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PAC/PVC worrys
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MedHelp Member's Question

PAC/PVC worrys

by timj141, Apr 18, 2007 12:00AM
Thank you for this opportunity. I am 42 years, in very good physical condition, and have a history (4 years ago) of A. Fib. I have had not reoccurance of it. About 6 weeks ago on a run I noticed a skipped beat. I have since went thru all of the tests at the ER and with my cardiologist. It was diagnosed as PACs, PVCs, and SVES. I wore a holter moniter for 24 hours. They have all said the same thing and agree with most of what is posted here - dont worry about it. I am a competitive runner and I have the Ok to continue running.
The problem is that the PACs really get active when I run and usually remain that way for about 24 hours (occuring every 5 seconds or so).  Other triggers are eating (everytime), upon waking, any physical activity, and stress. Mostly typical except for the eating. I have also had a tremendous amount of gas (belching) for a while that started prior to the PACs. My questions are: 1. Could the PACs/PVCs be caused by a gastrointestinal problem? 2. Is it really safe to continue to run when it increases dramatically when I do? 3. Why does it happen when I eat? 4. Is there a procedure such as ablation that may work? 5. Is this a trigger for A. Fib.?
I have stopped all caffiene and alcohol intake. I have increased my dosage of Toprol (to 50 mg). I have decreased my stress level as much as possible. I have stopped running. None of these things seem to be helping. To say this has negatively affected my life would be an understatement. The anxiety that accompanies this condition is tremendous at times. One more thing, I have a follow up visit with my cardiologist soon. I like the guy but his response to relax and learn to live with it seems almost obtuse. It may be the least dangerous thing he sees in a patient but it is huge to me. It seems from my research that a cure for this appears to be ambigous. Is that the case? Thanks, Tim
Doctor's Answer

by Forum-M.D.-MJM, Apr 18, 2007 12:00AM
Hello,

1. Could the PACs/PVCs be caused by a gastrointestinal problem?

I am intrigued that both posts today mention belching and gas, but am still at a loss for the cause.  Atrial fibrillation during eating and while falling asleep is usually attibuted to vagus nerve or the parasympathetic nervous system.  The vagus nerve is active during digestion.

2. Is it really safe to continue to run when it increases dramatically when I do?


Yes.

3. Why does it happen when I eat?


It could be increased activity of the vagus nerve.

4. Is there a procedure such as ablation that may work?

With the atrial fibrillation as infrequent as you describe, I don't think an ablation is the right option yet.  If it becomes more frequent, you are a very good candidate for an atrial fib ablation.  Pac ablations are difficult unless there is a single morphology (location) PAC that is easy to map.


5. Is this a trigger for A. Fib.?

It may be, but you will have to wait and see if it comes back.

It seems from my research that a cure for this appears to be ambigous. Is that the case?

The personalities that are drawn in to cardiology is one that likes to fix problems.  There is no easy fix to pac/pvc's and think that frustrutes you and us alike.

There is some research into the origin of ectopic beats.  Just last month in the heart rhythm society journal there is an article about neural crest cell migration and the origin of pvc/pac's.  I do not think we are very close to a 'cure' yet.  Ablations can help, but people have multiple morphologies and are difficult to treat with ablation.

I hope this helps.  Thanks for posting.


Thanks, Tim
Member Comments (31)

by arthur, Apr 18, 2007 12:00AM
To: timj141
Your symptoms are similar to mine, although I am now 59 and they started when I was about 53.  I've been running and playing soccer all my life.  It's my understanding that many athletes who train vigorously and routinely have a tendency to develop enlarged left ventricles (a good thing, as this is muscle and not edema).  In doing so, other things get stretched as well.  These things include the pulmonary vein entries (ostia) to the back of the heart at the atria.  It has been found that foci (electrically active cardiac tissue located randomly in normal cardiac tissue) that are located in the PV ostia can and do leak their electrical signalling into the normal timing pathways of the heart.  When this happens, you get the premature beat.  Atrial origins result in PACs.  Enough of them can result in PAF.  The theory is that stretched tissue affords more opportunity for the ions pumped out by these foci to affect the heart's normal rhythm.  

If they stay at the PAC level, they are absolutely harmless, but of course, may be difficult to ignore, especially when running.  I have found that a focussed effort to ignore them, in particular, by avoiding pulse checking, carried out for several weeks (or months, patience!) will produce two beneficial effects: (1) anxiety will be reduced and (2) you will notice the 'skips' less.  For me these two effects also resulted in less PACs.  Easy to say, hard to do.  In fact, it's extremely hard to do, but worth the effort.  Remember, the reverse is true...that is, checking up on your pulse will train your nervous system to remain at high anxiety, which of course, will cause adrenaline levels to remain high, and result in more PACs.

After you have been checked out with a normal heart, get back to running and ignore the buggers!

-Arthur

by dquenzer, Apr 18, 2007 12:00AM
To: timj141
The same thing happened to me when I was about 40.  I also did a significant amount of running and XC skiing.  The PAC's were incredibly nerve racking at the beginning.  I'll have to admit that they took me about 6 months to a year to really adapt to.  But I noticed that by getting anxious about them they occurred more often.  So I soon learned to relax.  I continued to run just because I wasn't going to let something that was benign control that area of my life.  

