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Q. I have backache and chest discomfort following RF ablation. How to confirm it is non-cardiac?

Answered by
Dr. Amit Arora
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 15, 2019

Hello doctor,

I am living with idiopathic RVOT NSVT for over ten years now. I had my RF ablation done a 20 days ago and my ectopic, NSVT episodes have come down by 90% and I am feeling healthy generally.

I had my echo, ECG, Holter, cardiac MRI. Echo, cardiac MRI are normal. Cardiac MRI was done post RF ablation and also has come out to be normal. MRI was ordered to rule out any structural abnormalities and to rule to ARVD, and cardiomyopathy.

I am feeling back ache, shoulder ache, and mild chest discomfort now continuously for a few days. It looks very much like muscle and back pain that I have always and is not related to exertion as some times I feel it even while sleeping. I have not been doing any physical exercise for a couple of months and have put on some weight too.

With normal MRI, echo, ECG except for ectopic beats, can I conclude the pain is not cardiac related? Attaching here with my reports. Does the MRI report also talk about ischemic factors or should I under go any further cardiac tests to rule out cardiac factors? If not cardiac, which specialist should I consult now for my back pain?

Dr. Amit Arora

Cardiology
#

Hello,

Welcome to icliniq.com.

I had gone through your all reports. (attachment removed to protect patient identity).

Your Holter monitoring suggestive of premature ventricular beats some time occasionally, sometime in bigeminy, other time in couplet or NSVT (nonsustained ventricular tachycardia) this could contribute to irregular pulse or palpitation. MRI (magnetic resonance imaging) not suggesting any ischemic areas, and your RVOT (right ventricular outflow tract) also not unduly dilated. There is a very mild defect in the mitral valve but that is not contributing to regurgitation or any symptom so nothing to worry and yes, you can exclude cardiac factor but only after some investigation like x-ray whole spine (cervical, thoracic and lumbosacral region).

For your shoulder and back pain, I want to ask a few things. Since how long you are suffering from this? Is this pain radiate to arms also? Back pain is confined to which area? Lower back or upper back? Did you have an episode of palpitation along with chest discomfort? Until then, I will advise you to use the hard bed without a pillow, do some physical exercises. Take Neurobion once daily for seven days. Reduce wait. Avoid oily foods.


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Thank you doctor,

MRI was taken post RF ablation and to find out any reason for arrhythmias. No ARVD or no other defects were found, hence doctor has told it is idiopathic. Not sure ischemic factors were diagnosed in the MRI but understand from you that MRI has in fact looked out for ischemic factors and no ischemic zones are found. Please correct me if I am wrong. I was thinking MRI test for ischemic factors was different from what ever MRI I had I could be wrong.

To answer some of your questions I have had this pain for a long time, but it looks consistent for the past few days now. Back pain is in the shoulder and some times in the left hand up to fingers. My ectopic NSVT was always asymptomatic and after RF ablation procedure my ectopic beats have come down by 90%. I do not feel any palpitation. There is only some discomfort in the shoulder, left side of the chest and some time in hands and fingers. Which doctor should I consult for the complete x-ray as you had suggested? Is there any specialist? I shall take Neurobin as you had suggested.

Dr. Amit Arora

Cardiology
#

Hello,

Welcome back to icliniq.com.

Very true observation by you. Here I want to make it more clear that arrhythmia or irregular pulse in your case is due to PVC or pre-mature complex or premature beat. In this condition, an abnormal premature beat or heart contraction occurs and there are many reason behind this.These kind of beats originate from an irritable area of the ventricle (heart) and that irritable area is usually an ischemic area and in your case, since these PVC some time occur occasionaly, sometime alter with normal heart beat (bigeminy) so your doctor had done MRI (magnetic resonance imaging) to find any ischemic zones but not able to detect. There are some other reasons also like electrolyte imbalance, excessive tea coffee or certain drugs and sometimes idiopathic (as in your case). But nothing to worry as now you do not have any ectopic or palpitation but still, I will advise you to not to consume much tea or coffee. Your shoulder and back pain had no relation with this and as it radiates to hands and fingers so it could be related to cervical. So better to get an x-ray spine done (cervical region only). You can directly visit some diagnostic center and order this x-ray. If the report shows some abnormality then it could be corrected with the help of cervical collar and some exercises, not a very big problem. You can contact back to us with the report and I can advise you medicines and exercise accordingly or you can visit some orthopedics surgeon.

Until then take Neurobion once daily, some pain killers like Combiflam or Flexon-MR sos (when required )after meals.


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