Af vs Ectopic beats

[Keswickman]

Hi all,

This may sound a like a silly question but is it easy to differentiate between AF and PVCs?

I’ve had PVCs for several years which sometimes occur only a few times a day and occasionally can be 1000s a day. I’ve recently been diagnosed with PAF but do not experience a racing heart rate and in fact have sinus bradycardia.

I’ve read posts on here where some people have a fairly normal heart rate but are in AF.

I do not have a Kardia and was wondering how I could definitely distinguish between AF and PVCs or whether I am experiencing both?

I have not been prescribed any medications or any medical procedures recommended.

Thanks everyone

Nick

[Finvola]

Taking your pulse manually may help you to differentiate. I use my carotid pulse in the neck and can feel the beat ...... beat .... beat...beat ..............THUMP typical of an ectopic. If you are having runs of several ectopics, try to feel if there are normal sinus beats there too.

AF will be more chaotic - slow or fast but ectopics - especially if there are few of them - have a background sinus rhythm.

[Keswickman in reply to Finvola]

Thanks Finvola. I had a couple of conversations recently with someone who had persistent AF but heart rate was normal and the only way he knew he was in AF was his Kardia. Everyone’s symptoms are different. Just wish it was simple to check.

All the best

[Buffafly]

No it’s not, even Kardia can get it wrong! It has been known for people to show their Kardia AF readings to their consultant only to be told it’s atrial tachycardia with ectopics. I used to think I’d had AF for a long time before diagnosed but I think I may have had runs of ectopics instead. Very violent bursts of ectopics seem more distressing than AF to me. Recently I had what felt a bit like AF though I thought it was ectopics and as I was having an ECG in hospital at the time the AF nurse was able to show me I had ‘sort of bigeminy’ - ectopics in a rather random pattern. People tell you to look for the p wave on a Kardia but my NSR traces show few p waves so not helpful. Probably TMI so back to simple reply - no.

[Keswickman in reply to Buffafly]

Thanks Buffafly. I do have bigeminy and sometimes quite random continuous ectopics and wondered whether I have that rather than AF but it seems I’ll not find that out until I have to see a consultant which is not planned for the foreseeable.

Thanks for taking the time to reply to a rather confused sufferer.

All the best to you.

[ETHEL103 in reply to Keswickman]

Hi during the pandemic I experience the start of an arrhythmia.Obviously practically impossible to see a gp but I did get verapimil which helped.I did buy a kardia which cost under £100 and it constantly showed possible a fib.As a result I persisted with private cardio appointment then private EP which set me off on my ablation wait.8 mo the later I had ablation and they couldn't trigger a fib at all even tho for 2 years the kardia had been saying possible a fib.zIt turns out I had atrial flutter and ectopics.I now take mag taurate every other day and e topics are so much better.

[lawspear]

Ectopic beats still have a P wave component on an ECG. The defining feature of AF on an ECG is the absence of P waves. Kardia picks this up and shows it reliably.

[Ppiman]

Even my Kardia got the difference wrong twice according to the cardiologist I was seeing then (my Apple Watch was correct, however). The indicative aspect on an ECG that determines AF is a combination of irregular heartbeats coupled with a lack of a "P" wave from the sino-atrial node. Using only two hand-held electrodes, it seems that home ECG machines can sometimes struggle as the sensitivity is too low . This atrial "P" wave shows as a tiny bump just before the enormous ventricular "R" spike.

In the end, following recommendations on this forum, I bought a Wellue 24-hour device that uses stick on chest electrodes and that has never got things wrong, using AI technology and giving a very comprehensive report indeed. I also went on to buy their handheld device with a touchscreen as that also has the option of electrodes and that too, has been very accurate (using AI analysis again).

As for telling AF from ectopic beats without a device, by using the pulse, it’s difficult for me as my AF is often at a quite low rate, too, (although the last few times have been high). Ectopic beats, especially when they come in runs, create a very irregular feeling to the pulse when taken by wrist and finger.

Steve

[Dabbott01 in reply to Ppiman]

Steve - will you share what handheld device with screen that you purchased?

[Ppiman in reply to Dabbott01]

Yes - it’s sold by a Chinese company called Wellue (the consumer arm of Viatom, a long established manufacturer of medical equipment, it seems) and I eventually bought two different ones from them. The first was the 24-hour AI ECG which two or three others here recommended highly - and I second that. That one runs from 5 minutes to 24-hours and, although it will work handheld, it really shines with the chest strap or, better, two chest electrode pads which come with it.

After that, impressed as I was by the AI analysis (which needs a laptop and a free program they offer), and further tempted by a cut price offer on their website (much less expensive direct than from Amazon, btw), I bought the “Touch-screen” handheld version for, I think just under £80.00. That also has AI but uses a mobile phone app which is somewhat less comprehensive in what it detects, but still very good indeed.

Steve

[AAJJTt]

Hi, I was diagnosed with PAF 4+ years ago (now stable with meds) and during the earlier period, I have had runs of ectopics too.

