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Premature Atrial Contraction
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Premature Atrial Contraction

I have been dealing with PAC's for 5 years now.  They have been of and on and very bothersome for me.  I have extreme anxiety from them and deprission.  I was put on 50 mg of coraguard and that seem to work ok but I wanted them to completly stop.  So I went to the cardoligest again and he told me to try Motropol 50 mg twice a day. So I did and now I am having major premature atrial contraction all day every day.  They are killing me. My doctor said that he still does not think it is from the medicine but I do.  He ordered another holter mointiter because I asked about anti arrythmia drugs and said that because he has only seen a couple pac's on my workup that he can't give that to me. These pacs are going crazy and I need help badly. I think I want to come of the Motropol but I am worried that it will kill me.  Can someone give me some advice as to what to do.
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How enlightening to see a good old PAC sufferer her among dozens of dozens of people complaining about PVCs ;) Sorry, I'm kidding. I suffer from PACs too. And I take Metoprolol. I know exactly how they feel.

I agree with you completely. The brand "Corguard" is a nonselective beta blocker, nadolol, in the same family as propranolol, where Metoprolol is a selective beta blocker, it works only on the heart. The point is, nonselective beta blockers are far better against anxiety and adrenaline release, which usually is the main trigger for PACs (more than PVCs which are more often caused by something in the heart).

In my case, propranolol alone removed the PACs with high anxiety, but the heart rate got a little slow and PACs at rest increased. Metoprolol didn't help so much at my low dose (25 mg x 1 a day). So I asked my doctor if I could combine them, a little of each. That worked great for me. Less anxiety and almost no PACs.

I hope your expression "the PACs are killing me" isn't literally. They don't. But they feel devastating when they are at the worst.

Don't ask your doctor for anti arrhythmic drugs against a few PACs. First, I'm pretty sure he refuses it, and second, that can actually in worst case kill you. Those drugs may have really severe side effects (ventricular arrhythmias and cardiac arrest). So they are only used if they are really needed (uncontrollable atrial fibrillation or ventricular tachycardia).

Ask your doctor what he recommends regarding meds. If something worked for me, it's not a guarantee that it will work for you. And NEVER change meds without asking your doctor.

Take care, and remember that PACs are only dangerous to the mental health.
I would have to comment on the last sentence of 'is_something_wrong' post

"and remember that PACs are only dangerous to the mental health."

In recent years a number of studies that discredited the hypothesis that frequent PACs (more than 200 a day) are benign. One of them is "Frequent premature atrial contractions in stroke of undetermined etiology. " This study came to a conclusion that "frequent PAC (more than 200 a day) should be regarded as a masked type of paroxysmal atrial fibrillation and should be included in one of the causes of cardioembolic stroke."

And another study "Excessive supraventricular ectopic activity and increased risk of atrial fibrillation and stroke." This study came to a conclusion that excessive supraventricular ectopic activity (30 or more PACs per any hour on a 24 h Holter Monitor recording) in apparently healthy subjects is associated with development of atrial fibrillation and is associated with a poor prognosis in term of death or stroke."

"Electrocardiographic predictors of atrial fibrillation." is another study which indicates that PACs found on a routine ECG exam  were predictive of new onset AF with hazard ratio of approximately 2 after correcting for age and sex.

There will be more studies like that coming out in the next few years, which will undoubtedly transform our view on PACs, from treating them as a completely benign finding to a an important risk marker for development of atrial fibrillation and stroke.
Thanks for your comment.

Well, to set off A-fib you need a PAC. That's similar with to make fire, you need a spark. But you also need wood. This "wood" is usually a left atrium that's dilated or hypertrophied (usually from high blood pressure over a long time) or damaged some other way. Yes, a perfectly timed PAC from the pulmonary veins may set off AF but in healthy people it goes away in seconds I think.

I don't think anyone doubts that in old people, an increase in PACs may predict an AF run.  I believe, however, that in order to keep a good mental health, we should address problems when they occur. Which means in this case: Almost everyone have PACs (70% or more during 24 hours) but A-fib is extremely uncommon at age less than 50. Yes, if you have thousands of PACs each day, you are at risk for developing A-fib later in life, but that's something you can deal with if it happens?

I'd like to quote a doctor from the Expert Forum:

Problem: I have a lot of PACs. I'm afraid of A-fib.

You can think as follows: I'm afraid every day because the PACs may trigger A-fib.

Or you can think like this: I've had a lot of PACs every day but they still haven't triggered A-fib.

It would be interesting to see the research you refer to. Do you have any links to the articles?

