Pacemaker Blues Part II

Dear Doctor, I appreciate your previous answer to PM Blues.  Today is plagued w increased irreg rates and PAC's which occur when up and moving about and seem to settle when I sit still.  Sent in a tracing from my Event Monitor.  Nurse on-call says, I'm pacing in the ventricle and occ in the Rt atrium, with what appears to be PAC's thrown in, she does admit the rate is irreg.-did not feel anything "life-threatening" going on.  Sitting still as I mentioned I am in perfect sinus rhythm without symptoms.  Up and moving about (trying to decorate for Christmas) I experience the irreg heart rate, skipped beat, and the feeling of the need to cough-l had about 3 hrs relief but back again.  I have requested that she try to get me in sooner to see the Doc (appt 1-3-08) as well as consider that I may need to attend Card Rehab if this is gonna be my life from now on...I need help!  Husband is even getting a little tired of my worrying over "non-life-threatening" events.
Questions- 1)Any thoughts on  why all of a sudden this increase in symptoms at week 11? -before only occ.  2) Could a lead be loose/perforating or would this be picked up on interrogation? 3I live on Sanibel Island, Fla- do you know of good EP Doc in the area should I decide a 2nd opinion is in order?  Thankyou.

[Michael J. McWilliams, M.D.]

1)Any thoughts on  why all of a sudden this increase in symptoms at week 11? -before only occ.  

There is usually no good explanation for why PACs and PVCs act up.  They tend to come and go on their schedule -- not yours.  Some people identify triggers sleep deprivation caffeine, stress, activity, etc.  The usual recommendation is avoid triggers, but asking you to avoid activity won't work that well.

If I saw you in clinic I would start or increase your beta blocker. I would also put on a 12 lead holter monitor and ask you do activities to increase the PACs.  If they are all from the same location, you may be a candidate for an ablation.

2) Could a lead be loose/perforating or would this be picked up on interrogation?

It is usually picked up by interrogation.  It might be worth a chest xray in the sitting and standing position to determine if the lead has too much slack or too little slack.  If it is bumping one of the atrial walls with a large loop, that might cause PACs, but I have never seen that clinically before.

3I live on Sanibel Island, Fla- do you know of good EP Doc in the area should I decide a 2nd opinion is in order?  

Not in that area.  You are in a pretty isolated  region of Florida.

I hope this helps.  Good luck and thanks for posting.