We all have different sensitivity and awareness to our conditions but I find it easy to distinguish between an ectopic beat(s) and Afib.

Afib - episodes have been very distinct - irregular pulse, fast HR with RVR causing familiar chest flutterings and trembling; no other symptoms. I really don’t need a Kardia reading to know I am having an episode.

Ectopics - feeling of a skipped or missed beat followed by a large forceful beat; sometimes they run in quick succession, then they are often uncomfortable and a little disconcerting.

I have a Kardiamobile 6L and I have usually found the determination to be accurate where Afib is concerned. I am not medically qualified, I look at the trace with interest but don’t try to analyse it too much. You can look at the wave complex and try to see if the P wave is there or not, etc but I just let it do it’s job 😀

A Kardiamobile doesn’t have a default determination for ectopics (PACs or PVCs). You can pay for an additional service which covers more determinations, which I think includes ‘Sinus with PVC’; I don’t have this service. What I found from experience, is that you usually can see the ectopics on the trace, they are displayed as big deviations on the I, II and aVF leads. If there are too many on a 30s trace then Kardia usually determines ‘possible atrial fibrillation’.

I do rate the Kardiamobile and have found it to be very useful tool. I tend to use it less now my Afib is stable and I understand my condition better.

For a period of time, I did suffer badly from ‘ectopic storms’, they drove me mad, robbing me of sleep. I found them more problematic than the Afib, it felt like my heart was going to stop. The anxiety just enforced a negative feedback loop that promoted more ectopics. They were investigated by my cardiologist, the burden was actually not that high and he wasn’t overly concerned but it was affecting my QoL. I turned to a course of cognitive behaviour therapy and for a period, an evening sedative. This worked for me, it broke the cycle and it all settled down. I still have some ectopics, which is normal but I can just ignore them and they don’t escalate into storms.

Best, hope you find a solution.

[Keswickman in reply to AAJJTt]

That’s such a great response, thanks very much for this. Agree it’s definitely an anxiety thing which makes the ectopics worse and eating too quickly doesn’t help either.

I did read a post on here where someone even in AF had a normal heart rate and the only way he knew he was in AF was the Kardia.

I suppose we are all different.

Thanks

[Autumn_Leaves in reply to AAJJTt]

Ectopic storms! Yes, I know that feeling! I’m glad the CBT helped you but as my worst 24h ECG showed such a lot of ectopics during the night I’m not sure it would be that helpful for me. I had very broken and fitful sleep that night but had no idea I was ectopic-ing like crazy until I saw the results. I have quite a high ectopic burden but so thankful for the calmer periods when they happen. The Kardia is very useful, I agree.

[AAJJTt in reply to Autumn_Leaves]

Hi, if you don’t have a solution then I wouldn’t rule CBT out. Admittedly, I was always a bit sceptical about the whole area - talking therapies/mindfulness - ‘not really for me’ but it did help; don’t ask me how 😀 The sessions covered how to spot unhelpful patterns of thoughts, feelings and behaviours and techniques on how to deal with them.

I still have ectopics, even runs of them but they don’t bother me the same. Ok, ignore it, breathe in, carry on (or in bed rollover), my heart is not going to stop. As I mentioned previously , it just breaks the cycle of catastrophic thinking (especially at night ) which descends into anxiety and promotes more ectopics and storms. Yes, there was the sedative for a few months initially but that was a number years ago now and I’m still coping. Coping is not the right word …. Just getting on with it!

My Afib has been really stable for a while too, so I hope this is not all hubris. I don’t think so 😀

[Mugsy15]

I'm not sure there's any point in knowing whether it's one thing or another to be honest, but I have a Fitbit Sense, which I consider reliable for identifying AF. My Cardio Nurse Practitioner, (who is married to the EP who did my Ablation) told me that Fitbit can't differentiate between the various non-AF arrythmias and reports them as 'inconclusive', but is very good at picking up AF and NSR. This has been my experience. I have friends with permanent AF and if they borrow it and test themselves it never fails to report AF. So in your case I'm confident to advise that buying one would help you in this regard.

Or if we meet in the Dog and Gun you can try mine! 😂

[Keswickman in reply to Mugsy15]

Brilliant thanks Mugsy.

I have a Fitbit charge which has the AF app enabled. It’s never shown any AF even when my ectopics are having a good go at me.

Dog and Gun is still a bit busy with tourists at the moment, prefer the craft beer shop in packhorse court. Only alcohol free for me though 🫤

[Mugsy15]

Well done on your will power! I don't often go in the D&G anyway, for the very reason you highlight. One of my friends with AF is the landlord of The Swan in Cockermouth, which is my watering hole.

Anyway, back to the subject; assuming that the technology on the Charge is the same, I'd trust it to pick up AF when it's there. I get lots of arrythmia every day, but as long as none of it is AF I'm content.

