Cardioversion and PVCs and PACs

[Debjimmay]

Does a cardioversion help if you have PVCs and PACs or does it only help if you have Afib? I go in and out of Afib but my PVCs and PACs have been non-stop for 3 months. Flecainide did not work. I’m considering a cardioversion as I’m to the point I will try anything to get my heart back into NSR but wondering if anyone here has had a cardioversion for arrhythmias other then Afid and if so, did it help?

[Ppiman]

I'm in a similar position and cardioversion has not been mentioned, only ablation, flecainide or a pacemaker to allow higher doses of beta-blocker.

It's no fun, is it?

Steve

[Debjimmay in reply to Ppiman]

No, it’s no fun at all. When my heart is in NSR I feel like a completely different person. My energy picks up along with my mood and desire to get out and do things. This is a terrible affliction to have. I pray that it goes away but as I get older, it seems like it’s here to stay.

[Ppiman in reply to Debjimmay]

We're a similar age. I feel that mine is becoming fairly constant in a way, although much of the time, it is not actual AF but persistent and regular atrial ectopic beats and a "wide" NSR beat caused by a left bundle branch block, along with "bradycardia" (i.e. a beat slower than required). I don't feel so different when in NSR, myself, although AF, when that happens, perhaps every fortnight, is hard going, even though the rate now seems to be a little lower, thanks perhaps to bisoprolol (1.25mg daily), being between 85-135bpm.

Steve

[Debjimmay in reply to Ppiman]

Same here….my Kardia will say I’m in Afib buy my Apple Watch says I’m in NSR. When I took a printout of my EKG from the Kardia to the EP nurse, she said it was PVCs and not Afib. So now I’m totally confused and unsure what to think anymore. I trust my Apple Watch more than the Kardia because it rarely says Afib. So usually the Apple Watch says a fib, I probably am.

When I think I'm in Afib it feels like a fish flopping around in my chest. Even then, almost all my readings on the Kardia say SR with Supraventricular Ectopy. I have no idea what that even is.

My heart rate is mostly in the 60’s all day. At nighttime it goes in the 40’s. I’m on 180mg Ditliazem and100mg Flecainide. I notice a lot of people on here are on the Bisoprolol. Do you have good results with this drug? Since the Flecainide does not seem to be doing much for my Afib and my arrhythmias I was considering asking my dr. if I should switch.

[Ppiman in reply to Debjimmay]

You sound very similar to me.

Every heart has two small areas of its own "pacemaker" cells, called "nodes": at the top in the left of the left atrium is the primary one, the sino-atrial (SA) node; and, in the bottom, at the top of the two ventricles, is the secondary one, the atria-ventricular (AV) node. The SA node sends regular electrical pulsations into the atrium and down to the AV node. This causes the atrium to beat regularly, squeezing blood through the valves into the lower ventricles. This pressure sets tells the AV node to cause the valves to open to allow the ventricles to fill and then to contract, sending blood to the body.

A problem can arise since there are other cells than in the two nodes that are capable of being a pacemaker. These "pacemaker cells" are spread throughout the atrium and ventricles. In our case, those in the atrium are also sending off signals, out of time with the proper pulse from the SA node, and some manage to get through to excite the ventricles, causing so-called ectopic or premature heartbeats. These cause the valves to be opened but out of time, which is what we feel (i.e. we cannot feel the heart, only the valves). In your case it is as if you had a "fish flopping" in your chest; in mine, more of a ripple and thump.

As with the proper nodes, these atrial ectopic beats still create their own (mis-shaped) "P" wave, the small bump that occurs just before the big R-wave spike caused by the ventricular contractions. It is, I should think, this that can confuse home ECG devices, sometimes.

In AF, however, there are no P waves at all. This is because the mis-timed cells cause a chaotic quivering in the atrium and no pulsation can occur to squeeze the blood into the ventricles. Instead, the blood has to flow by gravity and suction from the ventricles. The AV node also gets bombarded by these chaotic signals, some of which get through to create a fast and irregular beat of the ventricles. If it weren't for the AV node, however, we would be in a proper mess.

