pacs and pvcs and atrial flutter

[manyana]

i was hospitalized recently with palpitations - the dr said it was pacs and pvcs but they were keeping me in for 48 hours
while on a heart monitor (not ecg)i had a funny turn - loads of chest fluttering /nausea/felt faint - the senior cardiac nurse looked at the monitor which was flashing a red alarm and said it was atrial flutter - but she couldnt hook me up to the ecg machine quick enough to record it
now i am really scared - is it usual for pacs or pvc to turn into atrial flutter or atrial fibrillation - my docs havebeen telling there is nothing to worry about with them and it seems this isnt true?
could the cardiac nurse be wrong as the docs said as it isnt on ecg they dont recognise i had it?
am i likely to have reocurrences because i have had it once?
drs have reduced my thryoxine from 150mcg to 100mcg as it was reading 0.9 which they say is the higher side of normal - they said its common in thyroid patients and they would rather it was 2.5 as i am prone to palpitate - pacs/pvcs - have your heard this?
i have not had an echocardiogram here in the uk - is this advisable - all my ecgs ok and blood pressure usually between 110/60 to 120/70 - stress test in 2004 was ok
what can be done for atrial flutter?
many thanks
lynne

[CCF-M.D.-MJM]

Hello,

could the cardiac nurse be wrong as the docs said as it isnt on ecg they dont recognise i had it?

without seeing the EKG strip I cannot say if she was right or wrong.  It is possible she was right.  If you keep having the same symptoms you will be able to capture on monitor eventually.


am i likely to have reocurrences because i have had it once?

If you had Afib or flutter, you are likely to have a recurrence.


drs have reduced my thryoxine from 150mcg to 100mcg as it was reading 0.9 which they say is the higher side of normal - they said its common in thyroid patients and they would rather it was 2.5 as i am prone to palpitate - pacs/pvcs - have your heard this?

yes, I have heard of this before.  It makes sense too.  

i have not had an echocardiogram here in the uk - is this advisable - all my ecgs ok and blood pressure usually between 110/60 to 120/70 - stress test in 2004 was ok

You don't have to have an echo for this, but it is common practice in the US to obtain an echo for these symptoms.

what can be done for atrial flutter?

If you have recurrent atrial flutter, it can be fixed with an ablation procedure.  The procedure is relatively straight forward and usually takes 30 minutes to several hours depending on how hard the case is.

Good luck and thanks for posting.

[dquenzer]

I had pac's for about 8 years and it eventually went into atrial fib. and atrial flutter.  PAC's and PVC's are not serious by themselves.  But the cause (at least for PAC's) may be coming from an area in the heart that could turn into atrial flutter or atrial fib.

Cure?  I suffered for 3 years with atrial fib bouts from time to time.  Two meds just didn't keep me in.  So my cardiologist sent me to Mayo and an EP there.  He was convinced that the pulmonary veins were probably the source of the problem.  I then had an ablation done (on table for 7 hours), and I have been afib free for 3 years. I seldom get PACs and PVCs.  Do get some from time to time, but NOTHING like before.  They also cured some atrial flutter that I would get from time to time.

If I were you I would consider how bad the PACs and PVCs are and if you will have constant bouts with flutter.  An ablation shouldn't be the first approach because there are some serious risks.  But if they get bad, and it does turn into flutter or fib there are options other than meds.

Good luck.

[davidc]

I am a 45 yo male who was diagnosed with lone paroxysmal atrial flutter about 6 months ago.  My episodes were occurring at night, after I had gotten up to go to the bathroom and was trying to get back to sleep.  (Talk about annoying - just as I am drifting off to sleep - bam! bam! bam! bam! went the heart, until I stood up, which usually put an end to it). The cardio put me on a small dose of an antiarrhythmic  medication (flecainide acetate), coupled with a beta-blocker (metoprolol). This has done a good job of eliminating the episodes.  However, antiarrhythmics like flecainide aren't for everyone - they are contraindicated for post MI patients - I guess anybody with a mechanically compromised heart. I suggest you read   the ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias - it spells out all of your treatment options, etc. Ablation is not the only treatment. Good Luck!

