Ectopics/Possible Afib

[Auntielala]

Hi, hoping for some advice please. Was on PIP Bisoprolol 1.25mg for SVT and ectopics until cancer diagnosis in 2019, when I started taking Bisoprolol 1.25mg daily on doctor's insistence, upped to 2.5mg a year ago. Also on Amlodopine 5mg for BP. This has worked a treat and I completed surgery, chemo, radiotherapy and bisphosphonate infusions, now cancer free, fingers crossed, and have been completely SVT and ectopic free, until a month ago. BP still ok with Amlodopine, sometimes high, but generally within acceptable margins.

Now, out of the blue, I'm experiencing bouts of ectopics daily for 5-6 hours at a time. Kardia readings are mostly 'Unclassified', some say 'Possible Atrial Fibrillation'. I'm not on a subscription. Heart rate is ok, I see it go over 100 briefly during readings but generally it is in the 70's or 80's.

My last echo, 2 years ago, showed mild MR caused by leaflet bowing, otherwise structurally sound. Cardiologist said I was having some small runs of AF but not sustained, but he thinks AF is on the cards in the future.

So it seems that the SVT is still controlled with Bisoprolol 2.5mg but the ectopics are back with a vengeance. Its been going on for a month now. What would you do? I'm thinking I'll wait it out, they may stop again, but husband is pressing me to go to the GP.

[BobD Volunteer]

The problem is that ectopics beats are a normal function of a healthy heart and few doctors consider treating them. Drugs may help but ablation is extremely rare. Most people find that slow deep diaphragmic breathing helps enormously. Use stomach not shoulders and breath deeply slowing to less than 6 breaths a minute for at least five minutes.

[Auntielala in reply to BobD]

Thank you, I will try the breathing. I was offered an ablation for the SVT 4 years ago, but declined, electing to control with Bisoprolol. Maybe I should have had the ablation while I had the chance. Hope the deep breathing works, I'm not that worried by it, but do find it uncomfortable and a bother and really quite tiring. Thanks Bob 👍

[Hidden]

Good Afternoon Auntielala, if you are feeling otherwise fit and healthy then the best course of action may be to cut down on any stimulants such as caffeine or alcohol, as well as reducing stress if possible. If your symptoms are persistent and/or uncomfortable medical therapies may be appropriate and it would be best to discuss these with your GP. You may find our leaflet on Ectopic Heartbeats useful, it can be found here: heartrhythmalliance.org/afa... Please feel free to contact our Patient Services Team if you would like any further guidance or support on 01789 867502 or [e-mail]

Ectopic Heartbeats Sheet

[Auntielala in reply to Hidden]

Thank you for the leaflet info. I am on Bisoprolol 2.5mg and Amlodopine 5mg, and I don't drink alcohol. I can cut down on coffee though, and try the breathing exercises mentioned by BobD. The 'possible AF' Kardia readings I'm guessing are probably ectopics too. Thank you for the reassurance.

[Autumn_Leaves]

Hi Auntielala, excellent that you are now cancer free. Long may it stay in remission and not come back.

As for your ectopics, can you get your GP to arrange a 24h holter ECG? You can get one without having to see a cardiologist. Chances are it might not pick up any episodes of AF if they don’t occur that often but you will know what your ectopic burden is at the moment. From my own experience, self help measures have been of limited success. I’m a lifelong goody-goody and I have practically nothing to “give up”. Yes, I did give up caffeine but it didn’t fix my ectopics or prevent them from getting worse. Everything is worth a try but it’s not a moral failing when these measures don’t make any significant difference. I’m also in the position of having picked up episodes of AF on my watch but as with your experience with the Kardia, these were not considered diagnostic so I’m also in this diagnostic no man’s land getting by with a packet of beta blockers that don’t do much.

