PVCs, PACs and SVT risks

  Hi Dr. T. I am a 45 year old woman with a history of PVC's. I have had PVC's since I was 17. Within the last month my symptoms have gotten worse-increasing palpitations, dizziness, shortness of breath. During one episode of sinus tachycardia I was taken via paramedics to the ER. I was placed on toprol 25 mg daily which did not help. I was placed on a 48 hour holter monitor and it showed PVC's, PAC's and 3 episodes of SVT. I have also had episodes of sinus tachycardia with my heart rate around 170's. I attempted to complete a stress echo but could not finish due to an episode of sinus tachycardia. I have been started on diltiazem 180 mg day. I have always taken very good care of myself with low fat high fiber diet, exercise, no caffeine, no nicotine, no alcohol. Is diltiazem the best medication for my arrythmias? Is walking the best exercise to stay healthy? Will the arrythmias shorten my life expectancy?  What about ablation for my symptoms?  

PVCs, PACs and SVT are all arrhythmias for which drugs like beta blockers and diltiazem are often used to reduce their  frequence and incidence.

If your heart has been proven to be healthy otherwise, any further treatment such as an ablation requires consultation with an EP specialized cardiologist.   An EP test will confirm whether there is an "extra nerve" as occurs in most patients with SVT. Whether you would benefit from an ablation depends on the findings, your symptoms and risks involving the arrhythmias, vs. the risks of treatment. 

Just remember this:

  • PVCs and PACs are usually benign
  • Most patients with SVT usually have a benign clinical course.  In other words, SVTs as a rule do not usually cause fatality.  However, in some patients when heart rate reach very high level (above 250 bpm) serious consequences can occur, including fainting spells and Sudden Death. In some cases, heart failure can result from chronic uncontrolled rapid SVT
  • Just because ablation CAN be done, it doesn't mean it SHOULD be done. 

Heart healthy exercise usually requires more than walking. Of course this depends on how physically active you are otherwise.

Hope this helps,

Dr T


I don't know what these "episodes" are. An ablation is only recommended after tests have confirmed treatable disease when the benefits outweigh the risks.

Hope this helps,

Dr T

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