[Carey01]

OK -- I'm confused and kinda scared now... I have always been told that PVC's/PAC's do NOT lead to Atrial flutter or A-Fib.  And that you have to actually have that defect in your heart for that to happen.  I have always felt a little better believing they are "just" PVC's and they don't LEAD to anything but an annoyance.  Based on the above posts that sounds wrong!! Am I understanding that correctly??!

[Carey01]

I believe you missed the original poster first question ... If you have a moment please answer.
Thanks

[momto3girls]

Hi,

Dquenzer, was your heart structurally normal when you developed atrial flutter/fib?  You mentioned your pulmonary veins being the culprit.  Could you clarify a bit?  I think you freaked Carey01 a little (:  

Carey01, I've been told by several of my cardio doctors that pac's and pvc's are nothing to be concerned about if your heart is structurally normal.  I have had them documented on a holter/event monitor and only had about 300 in a day which didn't even cause my doctor to raise his eyebrows.  There are many, many posts here by people who've had these little buggers in the 1000's per day and are fine.  Lots of people even have them every other beat or every third beat and still there kicking!  From what I understand, the problem arises when you have some sort of heart defect or structural abnormality and pac's or pvc's.  Hopefully Dquenzer will clear up the confusion a bit for you (:  Take care.

[davidc]

My understanding is that atrial flutter is caused by an errant electrical pathway in the right atrium, around which an electrical impulse can repeatedly travel, exciting an atrial beat on each trip. The atrial rate is about 300 beats/minute.  Typically every second time around a ventricular beat will be excited, resulting in a ventricular rate of about 150 beats/minute.  I believe that a PAC  is needed to get the whole thing started (so it triggers the flutter), but if you don't have the errant pathway in your heart you can have PVC's and PAC's till the cows come home without exciting AFl.

Remember, I am not an expert, and I don't even play one on TV!

[davidc]

I should add that my afl came out of the blue - no pvcs/pacs (that I actually felt) until after my first episode of afl. In someone who has a history of symptomatic pvcs/pacs prior to developing afl it might seem like they "turned into" or caused the flutter, but the two things aren't necessarily connected.

Even though I evidently have this errant electrical pathway in my heart, my cardio calls my heart "structurally normal" - no atrial septal defect, no ischemia, no cardiomyopathy, no enlarged ventricles, etc.  I think this terminology is confusing to a layperson - how can your heart be "normal" if you are having symptomatic pvcs, pacs, afl, afib, etc? I think they mean to say that even with these symptoms you are at no greater risk than the general population of experiencing cardiac arrest.  So by that measure, your heart is normal. And you shouldn't worry.

[BRNEYED GIRL]

HELLO, I HAVE JUST GONE THRU 2 WEEKS WITH A MONITOR FROM CARDIONET. I HAD AN ABNORMAL HOLTOR MONITOR TEST. I HAVE RAPID HEART RATE WITH PVC'S. I HAVE EXTREME FATIGUE,I COULD JUST CRY. I HAVE BEEN DIAGNOSED WITH MITRAL VALVE PROLAPSE ALSO. I JUST WONDER IF THIS IS WHY I HAVE NO ENERGY... I HAD ALL KINDS OF BLOOD WORK DONE, ALL NORMAL. IF YOU HAVE ANY SUGGESTIONS PLEASE LET ME KNOW....

[dquenzer]

I did not say that PAC's are a sign you will eventually get AFIB or Flutter.  HOWEVER, if the PAC's are coming from a source that would be typically a source of AFIB then the PAC's can (not will) be a precursor to AFIB.  Before I got AFIB I noticed that the amount of PAC's I would have went up considerably.  Also I noticed that before I went into AFIB my PAC's would increase.  It depends on the cause and the source of the PAC's.

I can't remember where, but I also read somewhere that PAC's can lead to AFIB on a web site.

