Ectopics and AF - whats the link - Atrial Fibrillati...

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Ectopics and AF - whats the link

ian16527 profile image
16 Replies

The Doctors dont seem to be concerned about ectopics, but most of us with AF seem to suffer them.

I am 11 months post ablation but getting lots of periods of ectopics lately. I know when they are coming on as my chest gets achy, across the top and feels heavy.

I have had this symptom for 14 years now, but never got to the bottom of it.

I certainly dont think of these as benign. There must be a link.

Had them all day today, sometimes I get them every beat, not often luckily

Does anyone get these symptoms or are yours just the missed beat sensations.

Is there a link with ectopics and AF, i.e the precursor to an AF attack

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ian16527 profile image
ian16527
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16 Replies
BobD profile image
BobDVolunteer

I can only quote Sabine Ernst " ectopics are good thing. they show your heart is trying to go into AF and failing."

ian16527 profile image
ian16527 in reply to BobD

is there a link Bob

ainslie profile image
ainslie in reply to BobD

Could I ask who is Sabine Ernst

BobD profile image
BobDVolunteer in reply to ainslie

One of the top EPs in London. She assisted at the first catheter ablation in Germany many years ago and pioneered work with magnetically steered catheters at Royal Brompton Hospital. Google is useful if you want more.

ainslie profile image
ainslie in reply to BobD

Thank you , I will google 👍

AussieHeart profile image
AussieHeart

I hear you. I am 16 months post ablation and luckily still being monitored by a loop monitor which shows I experience ectopics. They are horrible and can make me feel really ill. My cardiac electrophysiologist isn’t concerned and provides no feedback on how to tackle them. So I did my own research. I find breathing in deeply via the diaphragm (not off the chest) for a count of 4-6 then breathing out with pursed lips like I’m blowing into a straw really helps! Google ectopics and Dr Gupta and you may find some tips. I can’t seem to paste the link.

ian16527 profile image
ian16527 in reply to AussieHeart

I have a loop recorder but it doesn't pick up the ectopics or they are not telling me, unless I record it.

AussieHeart profile image
AussieHeart in reply to ian16527

Ask your cardiologist what he finds when they download the results from your monitor. This was my reply when querying my weird symptoms: “Dr Jackson has had a look at the most recent download from your device and has advised that the leads are clear and it just showed some ectopics.” No info on how to treat it as I get fatigue with it. He is sending me for an echocardiogram but other than that I’ve had to find my own treatment for them.

maurice2 profile image
maurice2

Get a lot a them, for the last two years or so after a cardioversion. Don't really take any notice of them but I do breathing exercises to stimulate hrv every day (in 4, hold 7, out 8) very similar to aussieheart. And lots of moderate exercise, good diet, no alcohol. They have to seemed to improve over time, less pronounced. Are they connected? well everything your heart does is connected, but a lot of people get them and have no history of AF so they may be connected to AF in some cases, and not in others.

sponable98 profile image
sponable98

I suffered from frequent pvc's/pac's from (age 40) 1997-2011, at times very exhausting. (30-40+/min) Numerous cardiologists advised various meds, lifestyle changes, etc. But always stated they were benign. Meds and lifestyle changes helped marginally but did not resolve pvc's/pac's. Developed AF in 2009, found good EP in 2011. PVC ablation reduced pvc's by 99%+ for 12 years. EP insists that there is no causation between ectopics and Afib. He is the expert, but I will always suspect a connection. Currently, I do have infrequent ectopics (post 4 Afib ablations over last 13 years), but nothing as debilitating as before. I would recommend seeing an EP if you feel your ectopics are debilitating and need treatment, in my experience a cardiologist will pretty much ignore pvc's/pac's as they are so common. Best of luck to you!

ian16527 profile image
ian16527 in reply to sponable98

My EP has suggested taking a magnesium supplement which I am doing.

It puzzles me why yesterday, or today no ectopics. Previous 2 days had them all day. I ignore the odd thumps and bumps we get.

I have had ectopics periodically for nearly 40 years, usually when tired, after I had surgery and they used a central line which went in too far and caused VF every time they lifted my arm. Luckily I was in ITU and they realised so pulled it out a bit and luckily never arrested as the sister said to the surgeon.

How do you tell whats a PAC against a PVC?

sponable98 profile image
sponable98 in reply to ian16527

I rely on doctor or paramedic to interpret my ECG. Apparently, it is little tricky to tell the difference by a lay person who doesn't do it frequently. PAC's generally do have a p wave though it may often look strange. PVC's generally do not have p waves. Both pvc's and pac's have a pause after QRS complex. Plenty of examples online just search pvc vs pac.

