Holter results...a little worried, need advice.

[oceanminded]

Hi,
I'm a 38 yr old male, been having pac's on and off for about 5 years. Nothing too bad though and were manageable. Family hx of high cholesterol so I take meds for that. I don't smoke, drink occasionally, and only average 4-5 hours of sleep a night due to work schedule. Did all the tests in the past, ekg, echo, stress test, holter monitor and everything came back okay except for some PAC's. Problem was when I wore the monitors in the past my PACs were behaving so they never picked up many. I was doing great and then about 2-3 months ago I started getting a lot of PACs. Went to Electro Cardio Dr and he suggested I do another Holter. I was at least glad this last time that I was having a lot of PACs so they could see what's going on.
Got the results today and I'm worried. I had around 15,300 PAC's in a 24/ hour period with runs of atrial tachycardia of my heart rate going up to around 138. He said its probably coming from left upper chamber. Wants me to try metoprolol 2x day and come back in 2 weeks. Thing that worried me is he said this could turn into afib one day. I already have anxiety issues so this doesn't help. I have a wife and 2 young kids to support. I could use all the info and suggestions that you may have so I can be around for my family for awhile.

Thanks

[CFS56]

If you have an irregular rapid pulse you need to go have it monitored to see what it is.  I had episodes of atrial tach with an irregular pulse, felt like afib but when I went to the er it wasn't.  There is no way to tell for sure what it is until you catch it.

[oceanminded]

'If you measure your pulse, how does the PACs feel? Like skipped beats, like double beats with pauses, or just double beats?'

All of the above at different times. Sometimes I even notice a bunch in a row which seem to speed up my HR for a few secs.

[is_something_wrong]

Not easy to say what this was but if you have more runs like this, you should definitely get it monitored. Atrial fibrillation can't be ruled out if you had a heart rate of 130, irregular.

If you measure your pulse, how does the PACs feel? Like skipped beats, like double beats with pauses, or just double beats?

[oceanminded]

I notice most of my PACs. I feel like there is a lump in my throat all the time. My last holter recorded over 15,000 in 24hrs. I basically feel like I'm in PAC mode 24/7 as of late. The other night I may have experienced my first possible AFIB event. I woke up with a irregular heart rate of about 130. It felt different than multiple PACs. It was a more chaotic and jumpy. I had to get up and walk it off, took a beta blocker and after 30 min or so it slowed down but was still irregular. Not sure if this was Afib or just a really bad bout of PACs with some tachy. The beta blockers definitely help mask the symptoms but the PACs are still there.

[is_something_wrong]

First, atrial fibrillation is not the end of the world. Maybe you should think "If I end up with atrial fibrillation on my old days (like 10-20% of us do, lots of PACs or not), I can adress it then".

My dad have a really enlarged left atrium (after decades of hypertension) which puts him a risk group for atrial fibrillation. He never had atrial fibrillation yet (except post-op bypass, almost everyone in that setting get atrial fibrillation for a couple of days). He is not very worried about atrial fibrillation.

PACs may set off short runs of atrial fibrillation in rare cases but for the arrhythmia to be sustained, changes must have been made to the left atrium. You will not wake up one day being in permanent atrial fibrillation, you get warnings.

Yes, atrial fibrillation is noticeable and different from PACs. PACs are double or skipped beats now and then (how do you experience your PACs, by the way?). Atrial fibrillation is a completely irregular and rapid rhythm. If you are not on medications, I would guess atrial fibrillation in your case (young and healthy heart) would manifest with an irregular heart rate of 100-140 at rest, jumping up to 200 or higher with light exercise. Beta blockers will reduce the heart rate some.

[oceanminded]

Thank you for your responses. The thing that worries me is my Cardio Dr said that frequent PAC's and Atrial Tachy could lead to Afib one day. Not the greatest thing to say to someone who already has a lot of heart anxiety. What exactly does this mean. Will I just wake up one day in afib. Will I know if I'm in afib vs frequent PACs? Is there a chance that this won't lead to afib and I won't need an ablation. I'm just hoping I can beat this and return to a more normal life.

Thanks

[CFS56]

I had 2 episodes of afib that were bought on by severe stress, not your run of the mill every day kind of stress.  However, I have had many episodes of atrial tachycardia that were precipitated by job and home stress.  I don't think you can ever sucessfully eliminate stess from your life because life happens no matter what you do.  If you can change how you react to stressors emotionally it does help make the events less frequent.  And I found that worrying about having "an episode" makes it all the more likely that I will.  I take a beta blocker and it has helped but I have frequent PACs still every day.  Don't know how many because I haven't had a holter for a while.  Good luck to you.

[oceanminded]

Can stress and anxiety actually bring on atrial tachycardia and if so then can it be cured w/o an ablation. Either way, living with non-stop PACs and atrial tachy is no way to live. I'm willing to do whatever I can to eliminate them.

[itdood]

The one thing that's under you control is lifestyle.  We all know that lifestyle can have a huge impact on the state of your mind, anxiety, and body health.  Things like weight, caffeine, blood pressure.  If you can make any positive changes there you might be able to manage the issue yourself.

If it does continue to degrade to afib, there's a few surgical options.  PV ablation like is_something_wrong talked about.  There are also some other ablative methods that can be escalated to.  

[is_something_wrong]

That's... a lot of PACs! I have 20-100 a day and I hate them..

If your EP doctor think your PACs may trigger atrial fibrillation and is saying they origin from the left atrium, I guess there is a chance they origin from the pulmonary veins. If they do, they may with time trigger atrial fibrillation, but treatment is fairly easy, with a pulmonary vein ablation (doctors isolate the pulmonary veins that sometimes fire impulses independent from the rest of the heart), and the result is no more PACs (except the ones we all have) and no atrial fibrillation. You could discuss it with your EP doctor? Or you can just be reassured that if you once should develop atrial fibrillation, treatment is available :)

Permanent atrial fibrillation usually requires some changes in the left atrium, often caused by high blood pressure.

But if you are bothered with runs of PACs (atrial tachycardia) and that many PACs, maybe it's a good idea to discuss treatment with your doctor..

Good luck!