PV foci and exercise

Assuming a PV focus-generated PAC/PVC condition in an otherwise normal, healthy, althletic heart, what exactly is happening to the PV foci during exercise that begets the following typical symptomology?  

resting:  PACs at about 1-4/min  pulse 40-50 bpm
exercise:  some PACs (0-1/min)  pulse 120-150 bpm

After exercising about one hour, almost no PACs for 4-8 hours afterwards, pulse normal within an hour.  After 8+ hours PACs return at normal resting rate.

This does not appear to be a question of pulse rate (higher bpm = less PACs).  My own experience (being able to detect the foci firing) suggests the foci get irritated by physical (eg, hard breathing during weightlifting/sprinting) action (firing frequency increases, amplitude decreases)...they go from a perceived thrumming to a faint buzz...while at the "buzz" state their abberant signalling seems to be unable to reach the atria effectively.  Once things settle down and the foci fire at a slower rate, things go back to normal (ie, PACs get generated).

One further observation:  for days after very intense exercise, PAC production is increased over the norm (at the high end, ie, 4-6/min). This observation was verified several times by halting all exercise for periods of weeks which resulted in very few PACs...which reverted to typical rates (1-4/min) once an exercise regime was resumed.

What's up with those focal cardiomyocytes?  What "irritates" them and how? Is this effect tied to a nervous system thing? Is there a long term downside to exercising (producing even more active foci)?

[CCF-M.D.-CRC]

Dear arthur,
Pulmonary vein (PV) foci are sensitive to heart rate and autonomic nervous system changes.  In general lower heart rates permit more frequent firing and higher heart rates inhibit firing.  Adrenaline (created with exercise) increases firing and may improve conduction of the premature atrial contractions (PACs) to the atrium.  Exercise in general is beneficial for long-term health as long as your doctor approves.  You should consider coming to Cleveland for a repeat ablation procedure with Dr. Natlae which may aleviate many (if not all) of your symptoms.

[wilson-wilson]

Arthur you [along with others] have been a big help, and some real comfort to me in this forum; I too have searched to the end of the internet trying to come to terms with what was/is happening to me, then the other night as I was reading one of your comments I had an epiphany I'd like to share with you......[perhaps this 52 year old narcissist, with a strong separation anxiety disorder and a fear of dying can give some insight]

As I mentioned, I was reading one of your comments and I had the TV turned on in the background listening to one of the programs on Foxnews, [of course the news these days is about what has happened after 9/11] and my mind started thinking about ALL the  folks that died that day..and that's when I had this "epiphany".

I thought, "I wonder if any of these folks, had medical/health problems, or the kind I am having now [PVCs and such]? They all were going about their daily jobs and routines, some were flying to where ever they were flying, and all of the sudden....sudden death happened to them.  So moreover I thought, "sudden death" can come from ANY where at ANY time...and if these brave souls could look death in the face at the hands of terrorists surely I can live, (or die), with the (what I now consider minor) inconvenience of these damn PVCs, PACs, ectopic/premature beats or wherever the hell one would call them!  If I die from them, I die from them...!"

I surely -DO NOT- mean that the suffering of another human being has made me feel better about my situation, it DOES NOT!
It, [my epiphany], just put it -ALL- in perspective; [for me anyway].

wilson-wilson

[arthur]

I am 54 years old, get anywhere from 100 to 2000 PACs a day, and play soccer in a competitive league on a regular basis.  I've been checked out from A to Z, and the only thing the cardio/EP wonders about is that my knees haven't given out yet.  My workouts (3 times a week) consist of 1 hour of jogging and sprints covering about 3-5 miles...basically I run my head off.  I aim for complete exhaustion and have been achieving it ever more easily as I get older.  My basic qualm is the nirvana achieved right after working out...ie, no PACs for 2-6 hours, followed by their triumphant return.

Like wilson-wilson points out...If these things could kill me or get a whole lot worse, they would have by now.  I try to ignore the skips and like everyone who has them can attest to, that's a lot easier said than done.  I guess things could be a whole lot worse, and I am very happy that my PAF (of 1.5 yrs ago) was cured by ablation so that I could continue my suicidal athleticism...doing what you enjoy in this life is what it's all about...The worry and anxiety associated with these things are what can kill you (after the first episodes of PAF and PACs, there were times I was too frightened to get out of bed).  It was the determination to learn as much as possible about the condition that overcame fear for me.

I hope that this little anecdote helps out those individuals that are still rocked by their condition.  It's not a dead end!