[Visigoth]

I was in a similar position - I’d had ectopics now and then for years but had a period when they got far worse and gradually PAF was added into the mix! While I was waiting for a cardio appointment I installed the FibriCheck app and paid for a couple of months for the service whereby your readings are checked by a medical professional (in the US I think). The readings show whether you have straightforward ectopics, bigeminy, trigeminy or AF. I found them to be very accurate, borne out by the fact that when I had a 28 day monitor the readings were completely consistent. I think the service cost something like 24.99 a month but you don’t need that level of service beyond a couple of months because by then you can recognise yourself exactly what is going on from the pattern of the dots on the readout (different from an ecg). The app really helped me to have more peace of mind that I understood what was happening prior to seeing the cardio and starting medication (which has also controlled the ectopics). Oh and they send you a detailed report each month which you can email to your cardio.

[Vonnegut]

Kardias are very good at detecting stuff like that - I find mind a useful support, like this forum, though, fortunately, on my current dose of Flecainide, my heart is behaving very well and I use the Kardia just to record the drug’s success!

[richard_jw]

AF can result in a blood clot which can cause a stroke. Whereas other arrhythmias are benign. That's the main reason why you would want to differentiate between AF and other arrhythmias. I'm not aware of how to accurately diagnost AF except by reading an ECG trace. Although I suspect that if you get a bad attack, you will get to know yourself.

AF is apparently more likely to cause a stroke/blood clot as you get older. There is a formula which determines whether the doctor should prescribe anticoagulants. The formula takes age, medical history and sex into account. It's called CHA2DS2-VASc.

So for me, I'm over 75 and have had a heart attack and am male. My score comes to3 which suggests to the doctor that anticoagulants are needed. In your case, since you are younger, have not had any heart event, and are male, the formula would say "no anticoagulant"

I n my case, I have had 2 holter monitors worn for a week each, and they did not pick up and AF, the Kardia is not reliable in my case (the cardiologist cannot find AF either looking at the kardia trace, or in the holter reports.). Being a doctor, and concerned about litigation is being cautious and suggesting anticoagulants.

The gold standard way of determining if you have AF is to wear an implantable Loop recorder (ILR) for a month or more. You can wear them for a very long time, and I believe they are pretty much 100% accurate.

They also cost a fair bit, and in your case, the Holter seems to have diagnosed AF adequately

[Territorial]

I have ablations for ectopics and PAF to be honest had no idea when i had ectopics but i will say the doctor told me i got 33000 a day of them any way thats better now..The PAF was affecting my breathing and making me tired i noticed it quick smart though when first diagnosed i had pneumonia as well ..I use a pulse oximeter at home i need both functions anyway but it shows PAF when you use it i also use a blood pressure monitor ...

[Autumn_Leaves]

The only way you can know for sure is to have an ECG at the time AF is happening and someone who is experienced in reading ECGs to confirm whether it shows AF or not.

But maybe of us know from experience that it’s not easy to catch an episode on ECG when it happens. That’s why people invest in. Kardia or Apple Watch or similar, and it’s increasingly common for people to record AF on a personal device in order to have something to show their. GP or take to a cardiology appointment. Sometimes a recording that catches several ectopics with give an erroneous verdict of ‘possible AF’. That’s why it’s important to have an experienced health professional to look at it.

I have thousands of ectopics a day, and eventually I developed AF. I thought I was having a lot of bizarre ectopics so I checked with my watch and it was AF, later confirmed by a specialist. I was advised by a cardiologist that a Kardia was a genuine ECG but the watch wasn’t, but both of these devices have provided adequate information. I have had recordings of ectopics that the watch/Kardia identified as AF when it wasn’t, but eventually you can learn to tell the difference.

I couldn’t really tell from pulse alone whether I’ve been having ectopics or AF. I find that either the watch or the Kardia are more reliable, especially if you learn to identify the distinctive waveforms of various ectopics and AF.

I bought my watch a couple of years before AF happened because my ectopics were constant and I wanted to be able to record them to show to the GP or whoever, and I was glad I had it when AF first happened. If you have a high ectopic burden, it probably is an indication that you may be at higher risk of AF in the future, regardless of the “ectopics are harmless” mantra that I still hear to this day. Yes, they may well be “benign” BUT thousands a day isn’t quite normal, and won’t necessarily be cured by a few breathing exercises or not eating bread or whatever. So it’s a good idea to be vigilant but without falling into the health anxiety trap.

[Keswickman in reply to Autumn_Leaves]

Thanks very much for the detailed reply to my question. It does seem everyone has a different way of identifying and dealing with this.

As it stands my GP has said no medication or procedures are needed; may be because my CHADs score is 0. The cardiologist who identified PAF from a 24 Holter said the same and unless something else happens, it’s a case of getting on with it. The ectopics haven’t really been mentioned even though they did appear on an ECG.

I think I may have fallen into the health anxiety trap sometime ago!!

[Autumn_Leaves in reply to Keswickman]

They aren’t concerned about ectopics at all! In my experience they don’t offer much unless you are particularly symptomatic during AF and if it’s infrequent they tend to leave you alone. Contrary to popular opinion, they don’t shove pills at people unless there is good reason.