Do I have ectopics or AF?

I have a personal feeling that I have been over-diagnosed. The cardiologist, after a 24 hr ecg monitoring and my efforts at describing my symptoms, diagnosed paroxysmal AF. Coming to this group I have read a lot and the contributors here who endure AF, seem to have a wholly different experience to me. For me , maybe once or twice in an evening I feel an extra/missing beat with no other effects. On a Sunday (my laziest day) I can feel the ectopics for several hours, if I am sitting quietly. I work full time and do not have issues at work, other than tiredness (who doesn't!) , as this is a standing job. No way do I feel rapid heart rate. Moreover my bp is normal and my resting pulse a bit on the low side (55-65). I was prescribed bisoprolol - horrendous. It was as if I was trying to think and move through molasses. I stopped these after halving the dose with no improvement. Can I get by with ectopics without any medication? I have kept a bp chart with pulse rates (shame I cannot track the arrhythmias). I guess I have to return to the Dr or GP and start again, but would not be going full of confidence. Any responses by the helpful people here would help me move forward.

14 Replies

  • AF is hard to diagnose unless by ECG where the lack of p wave and chaotic trace are self evident. I once heard a GP ask a specialist when groups of ectopics become AF which showed a distinct lack of knowledge as they never can. Ectopic beats which feel like missed beats occur when the ventricle contracts before blood is in it so no pulse happens for that beat. You feel them as though no beat happened. I have had them every third beat, fourth, fifth, sixth etc up to eleven and back to three going on for several weeks but it wasn't AF. Very disturbing I grant you!. AF happens as the name implies in the left atria and with AF the rate is chaotic and can be felt at the pulse by an irregular irregular rhythm which can be fast or slow although most people feel it as fast beat. It can be impossible to get a good reading on BP machines etc as they get confused. Many patients are asymptomatic and are unaware that they have AF until it is found by accident or they have a stroke so don't be too sure that you don't have it. I hope that you are right but realistically you need a 48 hour or 7 day monitor to get what is happening on paper. Ectopic beats are quite normal and most normal people have up to 200 a day I understand . They are basically harmless although as said above can be distressing.


  • Hi genorm

    I have AF, 24/7 never drop out of it and for the most part don't even notice my HR is around 65 most of the time.

    The ECG or a halter monitor will usually pick up AF, but otherwise difficult to diagnose from solely a pulse rate although it's a good indicator

    What I am trying to say is that a rapid heart rate is NOT the only symptom of AF, you can have AF and have a normal heart rate.

    If you do have AF, then you need to consider anti-coagulation

    Be well


  • Ian - your comment above re normal heart rate is a bit misleading - it would still be irregular correct?

  • Yes Kbuck thanks for clarifying, yes it would could be normal rate, but would be irregular.


  • genorm,

    What took you to the cardiologist in the first place? Was it just those few ectopics?

    and...Are you sure there was no AF recorded on your monitor during the night?

    I was diagnosed with PAF due to one 90 minute episode in 2012 but I have had 'palpitations' for years..

    I have daily ectopics, which are single premature beats, sometimes they happen two or three at a time, known as couplets or triplets, and can happen every few beats for a while.

    However, as Bob said above, that is not AF.

    You could actually catch any arrhythmias yourself if you had an Alivecor monitor. You need a smart phone such as an iPhone in order to use one. Or an iPad. Here's one on Amazon designed for an iPhone 4;

    Many of us on here have them and my Alivecor has enabled me to catch lots of ectopics (single out of place beats), doubles, triplets and short runs that never turn up on holter monitors.

    My resting pulse is the same as yours and I couldn't take Bisprolol either. Bisprolol was prescribed for me for ectopics, before my one known PAF episode.

    Currently I am on no meds at all.

    You certainly need to find out what they found on your 24 hour holter.


  • I had to wear a monitor for a whole month before they caught my Afib. Not to say it took that long but the length of the test was for 30 days. Somewhere in that time frame it showed up.

  • Hi Paul,

    After your month long monitor and subsequent AF diagnosis, what medications/treatment was given to you?



  • They eventually suggested that I get on Tikosyn. I really had to think about this. It's a pretty strong drug and I would have to go in the hospital for three days to make sure they got the dose right. Decided to take the drug and it has really helped me. The last time I saw the Ep I asked him about cutting back on some of my drugs . He suggested that I stay on them awhile longer . He also said I was a perfect candidate for ablation. I told him at this point that is the last thing I want done.

  • Thanks for reply paulh1 - Tikosyn - which apparently is only available in US - certainly sounds like a serious drug - I'm happy to hear it has helped you. I'm also a little cautious about ablation.

    I think I'll leave ablation as a last option!



  • It would be worth asking your cardiologist for an alternative to Bisoprolol - I didn't get on with it at all (feeling of being a zombie, much as you are describing) and when I saw the EP he switched me to Tildiem Retard. The lethargy has gone and I feel much more back to normal.


  • You sound similar to what's happening to me. But I was on bisoprolol for over two years before I started getting ectopic beats as I had a heart attack 3 years ago, but I am fine with them..... I am starting to worry even mor about the ectopics, scared that it's progressing into AF? Take care x

  • Just to add to pats post re alivecor monitor - it now has a facility that alerts you to AF. So if you feel something unusual and you check it on the alivecor it will tell you if it is AF. You can learn to read the graph yourself or take it to your EP who will tell you what it is showing. Best of luck

  • I get massive amounts of "extra beats" all day long unless drugged and, untreated, it is very disturbing. I don't know what to say if you're experiencing lower volumes because as Bob says, ectopics are normal. But if they are bothering you then (and maybe you've already done this) I would insist on seeing an EP and take it from there. Mine tried me on 4 different drugs till we got one that worked and now I get virtually no symptoms at all. My drugs don't slow my heart down, which is faster than yours.

    Good luck getting it sorted.


  • I would certainly recomnend a 7 day holter monitor, picked up my af

    and other things happening I was unaware of, but only after seeing a

    EP. Thats your next step I think.

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