Pac couplets and significance?

[Joeylucy28]

I saw my EP yesterday. He said that I have a normal heart. I told him about my 2 episodes where a racing heart woke me up from my sleep. He thinks it could be svt. I haven't caught it on a holter.
Holter showed 35 PACs and 2 pac couplets. Anyone get couplets? I've read that it can be associated with svt or atrial fib

[is_something_wrong]

Artifacts often look like fibrillation or other arrhythmias. A good quality reading is essential. Once I read an article about a Holter recording revealing what looked like "torsades de pointes" ventricular tachycardia. It turned out that the guy was brushing his teeth, causing an artifact. If your EP has concluded you don't have atrial fibrillation, I would trust that if I were you.

PACs are far more likely to occur repetitive (couplets or runs) than PVCs. Ectopic beats caused by so-called "increased automaticity" meaning that some spot in the heart is "upset" by adrenaline stimulation, etc. and fires beats before the sinus node does, can cause one, two, three, or seven for that sake (it's totally random) beats in a row. Increased automaticity is a more common cause of PACs than PVCs, as the atria generally are more irritable than the ventricles.

You ask if PACs (and PAC couplets) may initiate atrial fibrillation or SVT. As atrial fibrillation and SVT both are caused by atrial ectopic activity, the answer is yes, atrial fibrillation and SVT starts with a PAC. However, almost every person alive have PACs, meaning that most people with PACs will never have atrial fibrillation. Some scientists claim that PACs that origin from the pulmonal veins can be more likely to cause atrial fibrillation, which is why the pulmonal veins are isolated when atrial fibrillation is treated with ablation. But this procedure doesn't always treat atrial fibrillation, so atrial fibrillation may occur elsewhere in the atria too.

SVT is another story. "True" SVT (not just some PACs in a row) is caused by a re-entry circuit, as Michelle decribed above. Because of this cause, SVT is very easy to differ from sinus tachycardia based on how it starts and ends. If you suddenly experience that your heart rate is doubled or tripled, like from one beat to the next, and it ends after seconds, minutes or hours just like a switch, you can be pretty sure it's SVT. If your heart gradually speeds up and slows down, and if the heart rate is variable during the event, it's very likely to be sinus tachycardia.

[MichelleP_3811]

Yes, you are in the right section.  This is the section for heart rhythm issues which is what you have.  I would not assume at this point that you have afib since 2 cardiologists do not believe the holter showed it and was recording in error.  I am sorry whomever placed it on you appeared to not know what they were doing but I think if you get another monitor do push for a 30 day so you have more time to try and catch the rapid beat and decipher if it is run of the mill svt or indeed afib.  Drinking a cold glass of water is one of the ways to try and get an svt to stop along with holding your breath and bearing down.  So if drinking something cold works go for it.  But that does sound like classic svt as opposed to afib.  

[MichelleP_3811]

Couplets are really of no significance though they can be a trigger for svt.  Pacs are not the same thing as svt.  Svt is generally caused by an extra muscle fiber in the heart that allows the signal to get caught in a reentry circuit usually running at rates well into the 200s causing shortness of breath and lightheartedness.  An ablation is the best way to cure it for good but it is helpful if the person is fairly active before they tried one because it might otherwise be hard to ablate.  The ep has to get it going and if he can't then they can't ablate.  But the first step is to catch it on a monitor.  If you know you have the episodes at least once a month an event monitor that you can wear for 30 days may be the best way to catch it.  The holters rarely catch it unless you have daily svt episodes.  I had one the day before I got the holter but not the day I had it.  I needed the event monitor to catch it.  So try not to worry.  Odds are it is run of the mill svt as opposed to afib and eventually you may find yourself having an ablation.  If it gets to that point come here to talk it out.  There are a lot of folks with ablation experience who can walk you through it.  Best of luck getting to the bottom of it and maybe do some research on vasovagal maneuvers.  The big one is holding your breath and bearing down like straining to go to the bathroom.  If you can stop the episodes on your own that will have less wear and tear on your heart.  If you have an episode you can't get to stop in a reasonable amount of time or you start to experience chest pain with the tachycardia then head to the er but otherwise you may be able to manage it on your own until you get it diagnosed and correct if you so chose.  Take care.  Keep us posted on how you are doing.

[Joeylucy28]

Thanks so much for that information. Very grateful. Why can't cardiologists explain it like this :-(
If I ever get an episode that wakes me up from my sleep again I'm going to make sure I take my pulse and see if it ends abruptly.

[Joeylucy28]

Thanks. I haven't had a proper episode during the day. Only a couple of little ones where they've only lasted 10 seconds, one time I was a bit dehydrated and had just eaten a lot of sugar and coke an hour prior and the other time I was extremely anxious about something and I had a fast heart rate again for about 5 secs and it made me get up from my chair and it stopped. So strange.
I just wonder if what I had was a sinus tachy from a nocturnal panic attack which I've never had before. I'm eager to catch it on a monitor, I think I need to see someone else so I can push for a 1 month one

[Joeylucy28]

Thanks just very anxious by all of this and I can't get my head around it. I have a tight chest and dry throat from all the anxiety.

[CFS56]

When I have an episode of afib  I have a very fast, very irregular rhythm.  It is something that is very different feeling than a regular rhythm svt.  That being said, last time I was in the hospital the afib converted to a flutter and that was a regular rhythm.  But a fib is very irregular, and you would definitely notice it. Try not to worry about it though.  It just makes your ectopics worse.

[Joeylucy28]

Thanks Michelle,
You say a lot of people on here talk about it... Am I in the correct area to post? Or is it under a different group?
I also had a holter monitor which showed paroxyml afib however 80% of the holter was artefact, a very bad recording, and 2 different cardiologists looked at it including an EP and thy said we can't see afib on it and it was jargon!
I just wonder what afib feels like then?
The 2 episodes that woke me up from my sleep only lasted a few minutes and I got some water to drink and it went. The rythym felt fast but regular.
I also suffer from anxiety, and ever since the first holter showed afib I've been having many more ectopic beats.