Aa
PAC -Is this really what it is?
I had my whole history and dilema ready to copy and paste, but will try to be brief and give enough info at the same time.........
Out of the blue several months ago I started having PACs, I guess. I wore the Holter monitor 48 hrs and only two slight episodes were recorded. Not realistic.
I have many every night, and they can shake me for two minutes or so before subsiding. I may have 20 of these during a night.
I can not understand why a PAC could last that long. Is there a chance these will go away eventually ontheir own?
I am 53 and have RA and don't want to take any more med. if possible.
I have had EKG, Echo, lipids...all good.
Thanks, GPO
Out of the blue several months ago I started having PACs, I guess. I wore the Holter monitor 48 hrs and only two slight episodes were recorded. Not realistic.
I have many every night, and they can shake me for two minutes or so before subsiding. I may have 20 of these during a night.
I can not understand why a PAC could last that long. Is there a chance these will go away eventually ontheir own?
I am 53 and have RA and don't want to take any more med. if possible.
I have had EKG, Echo, lipids...all good.
Thanks, GPO
This is common.
Doug
Doug
I have had skipped beats for ages now. I have got all the tests done and my heart was normal (they even x-rayed my heart!). I have them now as I am typing this comment! My problem is I only get them when I am sitting down and resting, I don't get them when I am moving about. Anyone else got this problem with them?
Dquenzer,
Well, I admit to being somewhat conservative but I'm not adverse to taking a risk when I think the payoff justifies the gamble. To use a poker analogy, I don't draw to an inside straight. I also have great insurance and live within a short drive of Johns Hopkins Medical Center, one of the major hospitals performing ablations. I'm really not opposed to ablations per se and will likely have one eventually when my AFIB meds begin to fail. Hopefully by then, the substrate modification procedure will have been perfected (my LA is 5.2 cm).
But I think it's a mistake to opt for ablation or even antiarrhythmic drugs like flecanide when harmless PVCs/PACs are involved (Note: Barbara's case likely justifies low dosage flecanide because her PACs have advanced to bigeminy). I believe that if PVCs are making one's life a living hell, psychiatric treatment should be considered rather than antiarrhythmics or ablation. If you have 10,000 people with PVCs, they will still hav an "average" lifespan (problems coping not withstanding). But if they take an antiarrhythmic (1% chance of proarrhythmia) or have an ablation, 100-500 of them will have serious complications. More than a few will die.
Yes, PACS do tend to eventually develop into AFIB. It did in my case too. But I had PACs for 30 years without the need for medication. I simply trained myself to tune out the palps and went on with life as normal. When I developed AFIB, there was plenty of time to start taking an anticoagulant. I believe that even if I had an ablation 30 years ago, once my atrium enlarged (as it is now), AFIB would likely have occurred anyway, even if the trigger had to come from the SA node. I must confess that if I were true to my philosophy about risks, I would probably not be taking Rythmol now. My cardiologist felt I was a perfect candidate for rate control since I seemed to function well in AFIB (at that time I was still participating in cardio-kickboxing workouts). As you may have read, the recent AFFIRM clinical trials established that mortality and quality of life were about the same for both the rate and rhythm control protocols (actually, the rhythm control being slightly more risky because of the use of cardioversion and antiarrhythmic drugs). But even though the Rythmol came with a risk, I opted for rhythm control because I instinctively felt that NSR had to be inherently better than AFIB, no matter what the study said. If I were convinced that I had an 80% chance of success, I would opt for an ablation too.
In the end, it's really up to each individual to assess the relative benefits and risks of a given procedure in consultation with their cardiologist.
Tony
Well, I admit to being somewhat conservative but I'm not adverse to taking a risk when I think the payoff justifies the gamble. To use a poker analogy, I don't draw to an inside straight. I also have great insurance and live within a short drive of Johns Hopkins Medical Center, one of the major hospitals performing ablations. I'm really not opposed to ablations per se and will likely have one eventually when my AFIB meds begin to fail. Hopefully by then, the substrate modification procedure will have been perfected (my LA is 5.2 cm).
