Getting Ready for a Premature Ventricular Contraction Ablation

Premature ventricular contractions (PVCs) are an abnormal heartbeat that come too early. They are common and can happen in people of all ages. PVCs can cause symptoms, but they don’t always. They can sometimes be dangerous, especially if you have other heart disease. Without other heart disease, they might not be dangerous, but they can weaken your heart muscle, especially if you have a lot of them.

What happens during a PVC?

During a PVC, an abnormal heart signal disrupts the normal heartbeat. This signal comes from the bottom chamber of the heart (ventricle) instead of the top chamber of the heart (atria). The signal causes the ventricles to squeeze too soon, and the heart skips the next normal beat. The early heartbeat (PVC) is followed by a short “pause” before the next normal heartbeat. Even though a PVC is an early heartbeat, many people who feel them describe them as a skipped heartbeat. This is because they feel the pause that comes after the PVC, which often feels like a skip.

What are other symptoms of PVCs?

Sometimes PVCs cause no symptoms at all. Other times, a patient may feel palpitations (irregular heartbeats). These can feel like “skipped” beats, or “flopping” in the chest, as described above.  If PVCs are frequent, other symptoms can occur. These include:

  • Feeling tired or fatigued

  • Feeling weak or faint

  • Shortness of breath

  • Chest pain 

These symptoms can occur because PVCs make the heart pump blood less effectively, so less oxygen is delivered to the body.

What is an ablation?

It is not a surgery. It is a procedure that destroys the heart cells that are causing your PVCs. In an ablation, your doctor finds the areas of your heart that put out abnormal electrical signals that cause PVCs. The doctor then sends energy to these areas to destroy or “ablate” them. Most people spend one night in the hospital and go home the next day.

What can I expect before the ablation?

  • Testing. You will have blood work drawn.

  • Medicines. If you are on medicines to help keep your heart in normal rhythm (anti-arrhythmics) or medicines to keep your heart rate slow, your doctor may have you stop them a few days before your procedure. If you are on a blood thinning medicine (Coumadin, Pradaxa, Eliquis, Xarelto or Savaysa), you will probably not stop this before the ablation. You will get specific instructions on any medicines your doctor wants you to stop taking.

  • Tubes. The day of the procedure, you will have IVs put in your arms.

What Happens During the Ablation?

You will get medicine to make you sleepy and not feel pain. Catheters (long, thin tubes) are used to find and ablate the problem areas of your heart.

  • Getting started. We wash the skin where the catheters will be inserted (both of your groin areas, and sometimes the right side of your neck). We may remove any hair in that area. To help keep the areas germ-free (sterile), we cover your body with sheets. Only the areas where the catheters will be inserted are exposed.

  • Inserting the catheters. We numb the skin where the catheters will go in. We use a small needle to make a hole in the vein, then guide the catheters to your heart. X-ray and ultrasound monitors help us guide the catheters.

  • Finding the problem areas. We use some of the catheters to make an electrical map of your heart. This is called an EP study. If your heart is not already in atrial flutter, your doctor will try to cause it go into atrial flutter. Using the map as a guide, the doctor knows where to ablate.

  • Fixing the problem areas. We send energy through the catheters to ablate the problem areas. We can do this with either radiofrequency to “burn” them or cryotherapy to “freeze” them. After ablating, we test your heart rhythm and try to make it go into atrial flutter again. If it won’t, the procedure is finished. If it does, we will see if you need more ablation. The procedure usually takes about 3-4 hours. It may take longer depending on several factors. These include the location of the PVCs (some areas are more difficult to reach than others) or how many areas of your heart need to be worked on. Most of the time PVCs come from just one area, but sometimes they come from 2 or more areas.)

  • Finishing up. When we are done, we take the catheters out of your body. We put a stitch in each catheter site to keep it from bleeding. We may hold firm pressure on the sites for a few minutes. You will be asked not to move your legs for 4-6 hours. You won’t be able to get out of bed during this time. This helps us make sure the catheter sites don’t bleed. The stitches are taken out before you go home. 

What are the risks?

There are risks with an ablation, but they are low compared to the benefits most people receive. The risks depends on the location of the PVCs. Because our doctors are very experienced with ablation, at UK hospital, the risk of damage to the heart needing for emergency surgery to correct or death is very low (less than 1%). More common and much less serious is the risk of bruising and sometimes developing a “hard knot” (called a hematoma) where the catheters go in. Your doctor will discuss the risks with you and whether or not an ablation is the best option for you.

What can I expect after the ablation?

For the first few days after an ablation, many people have:

  • Chest discomfort

  • Soreness and bruising at the catheter sites

  • Bruising where the catheters were put in

Some people have swelling, especially of their hands and feet.

How often does it help?

In general, PVC ablations are very successful. If your PVCs are only coming from one area of your heart, about 80% to 90% of the time we are able to lessen and sometimes eliminate your PVCs with an ablation. This number may be higher. But if the PVCs are coming from more than one area of the heart, the number may be lower.