Chinkoflight profile image
Chinkoflight

Hi Ian , I have SR bradycardia with ectopics from before I had any identified heart issues. Whilst waiting for a TV (I/V) ICD device to be fitted and starting on low dose bisoprolol, my frequency of ectopics rose considerably from random single/double/missed beats to runs of 3/4 and up to 10 a minute. I note this was not exceptional in the CCU unit but was very different for me. Another brief meds variation at the same time was stopping Edoxaban and replacing with injected heparin, but I don't think this was the key factor.

For me, the ectopics were never a problem, until my exercise related collapse and LVT event, picked up on an ILR , I was never aware of my heart and feel myself lucky for that given I know palpitations etc can be very uncomfortable for some.

However, I'm writing this from A&E right now because the atrial pacing lead on my device has failed and that has caused me massive discomfort and various palpitations. The explanation today is also that compensatory shocking from the other lead has been setting off my diaphragm with a significant jolt.

It's not all a wonder of science!

Apologies for the alphabet soup of devices etc. if any explanation needed please ask.

ian16527 profile image
ian16527 in reply to Chinkoflight

Hope they sort you out asap. Why do you need the ICD coupled with a pacemaker, or have they seen arythmias that are dangerous? Dad had AV node block and RBBB and had a pacemaker fitted. It gives the odd beat in between to keep his HR at 60. He is going into AF more often after passing out and had to go into a nursing home.

Never heard of a TV or is that a TAVI of which I have heard of.

Good luck and hope you feel better soon

Chinkoflight profile image
Chinkoflight in reply to ian16527

TV is trans venous, alternative to intra venous.Here is the logic which I had many discussions about.

The left ventricle tachycardia was recorded on my ILR and occurred at the same time I collapsed running so was absolutely conclusive for the syncope.

According to the hospital I had only one previous recorded Tachycardia 9 months earlier being described as a paroxysmal AFib.

Cardiac MRI revealed a significant scarring and wall thinning on my left ventricle and this was absolutely conclusive for the LVT event and sadly the likelihood of further such life threatening Tachycardia.

SR bradycardia with ectopics was a 'benign' additional issue.

No issues with an angiogram and no issues with an echocardiogram.

Unknown cause of the myocardial infarction/scar. Considered embolic or non-ischaemic.

So any risk of a Tachycardia needs a primary response and efforts to suppress it. The standard response is bisoprolol generally with as high a dose as can be tolerated. This drug is also used for lowering blood pressure where cardiovascular issues prevail but not in my case. My BP is already low. So 1.25mg dose, the starting point, was already lowering both my blood pressure and Bradycardia, into low 30's at night and once below 30! It was also causing me a little lightheadedness in exercise (walking).

A cardioverter defibrillator is a secondary prevention device should a LVT form in spite of the medication. So theoretically a single lead device or a newer non invasive (to heart) subcutaneous S-ICD as fitted to the Luton footballer would be an option. NOW

To your question. I don't really need a pacemaker as in the normal course of things I don't get frequent VT's or Afibs.

BUT the lowering of my resting heart rate as a consequence of the bisoprolol was a problem that could be resolved with a second lead pacing the atrium at a resting rate, in my case set to start whenever my HR was falling below 60.

I had lots of difficult conversations because I felt an s-ICD was most appropriate because of

1 my general good level of fitness

2 my age (72) and the certainty I might need a replacement if I lived a fit life as long as my parents (93&94). Replacement might then be somewhere between my late 70's and mid 80's. Late 70's might not be an issue but reluctance to operate in mid 80's because of age and the significant increase in risks with lead replacement if needed. The Achilles heal of the ICD device are the leads. Not generally explained is my understanding.

I was told that was too far off to consider.

Of course there is one other factor.

S-ICD is fitted under general anaesthetic and takes a lot more time. My experience says in a session if fitting IV-ICD's and/or Pacemakers they fit around 6 devices if all goes well. They would only fit one s-ICD in the same time!

They argued strongly that I 'needed' the pacing function to be safe to discharge.

That arguement has gone out of the window this week when they say I am safe with a malfunctioning reduced capacity pacing lead until it can be replaced in a month's time , go home and still take the bisoprolol!

I'll stop......

ian16527 profile image
ian16527 in reply to Chinkoflight

Thanks for that. Very interesting It's so funny when they change their minds when convenient

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