Hi all, any advice on this from you lovely people? Had ablation end of January and I've been recovering well until yesterday, just a few short runs of Af, less than a minute, no ectopics.
Early on Saturday morning i started getting lots of ectopics, mostly 2 normal beats then a pause or 2 normal beats quickly followed by a third then a pause. I think this may have been triggered by something I ate on Friday evening, because my stomach has been feeling very bloated and uncomfortable since then, haven't eaten much since.
It has been happening continuously since Saturday morning and is also causing headache, tiredness and just not feeling right. I'm fairly sure it's not AF, though. Counting pulse manually, it's in low 40s, with lots of pauses.
I take 2.5mg bisoprolol, 20mg rivaroxaban and 2.5mg ramipril as well as lanzoprazole. I've tried the valsalva technique but it hasn't made any difference, tried slow breathing, also no effect. I've got some old sotalol that i was put on a while back but stopped becasue it started triggering my asthma and I'm wondering if I should try one of them. I will email my EP's secretary tomorrow to see if i can get some advice, but until then, does anyone have any suggestions as to what else I could try?
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Ecki
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Probably the best advice is to search “Dr Sanjay Gupta York ectopics” on YouTube. He had produced several helpful and informative videos on the subject.
I still have ectopic beats almost a year after my ablation for atrial flutter. I had them before, though, and, in general, am used to them. I was told by my cardiologist that they are of no consequence and not to worry at all about them; he did also say that they arise in the same area of the heart, near to the pulmonary vein, from where atrial fibrillation begins.
I would say that the best course of action is to phone either your cardiologist's secretary or your GP to discuss your ectopic beats. I certainly would not take any prescription medicines such as sotalol without their say so; this is a potent drug , after all, and you have now had your ablation so your heart is not the same as it was when that was appropriate treatment.
The "trigger" as you call it sounds less like the kind of food than your stomach itself. In certain individuals, a bloated stomach can physically press up onto the diaphragm above it, and from there push against the base of the heart. This can act to amplify the heart beat significantly, making it more pronounced and potentially worrisome. In my case, I could hear a sound like I was clicking my thumb and fingers together at times. It shocked me to the core when that happened but I was told it was harmless. I have read of a little evidence that this physical movement can also irritate the nearby vagal nerve and, potentially, cause arrhythmias. Do you have IBS or diverticulosis as these can easily cause constipation that can also push the stomach higher against the diaphragm? A hiatus hernia can do the same, as can acid reflux. Worse than all these can be anxiety as this creates a dry mouth that leads to swallowed air, again bloating the stomach. It creates fear, too, of course - and can lead to a vicious circle of effects.
Anyway, I hope something you read in the responses you've received helps. The very best of luck with it all. I do hope that you soon get it all sorted out. These are awful times without extra problems such as we all have.
It varies so much. Often I don't notice them, but at other times, especially in bed at night, there can be several. On occasions during the daytime, they really stop me in my tracks, but I have trained myself to think "Well - you've had these for half a lifetime, Steve. You're all right really!"
I doubt that's much help, but I remember reading of a massive study that showed everyone has them at times, even younger children. Maybe they are more normal than we think but we become overly aware of them?
Appreciate that Steve, i just can't get my head round why i have them, or what makes them come on? i'm 9 months post abalation and i know my Anxiety or feeling unwell increases them heavily, but on a normal day when i get them i just can't get my head round them, seem to happen worse when i lean forward or lie back on my chair
I've never found anything that will stop them or anything that brings them on except for tiredness, "overdoing" it or when my stomach "plays up" (I have reflux and a hiatus hernia and I am pretty sure this is the seat of the problem).
When mine have got me too worried over the years, maybe three times since my twenties, I have managed to convince my GP to refer me and that has always pretty much reassured me. I recall one cardiologist, after I'd had my exercise ECG telling me I had had lots of them but that he had vastly more each day and he expected to live till a hundred.
