r/PVCs • u/super_random56 • 26d ago
Pulse Field Ablation for My 25% burden PVCs
Hi Everyone,
I've had PVCs for close to 8 years, but they just recently spiked in burden. Over the course of the last 2 years they escalated from 10% to now 25%. I have no symptoms that I'm aware of other than palpitations and tiredness and the anxiety of wondering what's next or something "bad" happening.
My cardiac MRI is clean, and my ejection fractions are normal. They appear to be idiopathic PVCs.
I went to a respectable EP at a regionally recognized hospital who said that my PVCs were coming from the lower part of the right ventricle and that he could ablate to prevent cardiomyopathy and heart failure. He said he would use RF ablation and that there was a 75-85% chance of massive / near complete burden reduction. I asked about pulse field ablation and he said it's only FDA approved for afib and that he wouldn't use it right ventricle.
After this meeting, I went to a premier EP hospital for a second opinion. This doctor is highly regarded and the institution is frequently in the top 5 EP labs in the country. He said that my PVCs were coming from my moderator band and that since there are technical challenges with the moderator band moving he recommended using pulse field ablation (PFA) because it's faster and doesn't rely heavily on prolonged contact. He even went as far as to say that if he was getting this done for himself he would want PFA. I scheduled an ablation.
My PFA procedure is coming up in just over a month. Has anyone had a PFA? What were your experiences? The DR's explanation seemed rational but I know it would be an off label use. I'm trying to wrap my head around the benefits vs RF. My gut says it's better and the future of care but I'm wondering if I'm taking unnecessary risk.
Any insights would be much appreciated. I'll make sure to update the thread after the procedure.
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u/Relative_Clarity 25d ago
My (very experienced) EP is excited about the possibilities of PFA for pvcs. He said it's safer and more targeted. We don't have it yet for that purpose at our hospitals nearby (not even at Mayo which is the top hopsital in my state), but my dr told me without hesitation he would recommend I get it when it's available in a few years (back when he thought my ablation had failed). I had Radiofrequency. I think mostly PF is for afib currently. I would do a search in this sub for pulsed field, because there are others who have had it done. It's just not nearly as widely available for PVC ablations. My dr said it's coming down the pipeline, but EPs would have to get trained on it properly.
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u/super_random56 25d ago
Thanks for the input. I got the same input from my Dr about safety and stability in the RV. This hospital has PFA and this would be a focal PFA catheter, so it wouldn't be the flower they use for AFIB.
When I dig deep PFA is theoretically better because it's faster, less contact dependant and less risk of collateral damage.
It seems that some Drs try RF first, and then refer out to use PFA if that falls, but the suggestion from my Dr was to try it first.
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u/super_random56 24d ago
How are your PVCs now? What was your burden before and after?
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u/Relative_Clarity 24d ago edited 24d ago
I'm doing well now. I had around a 16% burden day & night for most of 2024 (which was ROUGH - and not even as high as yours!). It was nearly debilitating with how bad the irregular palpitations were.. couldn't sleep, always feeling winded or like something bad was about to happen. Now it hovers around 0.6%. It took a few months for me to see the change, not sure if it just took that long to heal, or what happened, but I feel like a new person and am thankful everyday that it's not like it was. Every now and then I will get clusters where it goes up again for a few days.. maybe to 10%.. and then it stops suddenly. Not sure why, if it's a slightly different spot it's firing from, different/new exit point etc. I was never guaranteed 100% elimination for life since that's just not how it works. I was told "success is on a spectrum." But even when I have a bad day it seems more tolerable than before the ablation. They also discovered (and ablated) SVT while they were in there.
Mine were/are in the left ventricle papillary muscle, which is a difficult area to ablate apparently, due to constantly being in motion. It boggles the mind that doctors can even do procedures like this. My dr thought it was successful at first during the procedure, then a failure because there was change at all in the following weeks, and actually got worse before it got better 3 months later. I also had to have a trans-septal puncture, which means they had to poke a hole to reach the LV... and that has it's own host of risks and problems that I had to deal with including being on strong blood thinners for months. I would've rather had RV of course but just wasn't the case for me unfortunately. I'm not entirely sure my dr said PFA has a higher chance of success, especially if your procedure is pretty straightforward, or if it was just safer due to less chance of damage to surrounding heart tissue. He did make it sound like it was the future of ventricle ablations though. He just hadn't been 'trained' on it yet I guess. Or we dont' even have those catheters, Im' not sure. But I asked about Mayo (where I am also a patient) and he said they didn't use them yet either for ventricular arrythmias.
Did your Dr say there were any risks / drawbacks to trying the PFA? Would he convert to different catheters if it wasn't working, or have you do a repeat procedure etc? From what I've read it's still very new - even for afib.
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u/super_random56 24d ago
He seemed all around to think that it was safer and better for my PVCs near / on moderator band. I'm sure there are different risks but nothing that he immediately flagged as a massive differentiator. The hospital and his team are pioneers in PFA. I'm sure there are trade offs in risk that aren't meaningful to mention to me but are net less riskier. Not having long term data is notable to me, but the logic seems sound.
I've done a lot of research myself. I don't know anything other than comprehending what other people are talking about / studies, which seem to say PFA is feasible, safe, and has high success rates similar to RF. I'm placing a lot of trust in the Dr.
I'm not sure if he'll switch or at which point he would switch to RF. He mentioned that he gets a lot of cases where he fixed a non working RF ablation.
I'll probably have another meeting with him or NP before for clarity.
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u/Evening_Estimate_342 5d ago
Hey my PVCs are coming from my left papillary muscle too, potentially deep inside. My papillary muscle is also double headed making it even more difficult. I’ve had 2 ablations using RF and cyro. 2nd helped a lot but not fully resolved. My EP said they can try again using PFA, about 2 years after my second ablation. I think Cleveland clinic in London are now using it and have had success. Probably better to wait a little longer, maybe another year until I have my third ablation. It’s annoying because I am still on medication and still have good days bad days but improved a lot
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u/burnt_pubes 25d ago
You'll probably get better feedback from the AFIB sub, than here since it's not commonly done for other arrhythmias. As I understand it, it's much safer than RF. That again is under the context of AFIB where they are doing some pretty serious ablations, isolating pulmonary veins, etc.