I agree with previous post as to cause.  The main thing that you will need to be concerned about is that they will develop into AFIB for Flutter.  This is what happened to me.  I woke up one morning with AFIB when I was 46.  I then tried to treat it with meds for 3 years.  It didn't work, so I got an ablation at Mayo 3 years ago.  That did the trick.  It not only stopped the AFIB but also the large amount of PAC's I would get during the day. Still get a few, but nothing like before.  I continue to run at a modest rate.  No more 8 to 10 milers, but 2 to 3 a day.  Course I'm now 52.

The doctors stated at Mayo that runners are susceptible to this.   Ironically my brother (a runner) just got Flutter and had it ablated successfully.   Also a fellow track coach (former distance runner) just got diagnosed with AFIB after I hounded him to get his irregular heart beats diagnosed.

If they are PAC's/PVC'st I would do is simply try to relax about these things and not obsess about them.  I know it is hard to do because you think something is dreadfully wrong.  It isn't.  They will ebb and flow.

But I would also monitor for AFIB; especially since you got this before.  Also remember that if they do develop into AFIB for Flutter than an ablation is a cure (albeit expensive).

by Carey01, Apr 18, 2007 12:00AM
To: All
I'm concerned about the responses.  I have been assured and reassured (and then some!) that PAC's do NOT lead to A Fib UNLESS you have a structural abnormality that would lend itself to Atrial Fibrillation.  Comments?

by Carey01, Apr 18, 2007 12:00AM
To: All
I just ran a search on how that question has been answered her by the Dr and here is what I found:
"No, not all PACs lead to afib. In some persons with atrial fibrillation the trigger is thought to be PACs but if everyone with PACs developed afib the whole planet would have afib. Only about 5% of the population develop afib in their lifetime."

by tomslik190, Apr 18, 2007 12:00AM
My heart feels like it's going to stop ALL OF THE TIME...CONSTANTLY... since 11/29/1993 @ 5:05 PM when my heart beat oddly and violently for about a second.  Complete workup revealed occasional PVCs and nothing else.  They come in spurts and I can have several in a few minutes and then just several in a day or sometimes none in a day.  BUT... I still fell like I'm going to pass out constantly...like my heart is beating wrong...whether standing, sitting, driving, or laying down.  I have found that Co-Q10 (120 mg) has significantly reduced the PVCs and I also take Omega 3-6-9 which also seems to help reduce the number of PVCs.  I have also been on Xanax for 2.5 yrs due to the anxiety created by the way I feel.  I have lost 30+ lbs in the past 3 months but still feel no better than before the weight loss.  Just thought I'd suggest the Co-Q10 and Omega 3-6-9 oils.

by tomslik190, Apr 19, 2007 12:00AM
Forgot to mention...I also have a lot of belching...specifically belching "fits" that can last 30 minutes or so...I do also swallow air and force belching since this seems to make me feel better...I also lay on the floor with my hand between my chest (where my heart is) and the floor and roll around. This seems to help also.  Have seen 15+ medical professionals plus alternative medicine with no specific diagnosis or treatment that helps.

by timj141, Apr 19, 2007 12:00AM
Thank you very much for your responses. It all helps tremenously and I have gained some comfort from them. Its good to know that I am not alone with these systoms but disconcerting that so many people suffer with PAC/PVC and just have to learn to live with them.
Excellent advice Arthur about breaking the habit of checking your pulse. As if there was anything I could do about it if I did feel it happen! I am a little concerned about this being a trigger for A fib but I will chew that food when I have to.
As far as running goes, I am concerned that it increases the frequency and my heart rate tends to stay up longer post-run than it used to. I can still hit the gym without too much trouble but long sustained runs of 8 miles or more are out of the question for now. Writing this seems a little silly compared to some of the problems posted here. I wish I could help you all.
Again, thanks to all for your posts here. I will pray for each one of you for Gods blessing in your lives.
Tim

by arthur, Apr 19, 2007 12:00AM
To: carey
PACs are a trigger for AFIB only when the "substrate" is amenable.  As I understand it, paroxysmal AFIB occurs if the tissue making up the atria has just the right interwoven lines of electrically active cells, then a "spark" from the foci (which normally triggers PACs), can induce a 'circular' flow of polarizations/depolarizations (basically ions flying back and forth across the atria) which is self-sustaining or nearly so, as the pulsations from the foci may be needed to keep the circular flow going (kind of like the kid with the stick hitting a hula hoop to make it wheel along the ground).  This circular flow of ions is fast (something like 200-300 bpm), but the SA node is geared to repolarize at a slower rate, so the result is an irregular sinus rhythm that usually runs a little high.  This of course is all speculation based on a wealth of scientific information.  Take it with a grain of salt (or MSG).


-Arthur

by jeff 67, Apr 19, 2007 12:00AM
Can I ask what it is you all feel when you are running when you get PAC's? I can understand you would be aware of PVC's due to compensatory pause, but was curious as to what made you aware with the PAC's since they often reset the sinus node (no compensatory pause).

by timj141, Apr 19, 2007 12:00AM
To: jeff 67
As I understand it, and forgive me if I show my ignorance here, what I actually feel are the compensatory pauses from the PVCs. In all actuallity, I rarely feel anything while I am running. I occurs after the run when my heart