Just as it happens, I've had a short run of them while typing this. It's straight after a meal so I'm feeling bloated and I slept badly last night.
Hi Steve, I have a hiatus hernia and reflux disease. My AF started when an idiot locum GP told me to stop taking lanzoprazole and I ended up in hospital for 6 days. My heart has behaved very well since my ablation, until now, and I'm worried that these ectopics may be a precursor to the AF returning.
Thanks for that - your post has really got me thinking. I tried to come off lansoprazole about a couple of years ago - against my doctor's advice - and got myself into a genuine awful mess with nausea and a whole range of stomach pains that went on for months. No amount of alternatives helped and I eventually gave in, and went back on it. Well it took a long while to work but work it eventually did. I even had to double the dose for a time to 1x30mg morning and night.
But... not that long after I was suddenly ill on three occasions, even fearing a heart attack. It wasn't and my GP blamed the hernia, but on the third occasion I was told to go to hospital and it turned out I'd got persistent atrial flutter. I now believe there is a link even though the cardiologist would have none of it.
I have been certain there is a link between them since mine started. On one of Dr Sanjay Gupta's videos he refers to
Roemheld syndrome, which is where gastric problems cause heart issues. I have mentioned my belief that there's a link to my cardiologist and EP but, like yours, they were both dismissive. I would love to come off lanzoprazole but I don't see how I can because it would put me back into AF.
I've come to believe that the PPI drugs are safe enough and that the alternative of not taking them is too risky. I'll look that reference up but I do know that not all specialists accept Dr Gupta's ideas. His ideas about magnesium supplements, for example, are not backed by any scientific evidence that I can find online - and considering the wide availability of magnesium in all green vegetables, seem unlikely. Sadly magnesium did nothing for me - except, at a higher dose, is wonderful for my sluggish bowel!
Thanks for that link. It was very interesting. In the end it will be difficult to show a genuine ink, I suppose given the nature of the illness.
I'm very lucky to have a really good GP who I've come to trust on this and his views regarding PPI drugs seem to be based on the idea that they are so widely taken worldwide and have been for such a long time now. The problem with looking at any population of older adults, I suppose, is that they will all likely have several age-related "co-morbidities" (now there's word we've all had to read a lot of times since Covid!). To be able to attribute one or more of these to being caused by a side-effect of a single drug must be nigh on impossible. The PPI studies that did suggest a link with various illnesses read very impressively but were, if I recall, all "meta-analyses" of older studies that were not designed specifically to look at PPI long-term side effects. Such studies, in older populations especially, must always be tentative in their findings given the nature of the people involved.
Like you, I don;t know what I would do if the link was proven, but that applies to a lot of drugs - many arthritic drugs have worrying side effects, too. In fact, I suspect long term medication of any kind is likely to produce some undesired effects.
There is something you could try that has helped me. Take your shoes and socks off and stand on grass sand or concrete for half an hour. You can sit or stand - as long as you are earthed.
If you want more info look up Laura Koniver MD on
intuition-physician.com
Our bodies are run on electricity and need earthing. If we don't earth ourselves we can get overloaded with it and I think most people will understand that you don't mess about with delicate electronic devices by overloading them. Try it - it's free!
I still have runs of ectopics (atrial and ventricular), and tachycardia lasting anything from a few seconds to hours 1yr and 6months after my last ablation. I can have a couple of weeks with just a few brief bursts of ectopics/tachycardia and then for no apparent reason it returns to long runs and frequent tachycardia. I also get breathless during walking a lot which I don't think is always related to ectopics/tachycardia but sometimes is (this did precede my 2 x ablations but to a far lesser extent). I also get long bursts of arrhythmias or just very thumpy quite fast heart rate (in the 90's) often hours after activities - lifting something heavy, short walk, gardening, short ride on electric bike, psychological stress, etc. Seems my heart gets tired or sulky if much physical or mental stress is put on it.