But I think it's a mistake to opt for ablation or even antiarrhythmic drugs like flecanide when harmless PVCs/PACs are involved (Note: Barbara's case likely justifies low dosage flecanide because her PACs have advanced to bigeminy). I believe that if PVCs are making one's life a living hell, psychiatric treatment should be considered rather than antiarrhythmics or ablation. If you have 10,000 people with PVCs, they will still hav an "average" lifespan (problems coping not withstanding). But if they take an antiarrhythmic (1% chance of proarrhythmia) or have an ablation, 100-500 of them will have serious complications. More than a few will die.
Yes, PACS do tend to eventually develop into AFIB. It did in my case too. But I had PACs for 30 years without the need for medication. I simply trained myself to tune out the palps and went on with life as normal. When I developed AFIB, there was plenty of time to start taking an anticoagulant. I believe that even if I had an ablation 30 years ago, once my atrium enlarged (as it is now), AFIB would likely have occurred anyway, even if the trigger had to come from the SA node. I must confess that if I were true to my philosophy about risks, I would probably not be taking Rythmol now. My cardiologist felt I was a perfect candidate for rate control since I seemed to function well in AFIB (at that time I was still participating in cardio-kickboxing workouts). As you may have read, the recent AFFIRM clinical trials established that mortality and quality of life were about the same for both the rate and rhythm control protocols (actually, the rhythm control being slightly more risky because of the use of cardioversion and antiarrhythmic drugs). But even though the Rythmol came with a risk, I opted for rhythm control because I instinctively felt that NSR had to be inherently better than AFIB, no matter what the study said. If I were convinced that I had an 80% chance of success, I would opt for an ablation too.
In the end, it's really up to each individual to assess the relative benefits and risks of a given procedure in consultation with their cardiologist.
Tony
I understand that everyone will not benefit from an ablation. That is why I said maybe the EP can help. Sometimes PAC focal points are hard to find or hard to get at.
As to risk if we add up all the possible risks we take in life you would be amazed at how much danger we are in "statistically".
I understand that for you with an enlarged atrium it might not work very well. But I also had an enlarged atrium. Not significantly, but slightly. Obviously yours may be greater. One cardiologist didn't think it would work, but another cardiologist and EP felt it would and it did.
The issue for many people is that they read about all the complications and they "freeze", and begin to think about all the things that could go wrong. Most of the complications are not life threatening; especially when done under skilled hands. I prefer to look at all the things that could go right. There is a 99 to 95% probability that no complications will occur, and if they do most of them are easily dealt with.
I certainly would not recommend thinking about an ablation if meds could help or if the arrythmia was not highly symptomatic. But when an individual is about ready to mentally break down due to the constant anxiety, that is highly symptomatic.
I understand what Barbara is going through. I totally sympathize with her. I had the same thing happen to me about 10 years ago. If I had the opportunity to have an ablation (it wasn't an option then) to cure the problem I would have taken it in a "heart beat". Excuse the pun. I was absolutely miserable! Having the doctor say, "Don't worry it won't kill you," didn't mean a thing.
Also it is recognized that PAC's can develop into AFIB. Mine did. If Barbara's foci are on the pulmonary veins, like mine, there is a high degree of success with ablations, but also a probability of facing AFIB in the future. With AFIB there is at least a significant probability of having a stroke or heart attack if you are not on blood thinnners. But as one cardiologist told me, "Who wants to be on blood thinners for possibly 30 years. That in itself bears a risk for an active individual."
There is that "risk" word again.
I ask, "If you had a 90% chance of being cured of an arrythmia that altered your entire life, would you be willing to take a 1 to 5% chance of a complication?"
It's a no brainer for me. But then again I am also not a risk averter. I am a business owner and entrepeneur. But what in life is ever 100% except death and taxes.
Yes, check with your insurance. Mine wasn't cheap. But then again I went to probably one of the best EP's in the country.
I also sympathize with people who do not have insurance, because there is no way they could ever afford an ablation.
