Ectopics or Atrial fibrillation (?)

[Patient5555]

Hi I have been feeling fluttering in my chest for a while. 45 yr male, management role & 75kgs. The Cardiologists have described it as frequent atrial and ventricular ectopic. On reviewing my data, it did race upwards at times (100+) but the issue seems to be the inconsistent Ectopic/AF beats and usually well below 100bpm. Most commonly occurred in the BPM 60- 80's. All hospital tests ok (bloods, ultrasound, stress test and MRI). Medications via Cardiologist: Vasocardol (calcium blocker) and Flecainide 50mg to 75mg 2X a day. (I tried beta blocker Metoprolol but found it to be incredibly sedative so we swapped to a calcium channel blocker which has helped to allow me have higher energy levels). Heart seems to work better with the meds and if I dial down the medication it comes back. Below is the image of my ECG. I could certainty feel it! I would really appreciate to hear if anyone has an idea about this ECG. Thank you so much for contributing.

NB Updated since original post to provide the professional image of the ECG

[pottypete1]

I’m no doctor and haven’t been on a course to learn how to read ECGs but my guess is it is ectopics.

AF is an irregular heartbeat that is quite different to missed or extra beats.

What is important is how are you feeling. If you really feel very unwell go and see your doctor.

If the doctor is at all concerned he will refer you to a cardiologist hopefully an EP who specialises in heart rhythm.

Pete

[CDreamer]

Ditto what Pete has said. There does seem to be a P wave and the rate regular - was this a Kardia ECG and if so what was the indication of diagnosis on the trace? They are usually pretty accurate.

[Patient5555 in reply to CDreamer]

Hi CD, Thanks for you reply. I have had several professional ECG's but this photo is from a consumer product called SnapECG - it is a great product and I use to provide an indication of what I am feeling. Peace of mind really. I'll update the main photo to the professional ECG image soon. Sadly I couldn't post two photos! Again, many thanks for your input.

[BobD Volunteer]

If the blip is below the line as yours it is ectopic I understand. Also your can see the p wave quite clearly. NB not medically trained just been around AF a very long time.

[Patient5555 in reply to BobD]

With thanks

[Hidden]

I would also say that it's ectopics, visible p-wave etc

[Patient5555 in reply to Hidden]

Thanks Mike

[bantam12]

My ectopic shows as an increasing space between P and QRS which leads to a pause every 3-5 beats. I have both PACs and PVCs.

[Patient5555 in reply to bantam12]

Hi B, That must be annoying. Have you had an ablation or have tablets helped? Thank you

[Diamondgirl5]

There are many side effects to Metoprolol . I had quite a few. Fatigue was the worst. I was prescribed Bistolic which is in the same category with less side effects. But my heart flutterings remained - UNTIL I WENT OFF AMLODEPINE and then they were gone - after many, many years! I still can't believe it! Good luck to you!

[Patient5555 in reply to Diamondgirl5]

Hi D, I hear you re: Metoprolol! I understand some people are almost unaffected re loss of energy and fortunately there are many other products to try. The DR didn't hesitate to try something different. Everyone is so different! Wow that's an incredible story. Just to be clear - you stopped taking Amlodipine (calcium blocker) and still take Bistolic (beta blocker)? Or are you off all heart meds? Glad you are ok.

[Diamondgirl5 in reply to Patient5555]

I am still on Bystolic + Valsartan. I also have a pacemaker for my slow heart rate (30-40) which is now at 70! It is not fun getting old. Good luck to you!

[Bidens]

Speak to an EP as soon as possible. I found that GPs know little about AF for example. I was prescribed meds. like this one and they all made me very ill, Metoprolol on particular.

My EP did a successful abaltion procedure at Leeds and I am glad to say that I have been free from AF for 18 months as a result thank goodness. AF made me very weak, but no longer, now I am back to being a fit 75 yeart old.

[Patient5555 in reply to Bidens]

Glad to hear your ablation worked well. Well done.

[Fibfab]

That’s normal sinus rhythm with ventricular ectopic beats. It’s possible that you may be aware of the ectopics. It’s not a worry to have these beats from time to time. Could something be triggering them, caffeine, stress, alcohol for example?

[Patient5555 in reply to Fibfab]

Thanks FF for your time. It is hard to tell. Stress is quite possible as life is v v busy and hectic but nil on the others. Barely drink coffee and only a social drinker. I'll update the ECG image shortly. The regular beats are great, I just feel rather odd when the beat is different. Like a punch in the chest from the inside. Medicines from the Cardiologist seems to work, I juts feel I'm at 80% of my potential, or put differently, held back by 20%. Gym is so much more challenging as the heart is held back.

[Hidden in reply to Fibfab]

Hmm...

I would say a mix of sinus beats, atrial fibrillation and ventricular ectopics.

[Fibfab]

Think of the rhythm disturbance as a trip. Normal beats are the normal steps taken whilst walking.

The ectopic beat is the trip.

You then need a step to steady yourself back to where you left off. Because the ectopic is a bottom to top contraction, it’s bound to feel strange.... because it is. And even the next normal beat is not quite 100%. Does that make sense?

Exercise is good as it will improve your overall condition and should improve symptoms. In fact, it’s normal for ectopics to go away during physical activity.

However, you may need to pace yourself and don’t expect too much 💚

[bantam12 in reply to Fibfab]

Do you know why my ectopics would increase with exercise ? I generally get 10-12 every minute throughout the day.

[Patient5555 in reply to bantam12]

I find exercise is easy and leads to a normal heart beat. (The blockers are not so good as it restricts my bpm to 155 which means I’m limited. I’m v fit so

this is an issue). Sorry I can’t answer and isn’t something I’ve experienced. I feel them the most when relaxed!

[bantam12 in reply to Patient5555]

I have atrial and ventricular ectopics and my Cardio is telling me there are no meds that will help without causing increased bradycardia, I'm having a treadmill test next month and if it shows decreased ectopics then pacing at a higher rate might help but I think they increase so will see what that shows, just wish something could be done 😕

[Fibfab in reply to bantam12]

Ectopics should ideally decrease during exercise. You will know for sure when you have your ETT.

[bantam12 in reply to Fibfab]

Thanks for replying, I certainly feel them more when I'm exercising, whether they increase or I'm just more aware I can't tell, I'm having a two week monitor as well so hopefully something will be useful.

[Fibfab in reply to bantam12]

Perhaps you are aware of an increase in heart rate. Without ECH evidence it’s difficult to be sure. You could take your pulse and maybe identify the exact nature that way. The normal rhythm will be interrupted by a stronger beat in time with your symptom.

[bantam12 in reply to Fibfab]

Previous ecg and holter show trigeminy, salvos and pauses, heart rate increases with the minimal exertion, tiresome indeed ! I've got MVA and Mobitz 1 so Cardio is trying to sort out what's what.

[Fibfab]

Please note that my interpretation is of the AliveCor strip from P555 and NOT the rhythm shown in the photo of the ECG monitor, as it appears in this thread.

[Hidden]

Can’t give you a medical opinion, but to me this looks like a mix of sinus beats, atrial fibrillation and ventricular ectopics and maybe that is consistent with your Flecainide treatment. I would suggest you email a copy of this to your cardiologist. Are you considering ablation?

[Patient5555 in reply to Hidden]

Hi O,

Unsure what to do. Still discovering the issue. Off to the cardiologist this week to hear his thoughts.

Thank you.

[Khatpi]

I hope he can also recommend an Electrophysiologist to you. They’re the specialists that should be able to give you some solid info. And in turn make the proper recommendations and treatment plan for you. Best of luck. Sarah