My heart was structurally normal.  In fact I was (still do run) a distance runner so my heart was in excellent condition.  The reason I got AFIB was due to what my EP called pulmonary vein stretching that caused irritation in those veins.  The PVI ablation therefore worked wonderfully.   They have done studies at Mayo that tend to show highly conditioned athletes have a higher incidence of AFIB than the normal public.

[manyana]

hi - my docs have also said my heart very healthy and structurally normal - just the pacs and pvcs and not to worry
i have also now been told by a cardiologist on another forum that pacs not pvcs can trigger atrial flutter and atrial fibrillation - here is his answer to my question about pacs causing other problems -
PAC's can trigger atrial flutter.  Premature beats coming from the entrance of the veins from the lungs into the left atrium may trigger AFIB.  Hyperthyroidism makes atrial flutter and atrial fib more likely.  PVC's trigger VFIB only in people whose hearts have been damaged severely and don't pump well.  If the stress test included radioisotopes or an echocardiogram, then your heart is pumping well and you need not worry about worse ventricular rhythms.  The worst that PAC's can do is atrial fib, and that's easy to manage and doesn't produce symptoms in someone whose heart is pumping well.  I think you don't need to worry.  I hope the reduced thyroxine will clear everything up.
he doesnt say whether you have to have an abnormal pathway or anything so i will ask my own doctor and see what he says - i have only had one episode of atrial flutter and that was before they reduced my thryoxine dose 3 weeks ago - fingers crossed that was the problem
i dont know why the docs dont tell us this about pacs straight away - knowledge is power - they seem to just say they are the same as pvcs when they are not - pvcs cant trigger a-fib or flutter
take care all
lynne

[Carey01]

Thanks everyone for clarifying .. I'm still kinda confused but a little clearer.  I guess I just want to believe that PVC's are benign as the Doctors constantly tell us but then you hear of someone like the original post who is told they are "nothing" and then goes into A-flutter which my Dr says is something to be very concerned about.  I guess if I could ear they ARE no big deal it would help.  I'm just so worried they are going to start and I'll drop dead in my tracks!  Sorry for the rant -- I am just freaking out a bit!!! (a lot!)

[momto3girls]

Hi all,

OK, I'm really confused now myself.  Why on earth would all of these cardiologists say that they are benign?  I'm a little concerned now.  I thought there had to be other issues coinciding with pac's or pvc's in order for them to be a concern.  I've been dealing with these and doing well but now I'm worried about them triggering a-fib or flutter.  Is this new evidence or something?

[dquenzer]

Benign means that they do not affect you, and do not lead to death.  If all a person had was PAC's and PVC's they wouldn't ever kill you are cause serious harm.  I had PAC's for 8 years and I lived normally.

AFIB and AFLutter are more serious.  AFIB won't kill you in the sense that your heart will stop because of it.  People live with AFIB.  However AFIB can cause blood clotting in the atrium which can lead to stroke or heart attacks.  Also AFIB over a long period of time can cause heart failure if the heart beats too fast for too long.  This is also true for flutter.  Therefore if people can't be converted from AFIB through meds, then doctors try to control rate and you take blood thinners to prevent clots.  Flutter doesn't cause clots, but if the rate is too high this isn't good for the heart over the long run.

So are PAC's benign. YES YES YES YES.  Can they lead to other heart rythmns that aren't benign.  YES.  Will they?  Maybe. Maybe not.  In most cases not.

Are PVC's benign. YESSSSS!  In a structurally normal heart don't worry, but if they are a result of heart disease they can lead to VTACH.  And that isn't good.  That's why you get checked out.  If your heart is normal, then relax!

[yoshi74]

I am curious to know now myself...This forum has been a great help to me and I would like to make sure I am getting the correct information regarding the topic at hand...PVC's/PAC's I was told they were benign as well...no mention of them turning into something more....of course I am not an idiot and I understand that nothing is cor certain,but still no mention...not by any of the several cardiologist that I have seen!

