History of WPW/AVNRT and now I have PAC'S?

Hi Doc,

I was visiting with a friend tonight who used to be in practice as a General Surgeon. I felt like I was having palpitations, basically stops and starts with a hard thump and furthermore it didn't seem to follow a pattern. He termed it 'irregularly irregular'.

So, off to the ER to for an EKG and come to find out I am having 'ectopy'. The vast majority of consisted of PAC's with a few PVC's in the mix. The ER doc (who is quite savvy as well as having Afib himself) ordered some labs and it turns out that my Serum Magnesium is right AT 1.8mol/ml so he suggested I supplement Mag for at least a couple weeks.

I guess my concern here is this: I have a history of WPW. Back in 2000 I had TWO ablations for WPW. The first one was not a success as there were TWO pathways. They tried to burn the one I had in the left side of my heart by approaching it trans-septally but couldn't get a good angle on the cath, so I wound up having a 2nd done at the University of Colorado by Dr. David Mann. That one worked, allthou at that time I noted the discharge summary said "AV Nodal Reentrant Tachycardia" instead of WPW.

I guess I'm concerned about the PAC's now given my history of previous rhythm problems, as well as my Father having Afib (its transient in nature it would appear). My EKG looked good with NO delta waves and I was in sinus with the exception of the PACS/minor amount of PVC's on telemetry.

What would you suggest in a situation like this? From everything I've read PAC's are almost always benign and nothing to worry about so. I've had this pop up before sporadically and I usually notice it the most when I'm laying
still trying to go to sleep and think to myself "well my that's WEIRD, but its not FAST so don't sweat it."

To ME it seems like the supp. Magnesius is a good idea as I read tonight that people can/do start to experience the effects of hypomagnesia at 1.8mol/ml. Note: I do NOT drink alchohol, but I also don't eat a lot of green veggies like brocoli so it wouldn't surprise me if my Magnesium intake is too low.

Oh, here are the codes from the EKG:

1100 Sinus Rhythm
1470 with occasional supraventricular premature complexes
2210 Short PR Interval
2440 Incomple right BBB
9150 abnormal ECG

I think I asked about the short pr and BBB once before as was told it had something to do with my being almost 6'10" tall if I recall correctly.

Also if this helps:

Vent. rate 80bpm
PR int. 116ms
QRS dur 108ms
QT/QTc int. 352/388 ms
P/QRS/T axis 65/17/64

Looks like they didn't put my height into the machine so.

THANKS :)

[tom_h]

I'm sorry you haven't had any comments on this post.  I try and keep quiet unless I have something of value to offer.

WPW is a form of AVRT; accessory pathways. These are located in the atrioventricular valvular rings. They provide a direct connection between the atria and ventricles.  Accessory pathways that give rise to WPW syndrome and AVRT are located in the atrioventricular valvular rings.  Individuals with Wolff Parkinson White have an accessory pathway known as the bundle of Kent. This accessory pathway does not share the pulse-slowing properties of the AV node. This is a bundle of connecting tissue that may be
either between the left atrium and the left ventricle, in which case it is termed a type A pre-excitation, or the right atrium and the right ventricle, in which case it is termed a type B pre-excitation. Type A is the more prevalent, hence the transseptal approach the was done on you back in 2000 (and on me just 3 months ago).


AVNRT involves a reentry circuit which forms within or right next to the atrioventricular node. The circuit usually involves two anatomical pathways; a fast pathway and a slow pathway, which are both in the RIGHT atrium. The slow pathway is usually targeted for ablation. These pathways are formed from tissue and exhibit behavior very much like the AV node.

The question is can an indivdual have both AVRT and AVNRT as you were apparently diagnosed with?  Personally, I have no clue and which is why I hesitated to give a response.  I can tell you that although I was first diagnosed with WPW, it turned out that I had another form of AVRT called Circular Movement Tachycardia (CMT), a persistent form of SVT.

As a comparison to your figures at the bottom of your post, here were mine from a followup visit to the EP 1 month post ablation:

Vent. Rate: 82bpm
PR interval: 142ms
QRS Duration: 84ms
QT/QTc: 370/432ms
P-R-T axes: 40 28 23

As a reference, I'm a at the other end of the height scale at 5' 7" and I'm 60 years of age.  I don't know if this is of any help to you, but I thought I'd offer it up.

[wyo327]

Actually now that I think about it I'm pretty sure the 2nd discharge notes said "AVRT" which makes a lot more sense really when I think about it.

Most what I'm concerned about now are the PAC's and how they relate to my previous history. As near as I can ascertain they have NO bearing whatsoever.

I didn't realize this at the time of my ER visit the other night, but the next day I woke up with a horrible head cold and in some of the diff. diagnosis for PAC's that I've seen it lists "infection" as a possible cause so I'm wondering if it as just as simple as that, or the borderline Mag level or a combination of both.

Like I said I've had these things before off and on and just blew them off or perhaps didn't even notice them. Apparently 50-60 percent of healthy people put on a Holter will have ectopic beats in a 24 hour period without even knowing they are having them.