Mixed up...

Hello Cleveland,
Please could you answer the following:-
1. An EP study revealed I had scar tissue in the right atrium.  My cardio thought this would probably be due to a virus but a family member told me he thought it would be due to a 'silent' heart attack.  This worried me a bit.  What normally causes scar tissue in the heart?
2.  I often read the phrase "benign pacs & pvcs", given that I have this scar tissue in the heart does it mean my palpitations are not benign?  
3.  I can understand an ablation "sorting out" accessory pathways in the heart and troublesome cells causing extra beats to occur but how does an ablation "sort out" scar tissue, and does it work?
4.  I get various sorts of arrythmias but one sort is where any kind of activity seems to set it off, even walking - just a few steps and I feel a rush of turbulence in my chest, my heart goes all over the place for a while and when I sit down it generally stops.  When I get this sort of palpitation it is 'there' for at least a day.  Any idea what's happening here?  
5.  A friend of mine has a-fib which he describes as uncomfortable but bearable.  I once had a half hour episode where my heart went rapidly haywire and I always thought this might have been a-fib however when I hear of my friend's a-fib being 'comfortable' it makes me wonder what I experienced that day as it certainly wasn't 'bearable'!.  In my teenage years I had the classic svt, click, rapid heart rate, click, normal.  Do you think the 'haywire' experience I had might have been an irregular version of svt rather than a-fib?
Thanks :-)

[CCF-M.D.-MJM]

Hi Linda,

1. An EP study revealed I had scar tissue in the right atrium. My cardio thought this would probably be due to a virus but a family member told me he thought it would be due to a 'silent' heart attack. This worried me a bit. What normally causes scar tissue in the heart?

Viral illnesses can cause scar and so can heart attacks, among of a litany of other causes (MI, viral illness, cardiomyopathy of any sort -- genetic, tachycardia induced after LONG periods --weeks to months-- of tachcardia, HIV, right ventricular dysplasia, plus another half a page of typing).  Don't focus on this differential, it will make your head spin. Just ask your doctor directly. You didn't mention you age or presence of cardiac risk factors, so I don't know how likely it is that you had a heart attack.  An isolated atrial MI would be rare, but can happen.  However, if your doctor thought you had a heart attack, I think it would change the way he manages you.  I would ask your doctor directly, since he knows all your details, if he thinks you may have had a heart attack at some point.

2. I often read the phrase "benign pacs & pvcs", given that I have this scar tissue in the heart does it mean my palpitations are not benign?

If EKG, echo and holter are normal, other than isolated PVCs and PACs, and you don't have symptoms of chest pain, heart failure, or passing/almost passing, you have benign PVCs/PACs.  They are considered benign until something happens to change our minds.

3. I can understand an ablation "sorting out" accessory pathways in the heart and troublesome cells causing extra beats to occur but how does an ablation "sort out" scar tissue, and does it work?

The ablation catheter tip records the voltage of the underlying heart tissue.  Voltage less than 0.5 mV is considered scar tissue.

4. I get various sorts of arrythmias but one sort is where any kind of activity seems to set it off, even walking - just a few steps and I feel a rush of turbulence in my chest, my heart goes all over the place for a while and when I sit down it generally stops. When I get this sort of palpitation it is 'there' for at least a day. Any idea what's happening here?

Difficult to say.  I would put you on a treadmill and do a stress test (but in your case I would call it an arrhythmia study).  If it comes out with exertion, we should see it.

You can read many posts on this forum talking about PVCs/PACs go come and go, good days, bad days.  There is no way to predict when these days will come.

5. A friend of mine has a-fib which he describes as uncomfortable but bearable. I once had a half hour episode where my heart went rapidly haywire and I always thought this might have been a-fib however when I hear of my friend's a-fib being 'comfortable' it makes me wonder what I experienced that day as it certainly wasn't 'bearable'!. In my teenage years I had the classic svt, click, rapid heart rate, click, normal. Do you think the 'haywire' experience I had might have been an irregular version of svt rather than a-fib?
Thanks :-)

SVT (supraventricular tachycardia) is an anatomic title given to any arrhythmia originating above the ventricle.  Atrial fibrillation by definition is a subtype of SVT.  In the differential of SVT, there are two forms that cause an irregularly irregular heart rhythm: atrial fibrillation and multifocal atrial tachycardia (MAT).  For every 200 to 300 cases of A fib, you will see one MAT.  MAT presents in patients with underlying lung disease like COPD or other acute illnesses.  If your pulse was irregularly irregrular, you may have had atrial fibrillation.

If you cannot capture it on holter monitor, try an event monitor.  You wear an event monitor for weeks to months instead of days.  You are more likely to record and diagnose abnormal heart rhythms.

I hope this helps.  Good luck.