holter interpretation

i recently had a 48 hour holter for palpitations.  i had 'minimally invasive ablation surgery' last year (three holes in the right side and a sort of pulmonary vein isolation) for atrial fibrillation.  i was in sinus rhythm briefly after the surgery, but soon went back into afib.  i was on amiodarone for about three months or four months and was successfully electrically cardioverted.  a few months later, i noticed palpitations upon retiring and occasionally when leaning against something while seated.  the palpitations were fairly severe and a holter was run to see what was up.  the holter results were these:

heart rates:  min 69 bpm.  max 138 bpm.  avg 89 bpm.  total hours analyzed: 45:00:39.  total beats: 216742.

ventricular events:  total beats 437.  %beats 0.20.  forms 22.  no couplets or triplets and 1 bigeminy run.  max ve/min 6.  max ve/hr 52.  mean ve/hr 9.7.  ve/1000 2.0.

supraventricular events:  total beats 8657.  %beats 3.99.  couplets 430.  svtach runs 92.  longest 22 beats.  max rate 166 bpm.  max sve/minute 37.  max sve/hr 551.  mean sve/hr 192.4.  sve/1000 39.9.

impressions and findings:  sinus rhythm.  occasional premature ventricular complexes.  frequent premature atrial complexes, 430 atrial couplets.  brief runs of spuraventricualr tachycardian, max rate of 166 beats per minurte, longest 22 beats duration.

i've been told this is not unusual and everybody has some irregularities and not to worry about things.  either they'll get better or they won't.

current meds are hctz, lisinopril and amlodipine, all for hbp.

it was suggested i lose some weight (6'2"/242 age 67 sex male) and perhaps try a low dose beta blocker (which i despise and which i suspect caused me to go into permanent afib a couple years ago).

i am not on any blood thinners other than aspirin as warfarin has no effect on me (trial dosage got up to 40mg per day before we all chickened out.  highest inr was 1.2).

what do you think?

regards,

davetee

[Michael J. McWilliams, M.D.]

1. The beta blocker would not cause atrial fib.  Going from paroxysmal to persistent atrial fibrillation is part of the natural history of atrial fib.

2. I think your doctor is right.  People have variable numbers of pacs and pvcs, but you are still in sinus rhythm.  The reality is that they will either get better, stay the same, or get worse.  Time is the only way to know.  A beta blocker may help decrease the number or rate of your SVT runs.  If you can live with the palpitations, you don't need any other drugs but if they bother you, the best option is try a new medication.

I have never heard of 40 mg of coumadin -- the most I have ever seen on a consistent basis was 15.

I hope this helps.

[PikaPika88]

My holter monitor said : 0 ventricular ectopy ; 0 supraventricular ectopy.  Is that normal?  

[maggiemag]

That is 100% normal.  It could not be any better.