To CCF Cardio MD in response to answer about PAC's

  Dear Cardio MD,
  Thank you for your reply about PAC's on 5/28.  First did you mean to say that the ablation was probably unnecessary?  You would know be the first to make this statement as Dr. Grubb in Toledo who is in Toledo and is an expert in the field of autonomic disorders says ablations do no go for POTS.  I have only experienced the PAC's since the ablation, so I will assume that it is caused by the damage done to my atrio sinus node.  You mentioned a pacemaker, I would be extremely interested to know how this helps the PAC's.  It is very strange as some days I do not notice the PAC's much, but on others they happen all day long, and I experience fatigue, and tend to feel awful after may in a row happen.  Exercise is also causing these symptoms and as a result I am unable to do so without horrible symptoms.  None of these symptoms were present before the ablation.This feeling sometimes last for a few days.  Can you explain why?  I have tried beta blockers and you are correct they cause worse orthostatic symptoms.  Before starting a new drug regimend for the POTS, my BP was running in the high 80's or 90's.  I am currently taking florinef and my BP has now hit a bg high of almost 120's.  
  As far as structural heart disease, I have had echos, the ablation and finally a cardiac caterization due to the fact I was experinecing chest discomfort. Of course all tests are 100% normal.  Dr. Grubb explains the chest pain as most patients with pots do not have enough oxygen being delivered to the heart.  Would you think it wise to make an appointment with my elecytrophysologist at the University of Michigan and have  him evaluate my case.  He did a holter a week after the ablation and said there were MANY MANY PVC's, but did not want to do anything about them yet.  Thank you for your help.

[Cleveland Clinic, MD]

Dear Dorothy ,
Thank you for your question.   To explain PAC's let me tell you a little bit about the electrical system of the heart. The regular heart beat (sinus beat) starts in the upper chambers of the heart (the atrium) from a group of heart cells called the sinus node. The electrical signal then proceeds down to a area of heart tissue called the AV node. From here it travels to the ventricles (the lower heart chambers) down electrical pathways (fibers) called bundles.  The bundles conduct the impulse to the ventricles telling them to beat.  If the sinus node does not work properly (for whatever reason - i.e. aging, prior ablation, etc) and fails to generate an impulse other areas in the atrium, AV node and ventricles will respond and act as "back-up" pacemakers.  When the atria act as back-up pacemakers the beat is called a Premature Atrial Contraction (PAC).  When the ventricle acts as the back-up the beat is called a Premature Ventricular Contraction (PVC).  Everyone has some degree of PAC's and PVC's.  Most people don't even notice when they have them.  For some people however they are very bothersome and cause that person a great deal of concern.  If the heart is structurally normal (i.e. normal echocardiogram, cath, etc.) one is classified as having PVC's/PAC's with a structurally normal heart.  There is no decrease in lifespan or other serious medical consequences in this group.  
For those who cannot live with the symptoms beta blockers are the best drug choice.  Side effects of beta blockers include fatigue, impotence in men and breathing difficulties in persons with underlying lung disease.  If medical treatment is necessary and the heart rate becomes too slow a pacemaker can be placed.  The choice to treat PAC's should not be made lightly and I would recommend sitting down and discussing your options with your doctor.
Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.