Are ventricular couplets dangerous?

[stevecurrey]

Hi - first of all I'm new here so hello to everyone :)

I've had a history of what I thought to be premature beats (hard thumps in the centre of my chest) for around the last 8 years.  I had a lot of ECGs, 24 hour Holter and also an Echo (2 years ago) which all came back as normal.  I'm a 32 yo male, non smoker, social drinker.  Low to moderate exercise - 11st.

Over the last year - these things have been pretty much ruining my life and the fact that nothing was ever found in these tests only seemed to exasperate the situation rather than put my mind at rest.

I decided to have a 7 day holter monitor a few months back to try and catch these things once and for all.  I made a note of the times when I felt the thumps and confusingly - the consultant noticed no ectopic beats / arrythmias which was really odd.  He did however notice them at other points during the day.

I've just got the report back myself and the breakdown is as follows:

Period: 7 Days

Sinus rhythm with very occasional isolated supra ventricular ectopic beats and ventricular ectopic beats with one ventricular couplet.  Occasional T-Wave inversion in some areas.

No pauses or AV block
Max heart rate: 150bpm
Min heart rate: 52bpm
Mean heart rate: 75bpm

Conclusion:
No significant arrhythmia detected. No arrythmia when patient reported symptom of palpiation.

I realize that compared to many people on this board - this report is probably very good but the single couplet did scare me a bit (a lot) - especially seen as though I can see a print out of the electrical activity at the time!

So in conclusion I would like to know if this v. couplet is anything to be concerned about.

Thanks in advance.

Stephen.

PS - I would also like to say that this is a fantastic community and one which I intend to post more often if I can be of any help.

[1991freeway]

I have just received my results from Holter Monitor
Rate 59 to 185 bpm
VE's were frequest (1090) and included 3 triplets and 12 couplets.
25 runs of ventricular tachycardia were recorded
The longest run lasting 158 beats, the fastest 120 bpm
1 'ventricular run" at 14.44 appears to be ventricular pacing at 66 bpm
AE's were rare (45) _ 4 atrial couplets
1 Atrial run consisting of 4 beats with a maximum rate of 188 bpm
2.5 hours of atrial fibriliation was recorded representing 18% of the recording
The maximum rate was 185 bpm

As I have a pacemaker because my heart rate was 28, on Warfarin, aspro and Minax (2 per day).  I still don't know what this means, cannot get into the doctor until May.

Should I be concerned???

[Bromley]

This is probably similar to my holter, and equally confusing.  For one thing, I dont understand well how Supra Ventricular Ectopy (SVE) and Ventricular Ectopy (VE) would be inclined to exist in the same heart. Are they both SVE, but one just looks like VE because the holter makes it look like VE, or aberration makes it look like VE? What is the likelihood that both conditions would co-exist independently?

Next, I discover here that I dont know how to count PVC's.  Are we saying that a PVC can be either a VE event or an SVE event?  And how many are too many for one day?  

I assume this is a one day recorder result, which would make 4009 a fair number of PVC's to have. Hence the comment about the number being "very frequent".  If so, you should consider the possibility of an ablation to destroy the source of the problem, or at least following through on a conversation with your doctor.  Very frequent PVC's can be bad for you long term.

[Bromley]

Not sure this is really significant. It really takes a doctors input to assess the significance of something l like this.  You say you had a "consultant" look at it?  Hmmm.  I am actually really picky about who I let read and interpret my EKG and/or holter results. Is a consultant a normal medical doctor, or someone equally qualified?

I would not stop until you have a satisfactory explanation for the heart/chest symptoms which you were told registered no electrical activity on the holter monitor.  If you used a manually activated loop recorder, you should be able to request a complete print out of all data captured. As a minimum, to validate the data, I would expect to see a trace and timestamp for each time you activated the recorder. Look at those traces yourself. A PVC will be easy for you to spot, so you should be able to make at least some basic sense of the recordings.  If you haven't done so, you should also consider having a doctor look at this.

[MichelleP_3811]

You should really talk to your cardiologist about your results.  I am a little confused but the different numbers where one says you had 28333 isolated and the other says 4009.  Did you have two different monitors are 2 different times?  Basically you have an assortment of different type of pvcs.  The isolated and coupled aren't anything to be concerned about.  The runs of VT are a little more concerning than the other beats but they are not sustained long enough to be of any super big concern.  That said, you should really discuss with your doctor if there are any next steps you need to take.  If you haven't done it yet, you should probably have a whole workup of your heart, ekg, echo, maybe some scans.  If your heart is structurally in good health then the ectopics are generally nothing to worry about but do discuss this with your doctor.   Do you notice that exercising makes the ectopics better or worse?   Take care.