Thanks for the response right now my heart doctor wants me to see a psch. doctor for the mental part of this.  I still think the Metropol is making my PAC's worse and I do actually have some Corguard left from when they switched it.  I need to call them and see if I can try a little of both. The PAC's are going on all day non stop where is before they only occured in certain situations. Man this is really tough situation.
You're welcome.

I would try to write down specific triggers for the PACs. Some relevant questions are:

- Do they increase or decrease with aerobic exercise (running, walking, swimming, cycling, etc)?
- Do you drink a lot of coffee, or other caffeinated beverages?
- Do you eat a lot of sugar or chocolate? Does that worsen the PACs about an hour later?
- Do you smoke, or use other forms of nicotine/tobacco?
- Does panic, stress, anxiety or uncertainty make them worse?
- Do the PACs occur more often when you pay attention to them?

By the way, how do you experience the PACs? Skipped beats? Double beats? Long pauses? Something in the throat? Explosion in the chest after a PAC?
Please try to avoid all decaf products as well.  There is still some caffeine in these drinks/foods.  I have just ended a terrible 2 month bout of pacs and pvcs by discontinuing all decaf products.  It has helped calm my heart down significantly.
See I use to only get them right after excersise for like an hour or so.  Than I went to docter thaey gave me medicine to help Beta Blocker.  Which did not help them go away but did make them a little easier to deal with the thump.

I drink no Coffe or Sodas.
I use to dip tobacco I have quit that now. It has only been like 3 weeks.
I do eat right much sugar I will check on that.
Panic,stree, and anxeity for sure make them worse.
They seem to also become a whole lot worse when I pay attention to them.

I do feel a pause and than a huge thump everytime.  It is crazy how I can fell that everytime. I do sometimes feel them in my throat because sometimes when I talk it kinda interupts my voice a little. The beta blocker has only made the thump not has hard. Now it is just a blimp which is better to deal with but becasue I feel everyone it stills causes me to freak out and panic. Like I said earlier I use to just ahve them when I was really anxioue or after strenous excersise. I have gone from some PAC's to now all day PAC's and I reall only have one common thing and it is Stress from them and Medicine. The biggest problem is probably the cirlce of anxiety and stress that they cause and the medicine. It does feel better to talk about the though thanks again
I wish you were right! And I really wish young people would not have to worry about AF! Regrettably its not true.

You need three things for AF to exist

1) Anatomical Substrate - Ectopic Foci in the Pulmonary Veins
2) Dysfunction of the Central Nervous System - Overactive sympathetic nervous system triggers adrenergic AF (as well as contributing to anxiety/panic disorders) and overactive parasympathic NS triggers vegal AF (common in endurance athletes)
3) Trigger - could be anything from eating a spicy meal your heart rate falling too low when you are sleeping.

Yes over half of all people have PACs on a daily basis.  HOWEVER, only 1 percent have more than 100 PACs a day (Brodsky et al., 1977).  Frequent PACs are statistically very uncommon and could indicate that you have a predisposition to developing AF.

Lone AF is not that uncommon in young people.  Endurance athletes, alcoholics and people with CNS disorders (which often manifest as panic/anxiety attacks) are more predisposed to it.  There are many people on this board and in a Afibbers.org who developed Afib at an early age (20's and 30's). Few of them had hypertension, atria enlargement or hyperthyroidism.  Most of them had frequent PACs before they developed Afib. Regrettably, you don't need any of the 'wood' you talked about to develop long lasting Afib episodes.


Michael Brodsky et al.  "Arrhythmias documented by 24 hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease." The American Journal of Cardiology, Volume 39, Issue 3, 1977, Pages 390-395, http://www.sciencedirect.com/science/article/pii/S0002914977800945.
Thanks for the info.

I'm referring to another article where the number is 2-5% but I guess it doesn't matter. I didn't find your article in full text (not paying $30 to read an article) but I guess the conclusions are quite similar.

I have some questions:

1. The statement: "Frequent PACs are statistically very uncommon and could indicate that you have a predisposition to developing AF." Did you find that in the article?

I would think it depends on where and when the PACs occur. It's just like PVCs, many people may have thousands of PVCs which are completely benign, but a few may get other arrhythmias triggered. If you read this forum, many people have lots of PACs and no A-fib.

PACs from the pulmonary veins may be out of sync with the rest of the atrial activity, so if you are unlucky, they may have the wrong timing and trigger A-fib, but I wouldn't think this arrhythmia would sustain for so long.

Correct me if I'm wrong, but I always thought certain athletes would have some remodellation to the atria? The same goes for alcoholics (alcoholic cardiomyopathy).

Of course, all arrhythmias should be examined by a physician, but when my cardiologist tells me that my PACs are benign, I trust that. I know that A-fib in theory can affect everyone, but at young age it's a really uncommon arrhythmia, and I hope you agree to that.
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