Arrhythmias

[Wilkie1]

Hi Everyone,I have Afib, 1st episode in December 2022 resolved by cardioversion followed by 2 episodes in July 2023, lasting 24 and 12 hours respectively. I am currently on 1.25 bisoporal daily.

Over recent nights I have been getting arrhythmias which my scan watch and omron devices don't classify as Afib but which clearly show a fairly regular arrythmia as pictured. I was wondering if anyone has had experience of these. Whilst I feel fine they do prevent me sleeping hence I had very little sleep last night. Thank you for any help.

[Hidden]

That looks like atrial bigemini, which is sinus rhythm with coupled atrial ectopics. Can be uncomfortable but in isolation does not seem generally to be a cause for concern to the medics.

Edit: As Jim pointed out in his post below, this is not atrial bigemini. Just atrial ectopics. Apologies all.

[Wilkie1 in reply to Hidden]

Thanks for that Rambler and having checked it out on the web I think that you are very likely right. I don't feel any way unwell with it, unlike with Afib, and it goes away with any movements on my part that elevates my heart rate, only unfortunately to reappear. It's a problem when it keeps me awake as it did last night.

[mjames1 in reply to Wilkie1]

Not organized enough to be bigeminy. Looks like NSR with ectopics, probably PACs. In and of themselves, nothing to be concerned about, but always a good idea to show to your ep, both to confirm diagnosis and update your chart.

Jim

[Hidden in reply to Wilkie1]

Hello again Wilkie1,

Sorry about this, but as Jim has pointed out above, this ECG doesn’t show atrial bigemini. I should have said sinus rhythm with periodic premature atrial ectopics.

Jim has it in a nutshell as ever .

Again my apologies and I hope I didn’t alarm you.

[Autumn_Leaves]

Yes, I’ve recorded very similar. I initially thought “bigemeny” but when I showed it to my consultant he immediately said AF.

It’s unlikely that any members of this community have sufficient expertise to “diagnose” your arrhythmia from what is effectively a consumer product. I suggest you forward this to your specialist if you have one, or your GP. Otherwise all we’re doing is playing guessing games. You have a history of AF. You can’t pretend you’re way back out of it.

[mjames1 in reply to Autumn_Leaves]

"It’s unlikely that any members of this community have sufficient expertise to “diagnose” your arrhythmia from what is effectively a consumer product. "

----

While I wholeheartedly agree that only an EP should make a confirming diagnosis from an ekg , this particular EKG is not very complicated and is definitely not afib in my opinion, but rather NSR with a ectopics, proably PACs. Notice the very Pronounced "P waves", before each normal beat. The EKG does not resemble a fib all, nor does it resemble bigemeny, which would be evenly spaced ectopics every other beat. Of course, confirm with an ep before making any decisions on an EKG or simply for peace of mind. GP's are often not used to single lead EKG's, and even with a 12 lead, they tend to rely on the machines diagnosis.

Jim

[Wilkie1 in reply to mjames1]

Thanks everyone for your messages. I showed these to my GP this afternoon and she is of the view that it shows NSR with ectopics. The pattern is regularly irregular and she pointed out the P waves as PJames referred to above. Booked in for blood tests and ECG on Thursday and she's also requesting a 24 holter as it's very likely that they won't be present when I get the ECG. I asked about blood clots risk and she didn't think this was a high risk as the heart she view as beating relatively effectively. Suggested I cut back/out caffeine and offered to increase bisoporal prescription which I declined.

[mjames1 in reply to Wilkie1]

You are lucky you have a GP who can read a single lead ekg. In the US, most GP's are lost even with a 12 lead and rely fully on the machine's AI interpretation that is not 100% reliable. Hopefully, the ectopics will decrease over time. Mine did at various points.

Jim

[Wilkie1 in reply to mjames1]

Thanks Jim, she was very thorough taking me through everything and I was surprised to be seen so quickly. I hope that they do decrease as a sleepless night is a long night. Oscar

[Autumn_Leaves in reply to Wilkie1]

I cut out caffeine on the suggestion of my former GP. This was when my ectopic burden was becoming particularly troublesome but still some years before AF. I did, but there was no difference whatsoever. I’m now over sensitive to caffeine, still have ectopics and I eventually developed AF. So that advice was a lose-lose. If I drink coffee even quite early in the day I’m awake all night. Literally. But you need to try these things to find out if they help. Or in my case, don’t help.

[Wilkie1 in reply to Autumn_Leaves]

Thanks for that. I don't believe that caffeine is a trigger either for my AF or for these beats.