As to risk if we add up all the possible risks we take in life you would be amazed at how much danger we are in "statistically".
I understand that for you with an enlarged atrium it might not work very well. But I also had an enlarged atrium. Not significantly, but slightly. Obviously yours may be greater. One cardiologist didn't think it would work, but another cardiologist and EP felt it would and it did.
The issue for many people is that they read about all the complications and they "freeze", and begin to think about all the things that could go wrong. Most of the complications are not life threatening; especially when done under skilled hands. I prefer to look at all the things that could go right. There is a 99 to 95% probability that no complications will occur, and if they do most of them are easily dealt with.
I certainly would not recommend thinking about an ablation if meds could help or if the arrythmia was not highly symptomatic. But when an individual is about ready to mentally break down due to the constant anxiety, that is highly symptomatic.
I understand what Barbara is going through. I totally sympathize with her. I had the same thing happen to me about 10 years ago. If I had the opportunity to have an ablation (it wasn't an option then) to cure the problem I would have taken it in a "heart beat". Excuse the pun. I was absolutely miserable! Having the doctor say, "Don't worry it won't kill you," didn't mean a thing.
Also it is recognized that PAC's can develop into AFIB. Mine did. If Barbara's foci are on the pulmonary veins, like mine, there is a high degree of success with ablations, but also a probability of facing AFIB in the future. With AFIB there is at least a significant probability of having a stroke or heart attack if you are not on blood thinnners. But as one cardiologist told me, "Who wants to be on blood thinners for possibly 30 years. That in itself bears a risk for an active individual."
There is that "risk" word again.
I ask, "If you had a 90% chance of being cured of an arrythmia that altered your entire life, would you be willing to take a 1 to 5% chance of a complication?"
It's a no brainer for me. But then again I am also not a risk averter. I am a business owner and entrepeneur. But what in life is ever 100% except death and taxes.
Yes, check with your insurance. Mine wasn't cheap. But then again I went to probably one of the best EP's in the country.
I also sympathize with people who do not have insurance, because there is no way they could ever afford an ablation.
Hi Barbara,
I am right there with you. The pvcs pacs what ever they are .. are about to get the best of me.
I have had the occasiobal pvc off n on for years n years, just lived with it. BUT just recently they started with a vengenge... Bigeminy that last for 8 hrs straight.... or the switch from everyother beat to every two then every other then every three then every other one again on and on.... I hardly know how to act if I have a break for more than an hour or so. (oh what a heavenly feeling when it beats normal)
I feel sometimes that I am about to loose my mind over this. It is a constant nervous feeling....A constant reminder that my body is out of sinc..I HATE it!! I realize that it is not suppose to be anything to worry about, but just the FEELING drives me to tears sometimes. I cannot relax. I cannot concentrate. Sometimes I get light headed and weak I guess from not enough blood getting to my brain because of all the missed beats?
I am right there with you. The pvcs pacs what ever they are .. are about to get the best of me.
I have had the occasiobal pvc off n on for years n years, just lived with it. BUT just recently they started with a vengenge... Bigeminy that last for 8 hrs straight.... or the switch from everyother beat to every two then every other then every three then every other one again on and on.... I hardly know how to act if I have a break for more than an hour or so. (oh what a heavenly feeling when it beats normal)
I feel sometimes that I am about to loose my mind over this. It is a constant nervous feeling....A constant reminder that my body is out of sinc..I HATE it!! I realize that it is not suppose to be anything to worry about, but just the FEELING drives me to tears sometimes. I cannot relax. I cannot concentrate. Sometimes I get light headed and weak I guess from not enough blood getting to my brain because of all the missed beats?
Thank you both for your concern. The doctor would like to put me on a small dose of Tambacor. I do go to a very good teaching hospital in Pa. They saved my husband's life, so I feel very good about going there.
