Would anyone know an electrophysiologist  willing and capable of treating PVCs. 

 

https://www.bumrungrad.com/en/doctors?docid=072074

 

 

39 minutes ago, Sheryl said:

 

https://www.bumrungrad.com/en/doctors?docid=072074

 

 

Seen him, he  didn't  suggest ablation even though I was at 15% PVCs, which got worse, probably over 30% with persistent bigeminy. Now, since end of March I have very few.

 

It bothers me  that Thai doctors might see non symptomatic PVCs as always benign while they  get treated in the West when the burden reaches set limits. I went to see another cardiologist at Bumrungrad in February, he's reaction was "oh now you have PVCs all the time, come back for another echo within a year".

 

 

Just now, KiChakayan said:

Seen him, he  didn't  suggest ablation even though I was at 15% PVCs, which got worse, probably over 30% with persistent bigeminy. Now, since end of March I have very few.

 

It bothers me  that Thai doctors might see non symptomatic PVCs as always benign while they  get treated in the West when the burden reaches set limits. I went to see another cardiologist at Bumrungrad in February, he's reaction was "oh now you have PVCs all the time, come back for another echo within a year".

 

 

Even in the West, it is not customary to do ablation unless cardiac function is compromised. What is your LVEF?

 

 

32 minutes ago, Sheryl said:

Even in the West, it is not customary to do ablation unless cardiac function is compromised. What is your LVEF?

 

 

Don't  know the value, but in the past 15 month I had a couple of echographies, which were [still] normal. My understanding was that ablation was to be considered  if the PVCs  were symptomatic or when the  burden was over 10 to 20%. 

Our 18-year-old son went for a physical exam here in Bangkok as required by the US university he is now attending. The exam revealed he had PVCs of about 11%. We were told by local doctors that no limitation on physical activity was needed and no treatment necessary. In other words, "it's nothing".

 

Nine months later son ends up in ER for two days in the US after feeling dizzy and faint following rugby. After extensive tests, the PVCs were identified as the likely cause.

 

He's had the ablation procedure earlier this year and the PVCs are now less than half a percent. He's been given the green light to participate in sports and will follow up in a few months with his cardiologist to see how his cardiomyopathy has resolved.

 

Given Thai hospitals' propensity to over-treat and recommend everything they can think of, I can't imagine why ablation was not recommended here. Perhaps they don't have anyone that can perform it.

 

 

6 minutes ago, Etaoin Shrdlu said:

Given Thai hospitals' propensity to over-treat and recommend everything they can think of, I can't imagine why ablation was not recommended here. Perhaps they don't have anyone that can perform it.

My guess would that there aren't too many electrophysiologists in Thailand and that they are busy treating AFIB cases.  As a result of which they are only mildly interested in PVCs an have limited experience in ablating them.

25 minutes ago, KiChakayan said:

Don't  know the value, but in the past 15 month I had a couple of echographies, which were [still] normal. My understanding was that ablation was to be considered  if the PVCs  were symptomatic or when the  burden was over 10 to 20%. 

Main indication is decreased cardiac output.

 

With normal cardiac function, symptomatic PVCs would be preferrably treated with lifestyle changes and medications. Only if these failed and symptoms are really intolerable might ablation be considered.

 

What medications have been tried so far?

 

You could try https://www.bangkokhospital.com/en/doctor/assoc-prof-dr-charn-sriratanasathavorn

 

No guaranatee he will think ablation indicated -- especially as you say the PVCs have been infrequent since March. But no harm in trying.

1 hour ago, Sheryl said:

No guaranatee he will think ablation indicated -- especially as you say the PVCs have been infrequent since March. But no harm in trying.

Thanks.

1 hour ago, Sheryl said:

What medications have been tried so far?

Bisoprolol 2.5mg daily. Didn't seem to help at all for about a year. I was about to switch to a Calcium channel blocker when my PVC burden dropped dramatically.

 

I'll contact Bangkok Hospital, or possible Vejthani once the come back.