[Buffafly]

My AF nurse categorised a trace like that as ‘almost bigeminy’. It followed on from persistent AF. I have also found that raising the HR slightly stops it temporarily.

[Wilkie1 in reply to Buffafly]

I think that bigeminy is a particular pattern of ectopics. I have found the same as you if I move at all and my heart rate increases things immediately go back to normal. Thats why it's a particular problem in bed - during the day it largely doesn't happen unless I am sitting still at a desk for a long time.

[secondtry]

Sleep apnoea is a common contributory cause of the heart having to work harder intermittently , which in turn can cause AF or other issues. I have just had a sleep test to reveal mild SA. The NHS may then let you have a CPAP machine to overcome the problem.

[Ppiman]

Somehow that word "bigeminy" (like trigeminy) carries a near mystical quality. My Wellue ECG device reports that there's nothing to choose between having PACs, couplets of PACs, bi- or tri-geminy, which is also borne out online. They do all feel equally uncomfortable when in runs and for long periods, and feel not so different from AF itself, to me, but without the racing.

Below is a trace from my recent ECG which looks very similar to your own and as I sit here writing this, they are again frequent with their "thump"-like chest feelings and other slight but odd sensations.

For me they wax and wane but these have been with me on and off for some weeks now, during which time I've also recorded a few episodes of AF. The palpitations seem to be made much worse by my poor sleep, now worsened by night-time prostate issues (BPH). I feel, too, that there's a link with reflux acid as my gastric issues have increased of late, too.

Steve

Wellue ECG

[Wilkie1 in reply to Ppiman]

Thanks for those reflections. I do notice a tendency to have indigestion along with these however I can never figure sure if it's the ectopics that causes the indigestion or vice versa. I have thankfully mostly not had any today.

[Ppiman in reply to Wilkie1]

That’s what you need - a day without having to dwell on them. It’s been the opposite for me today but this evening has been rather better. I have written exactly what you have in other posts regarding gastric and cardiac issues.

Steve

[MeganMN in reply to Ppiman]

So that is what my rhythm looks like almost all the time. That is the reason I have been seeing an EP and attempting ablations. Even though they are 'benign', at the high rate of burden, he wants it treated, as do I. So do you not have symptoms with those? Because I do! Curious to hear if anyone else is receiving treatment for these or if EPs are concerned. Mine has been aggressively trying to treat them because of the 30% burden...

Ecg

[Ppiman in reply to MeganMN]

Hi Megan

I also have symptoms with the palpitations, but I can, so far, cope with them and manage with life as usual. That said I am retired and do just part time teaching from home. I struggled with one lesson last week when the ectopic beats were really prominent, but wasn't sure if it were anxiety, but I had a kind of foggy mind.

The symptoms are various and rather vague but not imagined. There's sometimes a strange feeling of a need to breathe in deeply (not breathless, as such), also, a slight discomfort in the left chest area, under the rib (sometimes this goes into my back). I seem to get an odd left-side headache at times. I have never tried to do anything especially strenuous during the episodes but I feel somehow as if my heart is not pumping quite well enough.

In terms of their being "benign", well, I think that is a comparison only with AF since ectopic beats carry no risk of creating blood clots or strokes. Also, the long term effects seem to be of no consequence to the heart overall, although if ventricular tachycardia is common, then I think an ablation is sometimes done.

Mine have become much worse recently and I am at the point of thinking a visit to my GP is needed.

Steve

[Ppiman]

And this is a portion of a trace that my Wellue AI ECG device calls "PAC trigeminy".

Wellue ECG showing PAC trigeminy

[Cavalierrubie]

l get this too. Ectopics are not considered dangerous or require any intervention. They can be worrisome, of course, and anxiety always makes them worse. I get the whole works, anxiety, acid reflux and gas along with ectopics and AF flutters. I was told that ectopics stop your heart going into AF. It does seem like that with me personally, as if my heart is being stopped by them. Anxiety is a trigger for my ectopics. I think the key is to relax and keep calm. Anxiety plays havoc with all of the symptoms and may be the reasons you are kept awake at night. Deep breathing, and telling yourself it’s not life threatening and that it will pass all helps. Mention it to your health provider next visit and put your mind at rest.

[Wilkie1 in reply to Cavalierrubie]

Thank you for your thoughts and advice. It would be good to think of them benignly as my heart's way of avoiding Afib. I've been more viewing them as those rogue cells straining to get into Afib but being prevented from doing so by beta blocker. I would agree that it's best to try and relax rather than getting anxious though that's not always easy to achieve.