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pulmonary vein focus - what is it?
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pulmonary vein focus - what is it?

I have been diagnosed with PAF and successfully treated by rf ablation of the offending pulmonary vein focus.  Several other foci were left untreated as these were found primarily responsible for PACs.

I understand that there is cardiac tissue located somewhere along the outside of the PV at or near the ostium (characteristically in the atrial sleeve surrounding the PV attachment point) and that sometimes (for reasons somewhat unclear) the electrically active portion of this tissue begins firing on its own.  This appears to result in at least two phenomena: (1) actual tremor-like movement of the muscular components of the sleeve (and PV?) and (2) abberant electrical (or physical) signals reaching the atria setting off an atrial premature depolarization ("skipped beat").

Three questions:

(1) In the case of an active PV focus, is it true that the muscular components of the sleeve and the PV actually move in a tremor-like mode?
(2) Can one be sensitive to such movement, to the point of feeling an internal "nervous" tremor-like sensation, often corresponding with heightened PAC activity?
(3) What steps can be taken to relieve this "internal tremor", distinct from treating the PACs...ie, I realize that the treatment of PACs alone by ablation may be unwarranted, however, the tremor component is driving me crazy!

I have asked two leading cardiologists about the tremor-like sensation/presentation, and both have conceded that it's possible (perhaps through amplification by the nearby phrenic nerve system), but neither has proposed a possible solution...other than "get used to it".

Any light you can shed would be helpful, and thanks for the forum!

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Avatar_n_tn
Dear arthur,

I don't know if one can really feel a PV focus firing or not.  The signals and any movements they may(?) cause are very small and one would have to be very sensitive indeed to feel them. I think it is more likely you are feeling the PACs.  If this is the case there are two alternatives.  One is medications to suppress the PACs and the second is a repeat ablation of the remaining PV foci to eliminate the PACs.  If you would like to be seen at the Cleveland Clinic for consideration of repeat ablation I would recommend Dr. Natale.
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Avatar_n_tn
Maybe I didn't make myself clear enough...the internal tremors ARE NOT PACs!  I suspect the doctors that are saddled with this responsibility just don't have either the time or the expertise to transcend typical symptomology.  When faced with a truly unusual case, it's just bread and butter time.  

The point of this question was to determine if anyone out there actually knows what the PV focus is really doing, specifically, what is the frequency of the electrical noise and what is the amplitude of the actual motion (how many millimeters back and forth)?  And...what nervous system link might be in place to make them palpable?  Why do they (the tremors) get worse when there is a rise in adrenaline? I know they activity is linked to the production of PACs.  The fact that I can feel them is NOT UNIQUE.  Check out the postings here and every once in a while you will come across someone with an unusual internal nervous feeling which accompanies those PACs and PVCs.


The unfortunate situation is that the PV focus link to PACs is relatively new, so most cardios are just learning what they are.  
Meanwhile...

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