Slowing the heart down using a beta blocker or similar (as in your case, diltiazem, a calcium channel blocker) helps create a more normal heartbeat and can even calm the ectopics completely. I doubt there's much overall difference in effect between the two drug types. Flecainide, an "anti-arrhythmic" drug, more directly stops the ectopic beats and fibrillation.

Yesterday, I went with my wife for a lovely country walk, maybe three miles. I had palpitations throughout with several occasions when I had to stop or sit down owing to a feeling in my chest that if I didn't, I might have no option. Sometimes activity sets off my AF, and that might have happened briefly on a few occasions yesterday but I couldn't catch it on my Apple Watch, not least as that acts up when my wrist is sweaty.

The atrium always naturally wants to beat normally and has its own mechanism to stop ectopics and AF. No one seems to know why or how this happens nor why it occurs quickly, slowly and sometimes, not at all (i.e. permanent ectopic beats or AF).

Steve

[Debjimmay in reply to Ppiman]

Thank you for explaining all of that to me. I really do appreciate it. I’m not sure I understand what it all means so I will reread it again and try to sort it all out.

I understand what you’re saying about activities setting off the palpitations. I’ve noticed that also. I used to be able to have a glass of wine or a mixed drink but anymore that raises my heart rate so high that it sets off palpations. So even though I would love to have a drink occasionally, it’s not worth it if it’s going to set off Afib or palpitations so I have refrained completely from drinking.

I think I’m going to have to change the feeling of a fish flopping in my chest to what you’re describing as a ripple and a thump. That describes it better and sometimes I may only feel the thump. I do get trigeminy quite often and because I have pulsatile tinnitus, I will just sit there and count the two beats and then the early beat. I may do this for hours or days. It’s enough to drive you insane sometimes!

It’s nice to know there are so many others out there that have similar symptoms and are going through the same thing you are. They are the only ones that truly understand what you are going through. I’m very thankful for finding his blog as it has helped me realize that I’m not alone.

[Ppiman in reply to Debjimmay]

We really are similar. Here's a trace from mine showing brief AF and multiple ectopic beats. Such fun.

Steve

Apple ECG showing brief AF and ectopic beats

[Debjimmay in reply to Ppiman]

Even though my EKGs show etopic beats on my Kardia when I show these readings to my doctor he said they are PVCs. I probably get this reading 90% of the time. So I’m not sure what I’m having or what is going on. All I know is I’m not in NSR and haven’t been for quite some time.

EKG Reading

[Ppiman in reply to Debjimmay]

Ectopic beats are any beat that occurs outside of the sinus node so includes both PACs and PVCs. The rhythm is irregular. Have you sent this to Kardia for a proper analysis?

Steve

[Debjimmay in reply to Ppiman]

No, I haven’t sent in the EKG for a reading when it comes up with ectopic beats but this is the reading I received when I sent in a reading saying I was in Afib. Actually I have never received an Afib reading from Kardia even though I have sent in several EKGs stating that I was, I’m not sure what to think anymore.

Clinicians review

[Ppiman in reply to Debjimmay]

The Kardia report shows that your heartbeat originated in the normal place (i.e. the sinus node in the atrium) but that some ectopic beats occurred in the lower chambers as PVCs. Everyone has a few of these, but if they become troublesome, they very occasionally need further investigation.

I think all home ECGs can mistakenly report AF when the actual issue is multiple ectopic beats (i.e. PACs or PVCs). The signal on an ECG from the atrial contraction (i.e. from the natural pacemaker in the atrium) is small and easy to miss. It's called the "P" wave and is seen just before the big R wave from the ventricle contraction.

Medical ECGs use sticky pad electrodes to stop the trace being "noisy" from muscle twitches and so on. I think only the Wellue home ECG uses these as an option, instead of fingertips. On such ECG traces, the P waves are usually obvious. In AF, there are no P waves owing to the chaotic twitching of the atrium.

Steve

[Debjimmay in reply to Ppiman]

I’m sorry, I just replied to myself in my last message I sent. Hope you get it OK

[Debjimmay in reply to Debjimmay]

Thank you for explaining this to me. It gets quite confusing sometimes but having someone explain it to you really helps.

I have one more questions that I wanted to ask you and this one has been bothering me for some time. I did ask my EP doctor about it and he just brushed it off like it was nothing. Would you have any idea why my “R” waves are so high? Sometimes they are almost off the chart. I noticed everyone else’s “R” waves are small, but mine are huge for some reason. It makes me wonder if there might be something wrong. Just curious what your thoughts were.

