Klonopin & PAC's

Posted By  CCFCARDIO MD sc on October 06, 1997 at 15:00:01:

In Reply to: Klonopin & PAC's posted by Doug Quenzer on October 01, 1997 at 18:28:51:

: My doctor recently prescribed klonopin for a recurring problem that I have with PACs.  He believes that my "fight-flight" system is too geared up and is causing too much adrenalin (norepinephrin I believe) in my system.  Since taking the Klonopin I haven't noticed that much of a reduction in PAC's.  I do however sleep really well, and I'm definitely more relaxed.
  Today I tried to not take a beta-blocker to see how things would work out.  It didn't work so well.  I had a signficant number of PACs.  So I just took 25 mg of atenolol, and within 15 minutes the PACs were gone.
  For those of you who are cardiologists out there, how long does it take generally for the fight-flight system to begin to calm itself down and get back to a more regulated form.  My doctor said it doesn't take too much for a heightened adrenalin output to mess things up.  Anyone ever used this method of treatment to get rid of PACs?
  He's also considering putting me on serzone?  
  Anyone try that with any success?
  Thanks for you help.
  Doug

[CCF Cardio MD sc]

Dear Doug
PACs are very common, and are in fact the commonest cause of a irregular pulse. Although benign in the vast majority of cases, they are more common when there is underlying heart disease. PACs may also  occur more frequently  in a variety of clinical scenarios such as during infection, inflammation, or myocardial ischemia  ( decreased blood flow to the heart ), or in conditions of high tension ( what you probably described as the fight-flight reaction.  Also known to increase pacs are caffeine, alcohol and tobacco and substances that contain these substances. More often that not, due to their benign nature no treatment is prescribed for this condition. If however they have become bothersome or are causing the patient some concern a beta blocker as you were on or a calcium channel blocker may be considered.  I would like to add one word of warning, never "cold turkey" beta blockers the way you did because this may cause an increase in the frequency of pacs to a number which exceeds that for which they had been prescribed in the first place.
Your doctor must think that you have a high tension level and it is probably for this reason that he has started you on klonipen and is considering the serzone. They may therefore indirectly cause a decrease in the frequency of your pacs and although this effect is possible, I cannot find a clear reference where serzone has been used just for the treatment of pacs. I hope this information will be of some use to you. If you have any further questions about your condition or would like to set an appointment with one of our eletrophysiology cardiologists here at the Cleveland Clinic please feel free to call 1-800-CCF-CARE to have this set up. Information provided in the Heart Forum is intended for general medical informational purposes only. Actual diagnosis and treatment of any particular medical condition can only be made by your family physician(s).