Af vs atrial ectopic

[patient1234568]

Hi,

Can someone tell me what the difference between an episode of repeated atrial ectopics and atrial fibrillation?

Thanks

[BobD Volunteer]

Yes. ectopics are miss timed beats . What happens is that the ventricle contracts before the atrium has passed any blood down to it so that is closes on nothing and no beat is felt. A F is a chaotic non rhythm in the atrium which transfers some of this to the ventricle. Your pulse will be chaotic with no rhythm and often very fast (180bpm +) . AF has been variously described as a box of frogs, a bag of worms or two teanagers pillow fighting.

On an ECG ectopics show as invert T waves. AF shows as a completely irregular bottom line with no P wave at all.

Ectopics are generally benign but damned annoying. AF can be damaging long term if left untreated.

[kevmca in reply to BobD]

Very interesting, thank you. I have low pulse permanent AF. Can I expect problems sooner?

[Mercurius]

Some minor corrections:

- Atrial ectopics if arriving in series may initiate and drive the atrial fibrillation.

- The ouput reduction has two levels:

a) Only atrial effort is missing. Then the pulse volume (ejected blood with one contraction) is reduced ~15 percent. This is functionally compensated by elevation of the heart rate with ~15 percent. This is my case. Because the output volume (pulse volume x heart rate) is normal there is no any symptom except the slightly elevated heart rate. This stage/type is "silent", only ECG can detect it.

b) If for instance for higher workload the regukation initiate a higher output and therefore higher heart rate, easily could happen, that some contraction will not pump out blood (ineffective contractions). This results in a self amplifying misregulation. More inefective contraction - triggers the regulation for increasing the heart rate, that increase will forther increase the number of inefective contractions. That is the mechanism of that what you wrote - the reduction of the output.

Why it is interesting? Recently came up, that symptomatic afibber frequently have silent afib events as well. One gud point if, the patient can "learn" by relaxation, stress allvieantion etc. to prevent the transition from the silent to sympotmatic afib.

[Alan_G in reply to Mercurius]

With regard (a), I understand what you are saying, but when you say that it can only be detected by an ECG are you saying that your pulse remains regular as well. I ask this because I've always been of the belief that I can detect when I'm in AF by feeling the pulse in my wrist.

[DK81 in reply to Alan_G]

Also with regard to (a), it is difficult to believe that a 15% change in heart performance, automatically compensated for, is anything to worry about.

[DK81]

Thank you for your explanation. I am puzzled because my ECG trace looked quite regular - when I was allowed a glimpse - albeit with a higher wave frequency. How an ECG can show how blood moves in the atria is a mystery. Also, I have no detectable loss of exercise capability when AF is occurring, compared with when my pulse is normal. I would really like to know what is going on here! Maybe you would be kind enough to comment.

[DK81]

Thank you for your further helpful paragraphs. As I have no chance of scrutinising the ECGs at present, I shall have to leave this aspect unresolved for now.

I tested myself walking up a steep hill, and could not detect any negative impact caused by AF. In contrast, 2.5 mg Bisoprolol daily slowed me down: I think it took about 39s instead of 33s to swim 25m, and walking up hills was a problem. I stopped taking this drug, because my quality of life was affected. So not everything is sorted yet!

[patient1234568]

Thank you for all of the replies they are very useful.

I was previously diagnosed with af and as a result had a number of ablations on my left side of my heart last year. This has improved symptoms significantly and previous triggers identified such as caffeine, stress and tiredness have a greatly reduced affect on me.

However, I am still experiencing similar symptoms periodically to what I had previously attributed to af - a general feeling of anxiety, an awareness of my heart rate fluttering and some chest pain. In a recent week long ecg when I experienced these symptoms it was noted I had experienced a sequence of ectopics at this time.

Are there any other conditions I should be considering that may cause these symptoms and effect my heart in this way.

Or should I just accept and live with it? It's not a massive inconvenience just the occasional episode these days