[ShannonLeroux]

Supraventricular ectopy - 1781 Isolated  
106 couplets

Ventricular ectopy

2833 Isolated
52 couplets
10 runs
43 beats in runs
31 beats longest at 116
11 beasts fastest at 220 beats per min.

46 min heart - 71 average
183 max

Very frequent 4009 isolate PVC and 7 ventricular couplets
8 runs of non sustained wide complex consistent with Ventriccular tach.  
the longest run consisted of 25 beats at 199 bpm and the fastest was of 11 beasts at 204bpm
occasional 121 isolated PAC ;and one atrial couplet.
faster thatn normal rates correlation with VT of 15 beats at 200 bpm

Not sure how to read this holter I just recieved... I am a 40 elite athlete witha  very healthy albiet mis firing heart....Perhaps you can share with me what your thoughts on these numbers are....It would be so appreciated... I am confused.....to say the least.

thank you so much,

Shannon

[Jezza1505]

Hi Steve - I am a 44 y/o male and I have Ebsteins Anomaly (CHD). In the last year have had arrhythmias numbering some 1500 ventricular extrasystoles in 24 hour period with about 10 ventricular couplets as well, measured on a Holter I presume. My consultant said that this amount was fine and has given me the option of taking a low dose beta blocker to control the rhythm. He advises that had the couplets been triplets or worse then he would definitely prescribe beta blockers to calm things down. So I see it that the couplets are not necessarily dangerous and I am quite happy to live with the arrhythmias without having to take drugs to control them. If they get worse I might think differently. I find it odd that I notice these most when I am 'at rest' so in the evening and throughout the night. When doing a stress test on a treadmill they found the arrhythmias were almost non existent! I would have thought that when the heart was stressed then that would be the time that it wasn't efficient ?? He suggested lots of fruit to build up the Potassium levels in the heart. Hope this helps.

Jeremy

[poohbear2026]

I have had 4 and 5 pvcs in a row (NSVT) caught on monitors.  My cardio was a little concerned at first and sent me to an EP dr at Duke.  But after having the cardiac MRI they said in structurally normal heart it should be fine as long as I don't start passing out or they start to last for longer then 30 seconds.  Only then would they consider doing an EP study/ablation.

[stevecurrey]

Hi Rilesnic

Yes I've heard that before.  

The odd thing was that I didn't even feel this "couplet" yet I feel weird things in my heart all of the time.

I did hear that a large population of healthy people will get couplets too but that was a long time ago and I did not pay much attention as I didn't think I had them!

I wonder if couplets are OK in a structurally normal heart.  There doesn't seem to be that much information on the subject and I've looked for the last few days,.

I expect that if there was a danger the cardiologist would have said so on the report - but I'm a worrier so what can you do ;)

Stephen

[rilesnic]

My doctors have told me that if they put a monitor on 100 "medically normal" people, all 100 would have PVC's, or PAC's, but not all would feel them or ever even know they had them. This makes perfect sense to me b/c it does not make sense that all hearts beat lub, dub 24/7. I believe some people never feel them and others, like us, feel many or all of them. Why? Who really knows, but I definitely think it is the way many of us wired...maybe type-A personalities, anxiety, worry, stress?? I believe this makes me at no more risk or puts me in no more danger than anyone else walking around although I don't think that rationally when they are happening to me. I sure wish I didn't feel them and remember the days when I didn't. Life was much different and a lot more fun back then.

[stevecurrey]

Thanks for all the replies

So it looks as if no one really knows :(

There was a study where people with PVCs were put on 24 hour holter and it came back that over 60% of them had couplets which I suppose puts things into perspective.

I suppose that I should think myself lucky that I only had the single isolated one in a 7 day period.

Oh found the link to that study on a forum:

http://palps.**************.com/cgi-bin/YaBB.pl?num=1195674804

[Mom2four85]

I'm there with all of you...couplets, triplets, salvo's, bigeminy, trigeminy etc etc can't stand any of them and wish they would leave me alone in my happy little world! =)

I've so often asked what's dangerous & what's not? I have mixed emotions on what dr's tell me and I've been to a lot of dr's since July 2009.  I finally found a dr who admitted there is NO way to know every single thing that goes on in the heart and even dr's are still learning, because of the 220,000 things that could go wrong with just 1 cell.  My head's still swimming from all the info he talked about when other dr's said my case was too complicated.

I'm a classic case of the weird and strange happenings :P

[rilesnic]

I feel the couplets as well when I take my pulse at times. I think I've had palps my whole life and didn't notice them until my anxiety kicked in. I too want a steady rythym or I want to not feel these darn things!

[bbxx]

Delta I am with you, i like it better when the rythm is steady too lol

[DeltaDawn23]

I have the couplets, usually when my blood pressure and heart rate is slower from my beta blocker.  I like it way better when the rhythm is steady!

[bbxx]

I would like to know if others with "normal" hearts feel couplets at times when they feel their pulse. I wonder if I have a LOT since I can take my pulse and feel the 2 quick beats together just when randomly checking every other day or so. I figure I must have a lot of them in order for me to just happen to catch them like that. Any ideas?

[bbxx]

I can take my pulse and feel couplets often. I hate it.