I was on Tambacor last year and was switched to Rhythmol (fewer side effects for me) to treat pvcs. Eventually had ablations, but if the medicine works and the doctor feels it is the right choice for you, why opt for invasive procedures? I had pvcs for over 20 years and I'd still have them today but for the ablations. However, it is very important to point out that ablation is NOT for everyone. In my case, it was ONLY recommended when I began to experience drop in EF. Otherwise, I'd still be beating to a different drummer. Good luck to you!
Dquenzer,
I realize that you are very pleased with the outcome of your recent ablation but I don't think ablations are necessarly for everyone. It's a matter of risk vs benefit. Someone with harmless PACs is not at much risk for a major complication even though the sensation may be mentally disturbing. To quote CCF-M.D.-RCJ : "Most top centers quote around a major complication rate on the order of between 1 to 5%, depending on the center, the patient, and what the centers count as complications. Major complications typically include stroke, major bleeding, and death." Is it really worth taking such a chance if you only have harmless PVCs and/or PACs and are having trouble "coping". I don't think so.
Driving to the grocery store does not represent a 1-5% chance of a bad outcome. Not anywhere near that. Most people typically drive 100,000 miles without having a single car accident. The ablation is far far more risky.
A further consideration is that the odds of having a successful ablation are at best 80% at a large Center with a highly experienced EP (to quote Dr. RCJ again). The odds go down if you necessarily (because of insurance or otherwise) must have the procedure done at a local center. Also, the odds of a complication go up. Furthermore, some arrhythmias are harder to cure than others. In my case, I have afib with an enlarged atrium. I'd say my odds of having a successful ablation with no future problems even at the Cleaveland Clinic is 50% or less (look at Dr. RCJ's answer to my "substrate modification" question). I know many people who have had failed ablations who had SVT. Some have multiple ablations seeking a permanent cure. In my own case, taking rythmol has made my life very comfortable and I don't see the need to any big risks at the current time.
Each person has to evaluate their own particular circumstances and decide for themselves if the potential benefit of an ablation outways the risk. In Barbara's case, I think she is correct to shy away from ablation at this point.
Tony
I realize that you are very pleased with the outcome of your recent ablation but I don't think ablations are necessarly for everyone. It's a matter of risk vs benefit. Someone with harmless PACs is not at much risk for a major complication even though the sensation may be mentally disturbing. To quote CCF-M.D.-RCJ : "Most top centers quote around a major complication rate on the order of between 1 to 5%, depending on the center, the patient, and what the centers count as complications. Major complications typically include stroke, major bleeding, and death." Is it really worth taking such a chance if you only have harmless PVCs and/or PACs and are having trouble "coping". I don't think so.
Driving to the grocery store does not represent a 1-5% chance of a bad outcome. Not anywhere near that. Most people typically drive 100,000 miles without having a single car accident. The ablation is far far more risky.
A further consideration is that the odds of having a successful ablation are at best 80% at a large Center with a highly experienced EP (to quote Dr. RCJ again). The odds go down if you necessarily (because of insurance or otherwise) must have the procedure done at a local center. Also, the odds of a complication go up. Furthermore, some arrhythmias are harder to cure than others. In my case, I have afib with an enlarged atrium. I'd say my odds of having a successful ablation with no future problems even at the Cleaveland Clinic is 50% or less (look at Dr. RCJ's answer to my "substrate modification" question). I know many people who have had failed ablations who had SVT. Some have multiple ablations seeking a permanent cure. In my own case, taking rythmol has made my life very comfortable and I don't see the need to any big risks at the current time.
Each person has to evaluate their own particular circumstances and decide for themselves if the potential benefit of an ablation outways the risk. In Barbara's case, I think she is correct to shy away from ablation at this point.
Tony
I'm not sure why you refuse an ablation? If the PAC's are making your life miserable it's well worth whatever risk is involved?
I had an ablation for AFIB on 2/20/2004 and I can't believe how much better I feel. Yes I was concerned about the risks, but I finally concluded that nothing in life comes risk free.
The risk of an ablation really isn't anymore than getting in your car every day and driving to the grocery store. We take risks all the time.
