Ectopic Atrial Tach

[BarryChurch]

Hi,
I am a 43 year old male, never smoked and about 25lbs overweight in spite of exercise.  Since mid-December, I've had PACs and have been subsequently diagnosed with ectopic atrial tachycardia.  The problems started when I had a cold and took allegra-d.  I had a lot of premature beats which disappeared  within 24 hours.  The problem has been reoccurring in spite of my elimination of caffeine and other stimulants. I also had a couple episodes of tachycardia that would last for a few seconds, stop, start again and thus resulting in a pretty chaotic heartbeat.  I had a nuclear stress test, echo, event monitor and all tests are normal.  Also thyroid function, potassium levels, etc are normal.

I'm currently taking cardizem LA 120mg and atenolol xl 50mg.  I continue to have skipped beats but no real events of tachycardia.  I met with an EP and he said that I should consider a PVI but scared me quite a bit by talking a lot about the amount of risk of a PVI vs. other types of ablation.  He also implied that my condition will most likely progress into afib.

So 2 questions:

1) Am I more or less likely to experience afib given the above facts?
2) Can you provide some info on the risks of PVI vs. anti-arrythmic drugs (assuming my condition worsens and I have to make a choice)?

Thanks in advance for your help,
Barry

[dquenzer]

I had a similar experience to you.  I started getting PAC's at about 40.  I had pretty much adapted to them and then one morning I woke up to AFIB.  I didn't know for sure, but my heart was very erratic and since my Mom had AFIB I kind of knew the symptoms.

It is interesting that the health insurance people did not want to insure me with PAC's.  I think they know it develops into AFIB.  They do they stats on it.

My doctor put me on meds.  The meds helped for awhile.  I tried two, the failed, and then he said it was time to try the PVI.  I think that is a prudent choice. If two meds fail then do the invasive procedure.

I decided to have the PVI.  The EP specialist was certain it would work, because I had been a track athlete and he said that AFIB coming from the pulmonary veins was common among trained runners, basketball players, and hockey players.

I had it done.  It worked wonderfully.  I have been AFIB free for over 2 years.  I have very few PAC's, and some PVC's at times.  But nothing like before.

If the meds can keep you from being symptomatic that would be the safest.  However my cardiologist said that bodies tend to adjust to meds and sooner or later they fail.

Although trying meds first is prudent I think I would have had the procedure quicker.  The meds really never worked very well and I endured 3 years of constant irregular beats.  I didn't sleep well, exercise was difficult, and my quality of life was affected.    Those are three years I would have loved to had back to enjoy with my family.

By the way, make sure your insurance will cover it.  My PVI cost 55,000.  Not cheap.  But worth every penny.

[Bebelle]

I'm new to this board, my symptoms sound alot like some of yours. What is SOB? Do you exercise alot?  I haven't for 5 or more years. Had palpitations many years, but have recently become more frequent. See my post under palpitations (chest sensations).  Thanks.

[only40]

I am 40yr.old female. Pain on left side of chest (just under breast) began 1yr ago, sporadically, not necessarily during exercise (sometimes middle of the night), lasting for minutes to hours. Progressively more frequent. No significant SOB or fatigue. Recent ultrasound revealed 1) Hypokenisis of left AND right ventricle, 2) mild pulmonary hypertension and 3) mitral regurgitation. Initial stress test appears normal (they didn't say otherwise), yet results are not back from 2nd round (cardiolite stress test). Appt. with Cardiologist not until April 5th.

My family doctor tells me these things should not cause pain, yet that is what got me to the doctor's office in the first place. Is this a coincidence? Should I be concerned? I feel so fragile and I want to resume exercising but can't bring myself to while this pain is still here.

I should mention that I have a history of kidney disorders, which have left me with slight elevation of BP, still within the normal range but on the higher end.

[jeff 67]

Wow ... PACs are so common ... I did not realise they were such a predictor for AF.

[CCF-M.D.-MJM]

Hi Barry,

sorry to hear about the PACs. They can be quite symptomatic.

1) Am I more or less likely to experience afib given the above facts?

It is difficult to say.  We just don't know a lot about this area yet.   We know that some people that experience PACs progress to atrial fibrillation, but not everyone.

2) Can you provide some info on the risks of PVI vs. anti-arrythmic drugs (assuming my condition worsens and I have to make a choice)?

Everyone should be a little scared about PVIs.  It is a difficult choice and you must compare risks / benefits to decide if it is worth it.

At this stage of the game, anitarrhythmics are the first line of care for symptomatic atrial fibrillation and PVIs are second line after meds fail.  The easiest thing to do is start an anti arrhythmic and see if it works.  If it doesn't and your symptoms are significant, think about the pvi.

risks of pvi:
death < 0.1%
internal bleeding (tamponade) <1%
stroke <1% (0.25% at our institution)
pulmonary stenosis 1-2%
bleeding requiring blood transfusion about 1%
bleading not requiring transfusion 3-5%
injury to the nerve that controls breathing rare, but possible

If decide to have a PVI, make sure you go to a high volume center.  I learn something new with each case.  Experience counts for success.

I hope this answers your questions.  good luck and thanks for posting.