[Ppiman in reply to Debjimmay]

Hi - I don't know for sure, but I am sure I remember reading that the size (and relative size) of the peaks signifies nothing at all. On the Wellue that I use they can vary in height a great deal. I have seen them various sizes on this forum and elsewhere on the internet. I wouldn't worry at all.

Steve

[Af8b_futter]

I have been on various doses of flecanide previously from 50 mg TDs to 100mg TDs. I wasn't very compliant before I had a stroke but I never miss a dose now. I still have episodes of AF 2 to 3 times a week and I'm very compliant with it

[MeganMN]

Have you tried Verapamil? It is the first drug to effectively control my PACs.

[Debjimmay in reply to MeganMN]

No, I have not tried Verapamil, but it may be something to consider. I will ask my EP doctor about it. I wonder if I would still take the Diltiazam then?

[listerines]

I have never heard of a cardioversion being offered for PACs and PVCs but depending on the severity of your ectopics you should discuss with your cardiologist or ep. I know that ablations can be offered for PACs as I have had one - along with 2 others for AFib. Ablation in combination with flecainide did help control my PACs for a few months (though things not as stable in my heart these days with long PAC runs and clusters and aura symptoms).Going back to the cardioversion possiblity, runs of PACs/PVCs are considered arrhythmias so perhaps a cardioversion could provide relief... I would be interested to hear what your health professionals say.

I can understand wanting to get rid of the PACs as I definitely can feel like crap when having severe episodes with 1000s of ectopics. Keep safe

[Debjimmay in reply to listerines]

This is definitely something I will need to talk to my new EP doctor about when I go in two weeks. If the cardioversion is only good for Afib then it definitely may not be for me. I need something to stop the PACs, PVCs and the trigeminy. It’s been going non-stop for several months now and I’m to the point where I’m willing to try almost anything to get back into NSR. The problem I’m reading on here is even the cardioversion or the ablation may work for a while, but it may not take care of the problem completely which is worrisome to me.

[listerines in reply to Debjimmay]

Hello Debjimmay - I can appreciate the concern over the your ongoing PACs and PVCs (I frankly have similar concerns especially when i am having high burden episodes sometimes for days). Frankly at times I find them physically and mentally worse that the AFib episodes (though AFib ain't no picnic at times either).Have a look at previous posts on this site as some have found some relief from ectopics with various techniques and the use of different diets and supplements (magnesium taurate, time release potassium etc...). Make sure to connect with health professionals to discuss any new supplement use as could be interactions with any meds you are taking (this is not addressed in your original post).

You could also discuss the use of other medication for the reduction of your ectopics. Perhaps a larger dose of flecainide could be more effective or perhaps another antiarrhythmic drug. Beta blockers and calcium channel blockers can also be used to reduce ectopics with various degrees of success (discuss this with health care team).

As mentioned above ablation for AFib/PACs would also be an option though this would be based on to your health profile and any other coexisting medical conditions.

Wishing you as much heart stability as possible 🙏

[AAJJTt]

Hi,

I was identified as having atrial fibrillation 5 years ago following a heart attack (nstemi type II). The Afib is very well controlled with Flecainide. I have been Afib free for +4 years with no sustained episodes.

Ectopic beats have been problematic to a varying degrees over the years and I’ve put a few posts on this forum about them. Your turn of phrase is interesting, ‘back into NSR’. I consider myself to be in NSR, it just NSR with ectopics - no Afib. Initially the ectopics were investigated by my cardiologist, the burden wasn’t actually that large ( less than 3%) or as large as I perceived and he wasn’t too concerned. Physically I am very fit and healthy, no limitations. It was a QOL issue and a case of dealing the mental / anxiety side of things. For the most part this has been successful with the odd wobble now and again.

I do use tech too, a Kardiamobile 6L. I find it’s Afib determination to be accurate. I do see some traces with ectopics but it reports NSR. Occasionally it can get confused in certain ectopic scenarios and reports Afib. On closer examination of the trace, I can usually determine it’s not.

I have never heard of cardioversion for ectopics. I would be interested to know what advice/guidance you are given on this.