He who fails to take a risk fails to live. You can live in a bubble and eliminate all risk, but no one would want to do that!
Go to a medical facility that does many ablations, and to an EP specialist who has a good track record. Get an EP study done. Maybe they can help, maybe not. But from what I have read from your post you are on the verge of a mental collapse. That in itself is a BIG RISK.
I had an ablation for AFIB on 2/20/2004 and I can't believe how much better I feel. Yes I was concerned about the risks, but I finally concluded that nothing in life comes risk free.
The risk of an ablation really isn't anymore than getting in your car every day and driving to the grocery store. We take risks all the time.
He who fails to take a risk fails to live. You can live in a bubble and eliminate all risk, but no one would want to do that!
Go to a medical facility that does many ablations, and to an EP specialist who has a good track record. Get an EP study done. Maybe they can help, maybe not. But from what I have read from your post you are on the verge of a mental collapse. That in itself is a BIG RISK.
In my experience PAC's come and go in intensity. I can remember having them every other beat for periods of time. Then that went away and I hardly had them at all. Then they would come back at a regular rate, and then they would decrease for a period of time.
Bottom line is that they are not predictable and everyone seems to get them in different ways.
My mistake was to let them control me early on. Then I decided that I haven't died yet from them and simply lived as normally as possible.
If they are waking you up, like mine did on a regular basis, I would take something to help sleep prescribed by a doctor. I would consider that before taking other meds if they are bothering you only a few times a day. That was the best way for me to deal with them at night.
Afer my ablation for AFIB they have decreased immensely.
Bottom line is that they are not predictable and everyone seems to get them in different ways.
My mistake was to let them control me early on. Then I decided that I haven't died yet from them and simply lived as normally as possible.
If they are waking you up, like mine did on a regular basis, I would take something to help sleep prescribed by a doctor. I would consider that before taking other meds if they are bothering you only a few times a day. That was the best way for me to deal with them at night.
Afer my ablation for AFIB they have decreased immensely.
I have been plagued with heart skips for many, many years. Right now I'm having a great time with bigeminys. That's every other beat. This has been going on for about 2 weeks, where I'm about to lose my mind. They last from 2 skips to maybe a half an hour. I may get relief for about a half hour between them, but that's it. Try and live like this. Had every test done that I could possibly have. Been to different hospitals. Everyone says the same thing. It's ok in a normal heart. Well I don't know how much more I can stand. I'm looking for help also. Anybody have any ideas. Gave up cigarettes years ago, stayed off of spicy foods and chocolate, tried yoga, tried counseling. There isn't anything I haven't tried. I take .50mg. atenolol a day. .25 A.M. and .25 Nothing helps. Also I take synthroid. I refuse to get an ablations. Too many problems with them. Thanks for listening. Barbara
GPO,
Thanks for the post.
A single PAC lasts on the order of 80 to 100 msec, but its effect can be felt for a second or two. Multiple PACs, atrial bigeminy (where each normal atrial beat is followed by a PAC), or atrial fibrillation can certainly be associated with prolonged episodes of palpitations.
An easy way to tell what is happening is to repeat the Holter, or alternatively wear an event monitor.
Sometimes PACs go away in the same paroxysmal manner in which they started, but often they do not. While some medicines (like beta-blockers) can alleviate the sensation of palpitations, somtimes developing coping skills, like meditation or biofeedback, is more effective treatment.
Best of luck.
Thanks for the post.
A single PAC lasts on the order of 80 to 100 msec, but its effect can be felt for a second or two. Multiple PACs, atrial bigeminy (where each normal atrial beat is followed by a PAC), or atrial fibrillation can certainly be associated with prolonged episodes of palpitations.
An easy way to tell what is happening is to repeat the Holter, or alternatively wear an event monitor.
Sometimes PACs go away in the same paroxysmal manner in which they started, but often they do not. While some medicines (like beta-blockers) can alleviate the sensation of palpitations, somtimes developing coping skills, like meditation or biofeedback, is more effective treatment.
Best of luck.
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