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Mechanism for delayed atrial ectopy due to exercise
I am an active amateur athlete participating in competitive soccer (most of my life) and am currently 53 years old. Almost two years ago I suffered the first of many paroxysmal atrial fibrillations (each clearing up on its own within 24 hrs). All typical tests (echo, stress echo, cat scans, sonograms, Holter monitors, other ambulatory monitors) indicate a normal athlete's heart with a touch of bradycardia (normal pulse 40-45). About six months ago an RF catheter ablation was performed to remove a pulmonary vein focus found responsible for the PAF. This appears to have been successful, as no repeat of the PAF has occurred even while pushing my endurance limits in training and competition. The EP left a few other PV foci responsible for PACs intact, as it was deemed an unecessary risk to proceed more aggressively than needed.
Through this two year period, including the 6-mo post ablation, I have noticed that exercise seems to induce an increase in PACs (which started within the same 2-year time frame as the PAF).
The typical scenario is that PACs disappear for several hours after exercise, then starting sometime that night and lasting for a day or two, I get numerous PACs (up to 6/min). If I stop exercising completely for a week, PACs are all but gone, and stay gone until I resume exercising.
So the question is, what is the mechanism behind such a delayed onset of increased PACs? It would appear that something is getting "irritated" and that "irritation" lasts for a while.
Is it a physical phenomenon (like blood pumping at high pressure against the PV walls? Is it a nervous system glitch?
One clue: In most cases of increased PACs, when I assume a prone posture the PACs cease within a minute or two, only to resume when I sit up or stand up. (This observation strongly suggests a physical transmission from some source to the atria, which gets interrupted by a slight shift in the location of internal structures).
It may be that you need to speculate here...and I would appreciate that, since my objective is to follow-up on any suggestions with further research and discussion with other experts. Thanks.
Through this two year period, including the 6-mo post ablation, I have noticed that exercise seems to induce an increase in PACs (which started within the same 2-year time frame as the PAF).
The typical scenario is that PACs disappear for several hours after exercise, then starting sometime that night and lasting for a day or two, I get numerous PACs (up to 6/min). If I stop exercising completely for a week, PACs are all but gone, and stay gone until I resume exercising.
So the question is, what is the mechanism behind such a delayed onset of increased PACs? It would appear that something is getting "irritated" and that "irritation" lasts for a while.
Is it a physical phenomenon (like blood pumping at high pressure against the PV walls? Is it a nervous system glitch?
One clue: In most cases of increased PACs, when I assume a prone posture the PACs cease within a minute or two, only to resume when I sit up or stand up. (This observation strongly suggests a physical transmission from some source to the atria, which gets interrupted by a slight shift in the location of internal structures).
It may be that you need to speculate here...and I would appreciate that, since my objective is to follow-up on any suggestions with further research and discussion with other experts. Thanks.
don't stop playing soccer or doing anything untill you are told to by a medical person. enjoy life and make the most of it.. find out things that can help you to increase your fun without hurting you medically......good luck :)
Thanks for the encouragement...
You may be interested in the pulmonary vein explanation for PACs.
There are a number of references in these postings, however, the bottom line is that, currently, cardiologists/EPs believe that under certain circumstances (age, stress, exercise...) the pulmonary vein ostia (connections to the back of the heart) which contain some cardiac muscle tissue become a bit sensitive. This sensitivity results in foci (locations in the PV) which fire signals out erratically, and some of these signals end up kicking off the atria (which then triggers a heart beat). So, when these PV foci are acting up, you may experience increased PACs. It's not necessarily the only mechanism by which PACs originate, but these are relatively common (based on my readings of the literature)...in fact, they are being blamed for not only PACs, but a whole host of other atrial-based arrhythmias including tachycardia, flutter and fibrillation.
You may consider yourself lucky that the payment for exercise is only 30 hiccups/hour...mine can get up to 6/min for hours. There are meds that can dull the heart's response to external stimuli (like the excited PVs) and possibly inhibit most or all of those PACs. Of course, you'll need to talk to your doc about that...there are always side effects.
Keep well and keep exercising and damn the hiccups!
You may be interested in the pulmonary vein explanation for PACs.
There are a number of references in these postings, however, the bottom line is that, currently, cardiologists/EPs believe that under certain circumstances (age, stress, exercise...) the pulmonary vein ostia (connections to the back of the heart) which contain some cardiac muscle tissue become a bit sensitive. This sensitivity results in foci (locations in the PV) which fire signals out erratically, and some of these signals end up kicking off the atria (which then triggers a heart beat). So, when these PV foci are acting up, you may experience increased PACs. It's not necessarily the only mechanism by which PACs originate, but these are relatively common (based on my readings of the literature)...in fact, they are being blamed for not only PACs, but a whole host of other atrial-based arrhythmias including tachycardia, flutter and fibrillation.
