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 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 of the AV node to cause the valves to open, the ventricles to fill and then to contract, sending blood to the body.

The problem is that there are other cells than in the nodes 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 a so-called ectopic or premature heartbeat. This causes 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.This confuses the Kardia sometimes.

In AF, there are no P waves as the mis-timed cells cause a chaotic quivering in the atrium and no pulsation occurs to squeeze the blood into the ventricles. Instead, the blood flows by gravity and suction from the ventricles. The AV node also gets bombarded by mini signals, some of which get through to create a fast and irregular beat of the ventricles.

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. 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 AF).

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.

[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