregular patterns.
When I noticed symptoms, I pressed a button on the monitor, and recorded the event information in a companion Zio app on my iPhone. These are identified in the report with associated triggered events and details around that time, as shown here with the circled area of the chart.
Here was a time while just watching TV in the evening where I actually had trigeminy, or PVC’s every 3rd beat, along with some PACs too.
There were several times when my blood glucose was low (70) during the night when I awoke from my CGM alert, and I noticed irregular patterns at those times which I recorded in the Zio app (diary).
This identifies there was PVC bigeminy occurring every other beat during this period because the normal sinus rhythm is suppressed after a premature contraction.
This was another time when I noticed early beats after waking with a low glucose alert.
I have a cardiac ablation procedure scheduled at 8 am later this week. It’s considered an outpatient procedure. I will arrive 2 hours early, and it takes about 1 1/2 hours usually, with 1-3 hours recovery (and probably an overnight stay). I can have 1 guest so my wife can come, and she will need to drive me home.
After they do an electrophysiology (EP) study to map my heart electrically from inside and identifying the source of the arrhythmias, he will zap those abnormal cell spots with radio frequency energy (“heat”) using catheters guided by robotics and electromagnets to permanently stop the PVC, PAC, and SVT from happening again.
It will be done in the Electrophysiology Center of the world-class Texas Cardiac Arrhythmia Institute at St. David’s Medical Center main hospital in Austin, where they have a special room with the most advanced technology in the world.
Electrophysiologists are heart rhythm specialists, or cardiologists with extended training as “electrical” heart doctors. This is an international treatment, training, and research center specializing in heart rhythm disorders – the first of its kind in the US.
Watch this 3-minute video about this new dedicated EP center that opened last year, although TCAI was initially established over 10 years ago. My electrophysiologist (Dr. David Tschopp) is shown at the beginning and end in this video.
Overall, these tests were all really good news, and quite a relief, even though there are some issues that need to be addressed. I will provide an update after the procedure to let you know how it went, and whether it resolved my irregular heart rhythms.