Ablation and Heart Function

Hi, I am a 47 year old African American woman who has had an ICD/Pacemaker for nearly a year. Right before having my device implanted I was told I had bigeminy heart beats that were severe, and that my EF was around 30%. After placement my EF was up to 42-47%. Now, nearly a year later, I am told by my new EP doctor that my EF is 20-25% and that it could be my extra beats of VT causing my heart to weaken and thus I should have an ablation right away. I am an avid exerciser, and I jog and lift weights and sometimes do two hours of cardio a day without a problem. I understand about my heart's extra beats and how they might impact me negatively, but I just can't wrap my mind around a 20-25% EF when I feel fine. Can you give me a bit of clarification and your insight on this situation? Thank you.

I think you are right. An EF=20-25% (about 1/3 of normal heart function) is low enough that you would not be able to exercise at those levels. It is not unusual with your rhythm under control that your heart function would improve, especially if you have recovered from this (viral?) "cardiomyopathy". However, the cardiac illness that you were treated for may still have some active components and thus the possibility of worsening. The best and simplest way to judge this is with serial cardiac ECHOs. Ultimately, an ECHO is only a snapshot of what happens at that precise moment, and thus changeable under different circumstances. I would ask for a stress  ECHO.
You can read more about ablation and stress ECHOs here:
Stress tests

Hope this helps,
Dr T


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