PACs and Aflutter / PACs vs. PVCs

[frs87]

I have two questions totally different, but I feel I can get satisfying answers with you guys that although are not doctors, have so much experience and knowledge in the subject.

1) Is it true that PACs do not originate form the same pathway that conducts Atrial Flutter? As I said many times before, I have had ablation for this kind of arrhythmia, and was been told by a doctor that it couldn’t provoke any PAC, because it was a different system or something. That sounded really strange, because my PACs decreased dramatically after ablation. How can is be possible if that principle was true?

2) I have noticed in this forum millions of people suffering from PVCs, but rarely from PACs. Ok, not rarely, but in terms of comparison. Why? I’ve got just a wrong impression or there’s actually an explanation to it? I have had five holters and had just one PVC against many PACs. I wish I got the other one, at least I would know it has nothing to do with my Aflutter. I fear a recurrence.

[va_tony]

"1) Is it true that PACs do not originate form the same pathway that conducts Atrial Flutter?"

That's my understanding. PACs mostly originate in the pulmonary vein. Since PACs typically trigger afib, afib is treated with a pulmonary vein isolation (PVI) ablation. In atrial flutter, the usual ablation makes a complete lesion from the tricuspid valve to the inferior vena cava or eustachian ridge, which blocks a needed pathway for the atrial flutter .  So if the latter is the type of ablation you had, then it shouldn't prevent PACs unless your PACs were due to another ectopic source. On the other hand, perhaps you had a PVI.  That would stop the PACs, which act as a trigger for the flutter.

"2) I have noticed in this forum millions of people suffering from PVCs, but rarely from PACs. Ok, not rarely, but in terms of comparison. Why? "

The PACs and PVCs originate in different places.  Most people experience neither, at least while they are young and so never post. PVCs are perhaps more common because they often resilt from stress and the modern world has a lot of that (plus they also result from hormonal imbalance, magnesium deficiency, ventricle scarring and dysautonomia). You were just unlucky enough to have PACs, which likely triggered your aflutter. I too have both PACs and afib.

" my Aflutter. I fear a recurrence"

If you had the first type of ablation I mentioned above, the aflutter won't come back.

[va_tony]

I meant to say if your ablation was to form a lesion from the tricuspid valve to the inferior vena cava, your aflutter won't come back even though you might continue to get PACs which originate in the pulmonary.

Next time you see your cardiologist or EP ask what type of ablation you had (what exactly was ablated?)

[frs87]

Thank you for the answer.

I had an ablation for atrial flutter forming the lesion from the valve to vena cava. This makes sense because, though I haven't had a crises ever since, I still get lots of PACs - probably coming from the pulmonary vein, which I didn't know was a major source of them. Both doctors I saw - the one who ablationed me and the one I asked a second opinion for - guaranteed the a-flutter woudn't come back.

My arrhythmia was triggered mostly during exercises. At elevated heart rate I would start having PACs, and if I continued doing the physical effort, they would turn into SVT. If I stopped the exercise at the precisely moment I felt the first PAC, I would have lots of them, but luckily no arrhythmia.

Today, I still get PACs during exercises (and sadly in especific situations like laying down too fast), but very isolated. One here, one there... this is the thing that intrigues me. I'll take your suggestion and ask my doctor for more details. I think the more knowledge I get from the situation, the better I can deal with it. Thanks again.

[va_tony]

I've heard that the pulomonary veins (there are 4) get stretched during exercise, sometimes irritating the walls leading to electrical activity and PACs during and after exercise.

[frs87]

This doctor I saw said this stretching happens when we lay down on the left side, which can explain why some people (me included) has PACs in this situation.

[deedle1976]

A recent study of 625 healthy people showed that more people get pacs than pvcs during 24 hours wearing a holter.  here are the no of people with each:
PACs 81%
PAC couplets 16.8%
PVCs 63%
PVC couplets 8.8%
Bigeminy 3.2%
nonsustained vtach 3.4%
More people do seem to complain about pVCs on here. Maybe more people can feel them because it is the ventricle contracting which causes a funny sensation.

[yellowrose]

i have pac and i feel everyone of them. i very few pvc. not sure which is worse or are they the same been told pac cause afib true or not .