However, looking on the bright side I do think that my heart is improving in relation to the number of very long attacks of tachycardia and ectopics I get now, although it is still very difficult to predict when things will occur. I'm trying to slowly build my heart up via very slow walking, light gardening and occasionally (only with back up from better half) e-bike use.
My only downside is that I appear to be getting more long running bursts of atrial ectopics which worries me that it may be the start of the rapid PAF returning. My Kardia occasionally thinks I'm going into AF but paid for reports are saying its runs of Atrial ectopics.
I'm awaiting another angiogram as I may have a blood flow problem in the right cardiac area which may be causing some of the above symptoms - I'm guessing the breathlessness which was a at a lower level prior to ablations but was still there. So my picture is probably not as straightforward as yours.
When I get bad long runs of ectopics I now take bisoprolol 1.25 to help calm them as pill in pocket - I can use flecainide as pill in pocket but reserve that for very long runs of tachycardia and ectopics. Often the additional bisoprolol helps. It may be worth ringing your EP or GP to see if you could increase your bisoprolol dose at these times as a pill in pocket and see if that helps.
I did use to take lansoprazole and found it made my ectopics and tachycardia worse - I believe it stops various vitamins and minerals being absorbed due to the lowering of stomached acid (you would have to look this up on this site or the internet as I cant remember where I found the research on this. I've stopped taking the Lansoprazole and take magnesium (see Yorkcardiologist you tube channel re magnesium affects) and that did definitely help calm my heart quiet a bit. - I use home made kefir and sauerkraut to ease my stomach issues instead.
2 years 3 months and 4 months from my flutter ablation and PVI CRYO afib ablation respectively. I still get ectopics, can be short( seconds) violent bursts which are less common now but I do get long runs of less violent but more irritating ones as i get the fluttery feeling in the throat if the missed beats are too frequent . I try to ignore all of them as they go away and don't stop me doing anything so I am used to them. The longer runs missed/extra beats are random, can be the 3rd beat, the 22nd,the 12th , the 19th, the 30th., anything over 30 i dont count and i would not notice now anyway! Its the closely spaced ones which are irritating
In between the missed beats the heartbeat is stable and regular. Hence why I think they are ectopics and not afib. I did discuss with my EP on the 1 year follow up and he was unconcerned, but I have never had an ECG for them.
If and when you are sure they are ectopics i suggest you also ignore them! HOWEVER, as I am not medically trained , I suggest you discuss with your medics. My experience is that worrying about your heart causes problems and promotes it's bad behaviour! (Adrenaline released) . I also suspect but will never prove , that I have had ectopics before I had afib and probably all my life, but as I was healthy I never noticed. It's the hypersensitivity you develop with afib which reveals them so easily, so you must beak this cycle. I was in the state where I could hear my heartbeat at all times. I don't notice so much now.
Happy for anyone else who has ectopics on going to contradict anything I have said , as I only have my own experience. I am a couple of months short of 60 now with no other co morbidities ( that i am aware of!)
Thanks for your reply. I'm concerned about the ectopics because I've had none since the ablation so it's a new thing. I do think it's linked to the stomach issue, as I also have a hiatus hernia and reflux disease.
Can only echo and agree with everybody who has said try and ignore them. Ectopics, or mine at least, get worse when i get anxious about them kinda like a vicious circle really. When i think back i can remember the chest fluttering every now and again but never concerned myself with it. But once i zoned in and got the results back to say they were ectopics thats when every small change in heartbeat etc would start it up. Assuming you have had an echo and the cardiologist is happy the best bet really is to learn to ignore them and they do get less. Easier said than done though!
Had an echo the day after my ablation, before I was let out of hospital. I've emailed my EP's secretary to ask for an opinion.
sounds very much like bigeminy, something that I suffered from following my ablation 3 years ago. I'm mostly free of it now but it does come back when I am stressed or fighting an illness
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