Forgive me for asking yet another version of the same question, however, I have not yet received a clear explanation. I, and many others with atrial ectopies, have been diagnosed with "pulmonary vein foci" which promote premature atrial contractions (or depolarizations). I understand where the foci are located (in the short section of cardiac tissues which acts as a sleeve over the vein connection to the rear of the heart). I further understand that there is some kind of lesion in this section of tissue which is referred to as a "focus". The assumption here is that this "focus" is busy "firing" signals abberantly, some of which are picked up by the atrial electrical system.
I am one of the unfortunate few who can apparently feel these foci at work...they present themselves as a fine tremor felt (and sometimes palpable) at the throat and abdomen. At night, especially when a small adrenaline rush (due to a vivid dream) occurs, the tremor kicks up for 5-10 mins, then subsides to its normal slight buzzing sensation (located behind the heart). Extensive diagnoses (all typical tests including ep and ekg monitoring) have suggested to my cardio that I am simply sensitive to these foci and "I should get used to it."
I am on 200mg/day flecainide which does a good job of keeping the automaticity of the atria down and basically protects me from the added aggravation of APCs. At this point I am just trying to understand the nature of this beast.
Can you please explain what one of these foci really is? Is it akin to a small muscle relentlessly twitching? If it was caused by a viral insult, is there any hope of eventual reduction or reversal of these symptoms (akin to post-viral fasciculations)?
I would appreciate any insight you could give. Thanks.
There are basically two types of cells that make up the heart: contractile (or muscle type) and conductive (or electrical type). These cells are present as the heart is being made and usually end up in all the proper locations. In many individuals however there are electrical cells in locations where they shouldn't be. This is what makes a 'focus'. They may be electrically silent or they may be electrically active at various rates. There is not a viral etiology to foci and generally there is not a reversal of the firing rates without medication or ablation. I would recommend considering an ablation of the focus that is causing your symptoms. Hope this helps clear things up for you.
Thanks very much for the follow up!
The "stretch" hypothesis does seem to be popular...It's also what my cardio/ep (Dr. Marchlinski/UPennHosp) suggests. If true, it's particularly worrisome to me, as I am an avid athlete and have been all of my life (now 53)...since the symptoms seem exacerbated by strenuous exercise (palps and incresed internal tremor showing up the next day), I have the impression that I am making things worse by exercising.
Nonetheless, we only live once, so damn the palps.
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