[tickertock]

Read this. http://europace.oxfordjournals.org/cgi/content/full/7/3/221


PVCs can trigger atrial fibrillation on rare occasions, usually in association with bypass tracts. PSVT/AVNRT are triggered by PVCs about 25-30% of the time. This is just an example of a documented case. This might not apply to your case at all.TRust your doctor/doctors if in doubt get a second or even third opinion.

I'm not a doctor, in general though real nuisances most arrhytmias such as pacs , pvcs , and SVTs are benign with a normal cardiac evaluation.

[Carey01]

I think we all really need to KNOW for our peace of mind.  I am finding conflicting articles -- I wish I could get a question to the Dr but I can NEVER get through.  If PVC"S/PAC's are "harmless" -GREAT!  But now I'm thinking they arent OR we all have totally got ourselves confused!! :(

[BRNEYED GIRL]

I AM VERY CONFUSED.... IT REALLY SCARES ME TO DEATH....
I AM SO WORRIED.

[momto3girls]

Hey there,

I know, I'm a little freaked myself now (:  Just so you know, I finally posted a question in May after about 6 months of trying.  I got through before 8:00 am Eastern time.  Maybe try early in the morning, I know I've read others say this too.  Good luck trying to post (:

[dquenzer]

It appears to me that some of you are getting stressed out for no reason.  Saying that PAC's can lead to Atrial Fib doesn't mean you are going to get AFIB. Also AFIB is NOT heart failure!!!!

I lived with bouts of AFIB for 3 years.  Did you know that some professional athletes have AFIB?   A former center for the Houston Rockets played basketball games with AFIB!  Former President Bush has AFIB.  How old is he?

Also AFIB is treatable.  I HAD AFIB.  I am now cured because of an ablation. I HAD AFLUTTER.  I am now cured because of an ablation.  We can be thankful about the myriads of treatment options.

So please relax.  PAC's and PVC's do not harm you. They can't kill you.  They do nothing to you.   That is why they are called "benign".  Look up the word in the dictionary.  Some of you think that if you get AFIB or Flutter it's a death sentence.  It isn't. You'll most likely die from something else. Some of you are going to work yourselves into such an emotional state you will simply get more PAC's and PVC's.

Live one day at time.  Why worry about the future.  By worrying you can't change anything, and 95% of the things we worry about never happen anyway. It's a waste of energy, and worry will destroy your health.

[manyana]

hi
you are so right about the worry thing - i have been doing just that and getting things totally out of perspective
every pac i get now i think will trigger a-fib or a-flutter and the more i think like this the more pacs i am getting
its the not knowing - docs dont give anything away - my doc has said i can have beta-blockers for the pacs BUT he would rather i didnt as its not necessary - so that makes me feel i shouldnt have them! - he said if i have more a-flutter then i will need to go on meds - but all meds have side effects
the future scares me - so i will try and live day to day as you suggest - i feel like i dont have a future which i know is not the way to think
its not easy coming to terms with things going wrong in your heart when you are in your 40's !! or any age for that matter
thanks for your good advice
take care
lynne

[BRNEYED GIRL]

HAS ANYONE EVER USED THE CARDIONET MONITOR?

[jctwin]

Hi im 24 years old and have experienced what i thought was pvs for about a year...my twin brother has them too so i never worried about seeing a doctor i just delt with them...well i did something stupid i did exctacy and smoked weed one night ..thought i was going to die felt like my heart was racing out of control lasted like 2 hrs..that passed put after that starting having panic attacks ..so i thought id see a doctor ..i told him what i did and what happen ..he didnt think it was panic attacks which im fine with that he did ekg and the ultrasound of my heart and wore a holter he said the only thing i had was PACs......my problem is i still think i have something wrong with my heart even though he says im ok...scared to push my self when i work out....at night is my biggest problem ...im on toporl and barley ever feel pacs...but right as i begin to dose off ...i start feeling a wired sensation  and i dont know if my heart is racing as much as i can hear and feel it beating and it causes me loss of lots of sleep ...the only way i can fall to sleep fine is with xanax....anyone know what that can be ...doctor tells me im fine but i hate going to sleep now cause of that....thanks

[mustang2005]

A related discussion, hey was started.