You may consider yourself lucky that the payment for exercise is only 30 hiccups/hour...mine can get up to 6/min for hours. There are meds that can dull the heart's response to external stimuli (like the excited PVs) and possibly inhibit most or all of those PACs. Of course, you'll need to talk to your doc about that...there are always side effects.
Keep well and keep exercising and damn the hiccups!
Arthur this is very interesting.
I get PAC's (30 per hour) for the first 4 hours after excercise. Mine never completley fade away until i stop working out for a week or so.
Please, the guy that told you to stop playing soccer. What is he talking about. I wouldn't rely on his advice to save my life. I think your doing just fine on your own.
Steve
I get PAC's (30 per hour) for the first 4 hours after excercise. Mine never completley fade away until i stop working out for a week or so.
Please, the guy that told you to stop playing soccer. What is he talking about. I wouldn't rely on his advice to save my life. I think your doing just fine on your own.
Steve
dah - thanks for the support, and good luck to you in your adventures in hockey...isn't it amazing that as one ages and participates in competitive sports (within one's age group), everything is simply relative...we like to think that finesse and skill outweighs inexperience and speed.
Exercise - like you (and many others) my PACs are inhibited during exercise (although they are inducible by adrenaline, as long as that adrenaline is used up physically, there's no problem). Indeed, in my case, PACs are basically silent for hours after exercise. It's the day after when they show up in droves...lasting for a day or two. The cycle is re-initiated every time I exercise. It's like there's a irritation produced as a result of physical activity that's located close enough to the backside of the heart to produce these glitches.
Oh well, if it wasn't for stuff like this, life would be a whole lot less interesting.
Exercise - like you (and many others) my PACs are inhibited during exercise (although they are inducible by adrenaline, as long as that adrenaline is used up physically, there's no problem). Indeed, in my case, PACs are basically silent for hours after exercise. It's the day after when they show up in droves...lasting for a day or two. The cycle is re-initiated every time I exercise. It's like there's a irritation produced as a result of physical activity that's located close enough to the backside of the heart to produce these glitches.
Oh well, if it wasn't for stuff like this, life would be a whole lot less interesting.
Arthur,
I applaud you for playing soccer at 53. I have been reading that as people age, they can still play sports as long as they can stand up and move around. Lots of people become inactive after 40 or 50 because they think they can't be athletic anymore. Stiffness and injuries come from inactivity more than anything else. I just started ice skating a year ago for the first time in my life and am now playing ice hockey; I am 44 years old. I'll never play like a 25 year-old but I sure am having fun. By the way I am a long sufferer of PVCs, PACs, PAT, and SVT. Exercise actually reduces the weird beats. Funny how arrythmias behave differently in different people. Good luck and happy soccer playing!!
I applaud you for playing soccer at 53. I have been reading that as people age, they can still play sports as long as they can stand up and move around. Lots of people become inactive after 40 or 50 because they think they can't be athletic anymore. Stiffness and injuries come from inactivity more than anything else. I just started ice skating a year ago for the first time in my life and am now playing ice hockey; I am 44 years old. I'll never play like a 25 year-old but I sure am having fun. By the way I am a long sufferer of PVCs, PACs, PAT, and SVT. Exercise actually reduces the weird beats. Funny how arrythmias behave differently in different people. Good luck and happy soccer playing!!
Perhaps, at 53, you should retire from soccer and take up exercise which is less strenuous. It may be a blow to your ego, but may save your life. I exercise every day, usually fast walking, hiking, or back country skiing, but no longer run or do very strenuous aerobic exercise.
Of course you can go on beta blockers to help with PAC/PVCs but they pull you down physically and don't always work.
I have found that the BP med Altace has really helped with my occasional PAC/PVCs since my heart attack 18 months ago. Beta blockers are good for the heart and vasular system on several levels.
Do you drink? Drinking aggravates arrytmias for as much as 24 hours.
Of course you can go on beta blockers to help with PAC/PVCs but they pull you down physically and don't always work.
I have found that the BP med Altace has really helped with my occasional PAC/PVCs since my heart attack 18 months ago. Beta blockers are good for the heart and vasular system on several levels.
Do you drink? Drinking aggravates arrytmias for as much as 24 hours.
Playing soccer at my age is less strenuous than my workouts.
I don't drink or smoke. The good doc's reply was about what I expected...no clue.
I don't drink or smoke. The good doc's reply was about what I expected...no clue.
It could be that the adrenaline release with exercise stimulates your arrhythmia. If it is not just a coincidence, I suppose it is conceivable that changes in position affect the blood volume passing through the heart causing various degrees of stretch on the pulmonary vein that lead to your arrhythmia.
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