[Auntielala in reply to Autumn_Leaves]

Aah, I didn't know you can get a holter from the GP, worth a try, thank you. Sorry to hear the pills aren't helping you. They've been good for me until now, but it seems they're not working like they did. Hope we both get some resolution before too long. Thank you for the good wishes 😊

[MikeThePike in reply to Autumn_Leaves]

Doctor offered me beta blockers for my ectopics and I said no. There is no point. Beta blockers won't cure ectopics. If you are lucky you just wont feel them for a time but then you may start feeling them worse than before. The only thing that can potentially cure ectopics is an ablation. I'm not ready to go down that road yet but I'm keeping an eye on my ectopic burden. If it starts creeping up over the years, which I suspect it will, I'll take action. Without ablation ectopics will never go away.

[Auntielala in reply to MikeThePike]

Yes, I should have accepted the ablation when it was offered. We live and learn. The Bisoprolol was prescribed for SVT, it is controlling that quite well. It's just thee pesky ectopics. I'm going to try Bob's breathing technique then see where I am. All the best.

[JOY2THEWORLD49]

Hi

Whee was your cancer? Thyroid?

That's what caused my Stroke and AF, diagnosed 4 days after stress.

With cancer removed the inflammation will be healing too.

I read that with my series of events my Heart may revert on it's own. But still waiting 2 years 7 months later.

My Christmases will come all at once.

Positive is an obsession I have, lucky that in hospital the thyroid Papillary cancer was diagnosed during a carotid artery scan. Nothing in the carotid arteries.

Life is a lot of ups and downers but keep on the positivity attitude to help you glide through it all.

A CCB finally controlled my H/R and helped the AF.

Take care, JOY 73 (NZ)

[Auntielala]

Hi, no mine was breast cancer. The day of my mastectomy the anaesthetist insisted I took my Bisoprolol, I had been using it PIP, she put ICU on alert, but I was fine, just a few anomalies she said, but from then on I stayed on Bisoprolol and Amlodopine, and my pulse/BP mainly ok all through chemo and radiotherapy. Now, it decides to play up! I'm on an oestrogen blocker med for 10 years, done 2.5 years so far, could be that affecting things, not sure.

What a journey you have had, but despite all that you have been through, you sound wonderfully positive. Hopefully you're cancer free now? I agree positivity is key, it's so important isn't it? Is CCB calcium channel blocker? Glad it's helping, and I hope your heart does revert on its own and that your Christmases do come all at once 😊. Take care x

[Clyde12 in reply to Auntielala]

I was diagnosed with breast cancer in 2014. Had similar treatment to yourself (plus herceptin for a year). I’m in my 8th yr of letrozole and was told it and other treatments MAY have caused AF diagnosed roughly 4 yrs ago. I dread coming off the letrozole in spite of all its side effects and will be asking to remain on it til death! It (and a much healthier lifestyle) have kept the aggressive cancer at bay! Take care all.

[Auntielala]

Hi, yes I'm on Letrozole, I tend to blame anything and everything on it lol. But if I ask medics about any of the many side effects "could it be the Letrozole?" .... always the same answer "maybe". They just don't know, do they? But I'll keep on it anyway, the alternative could be worse! So good to hear you are 8 years cancer free, that's brilliant, you're winning 💪, but sorry about the AF though, as if you haven't been through enough! Hope it's under control with meds and not causing too much bother for you. x 😊

[listerines]

Overall, probably depends on level of ectopic burden and how ectopics make you feel. If you are having a few random ectopics with no challenging symptoms then perhaps you can just journal the happenings and bring this up to health professionals on next routine visit. On the other hand if you are having 100s/ 1000s/ 10000s of pacs or pvcs per day and they are perhaps triggering runs of afib and their symptomolgy is high, then likely discussions with health professionals, preferably EP, should occur sooner rather than later l

Ectopics can certainly wax and wane and hopefully they have calmed down for you by this point. Keep safe

[Auntielala in reply to listerines]

They're pacs and pvc's, constant for 5/6 hrs at a time but so far this week it's a fair bit quieter. I'm saving Kardia readings and hoping it is on the way out, but if it ramps up again, I think I'll see if I can get a GP appointment. I was discharged back to GP but can ask to be re-referred if any issues. It's taken me by surprise after 2 clear years. Very tired, but keep telling myself, and my husband, they're only ectopics, but I'll certainly be relieved if they go away! Thank you so much for your good advice 🙂.