Plagued by nocturnal ectopics.

[Samazeuilh2]

For the last eight or nine days I’ve had more ectopics than usual, often at night when lying on my back or right side, but also during the day. Sometimes the pulse feels very weak, almost imperceptible. Sometimes the ectopics are very persistent, occurring every four or five beats. It’s possible there’s some bigeminy. Kardia is not showing AF. I recently stopped taking omeprazole and a magnesium supplement but have now resumed these.I have not been sleeping well recently, waking up every few hours. I fall asleep quickly but wake up several times and it difficult to get back to sleep. What could be driving this increase in ectopics? It’s a change in pattern from the usual. Needless to say, getting an appointment with a cardiologist will be near impossible.

[Ennasti]

I had a similar issue from Nov to March last year. I’m not sure what brought mine on however it coincided with a COVID vaccination. It appeared to kick in within a short time of the vacc but I had also travelled overseas around the same time and had an allergic reaction to mud at a hot springs and came out in all over body fine rash. Then again, neither of these things could have caused it!

Anyway, it took my ectopic count up to over 10,000 a day for several months, most of which seemed to be at night - again though, the night time thing is only my perception. I wonder if it was just that I noticed it more at night. I could sit quietly in bed though reading and not feel them, then lay down and bang! A dancing heart. 😁

I still have ectopics and arrhythmias daily but not like it was during that time. Thankfully I’m not prone to anxiety and I don’t fear my heart skipping around. Plus my ability to sleep is excellent!

[Samazeuilh2 in reply to Ennasti]

Yes, your frequency was about 7 per minute which is probably similar to what I’m getting (although I sometimes get 3 or 4 ectopics in succession followed by, say, a minute without any). They seem calmer when I take 10mg of Bisoprol in the morning. What’s new, is getting them every night. My last Covid vaccination was in February so I don’t think it’s that. Did your GP/cardiologist make any recommendations for dealing with them?

[Ennasti in reply to Samazeuilh2]

No, it’s expected with my condition, and they’re not that concerned about the ectopics. I have bigeminy, trigeminy, triplets and couplets, bradycardia, low rate AF, episodes of NSVT, and a LBBB! I’ll continue to get them and the ectopics are the least of their concerns. As long as I’m not passing out they seem to be ok with all of this happening.

I’m on carvedilol, candesartan and apixaban, but the beta blocker really doesn’t do anything to control them - and it’s not meant to. They’re trying to slow down any damage and changes to my heart muscles (mainly the left ventricle) which is why I’m medicated. Eventually I’ll get a pacemaker - mainly to help with the LBBB and brady.

I’m thankful I don’t suffer with anxiety. It is what it is - I have a heart which often has rave parties and doesn’t invite me!

[AAJJTt]

Hi, ectopics are tough.

I started out 5 years ago with a heart attack (nstemi II ), this was my introduction to paroxysmal Afib (the root cause). Treatment - Flecainide; no episodes for 4+ years.

In the early days, before treatment, ectopics were always the harbingers of an Afib episode and my constant nemesis since. I am very wary of them.

I did suffer badly from ‘ectopic storms’, which drove me ‘mad’, robbing me of sleep. Anxiety just enforced a negative feedback loop that descended into more ectopics. They were investigated by my cardiologist, the burden was actually not that high, less than 3% and he wasn’t overly concerned. It didn’t feel like that though! sat up and alert at 3am, slavishly watching 5+ pvcs on my Kardiamobile trace. Anxiety is definitely a catalyst and an amplifier; getting control of it, is the way forward. 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.

CBT - I was always a bit sceptical about the whole area - talking therapies/mindfulness but it did help; don’t ask me how though 😀 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, daily sometimes, my Afib is also vagal in nature and I tend to pick up on ectopics after I’ve eaten. I still have runs of them too, Dec/Jan is always bad for me for some reason and I had a stint earlier this year. They just don’t bother me the same and I know I cannot let them ‘get into my head’. I literally give myself a good talking to - “ 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.

- Breathing - good too. LSD = long, slow deep. Inhale and exhale slowly (something like 6 a min) with slight pause before exhale. Filling your belly with air (diaphragm) not just raising your chest and shoulders. You need to persevere with this - 5mins, it’s not instant but just breathing calmly slows down you down, allowing you to relax.

At the moment, life is normal. I am currently in a good period of stability and I honestly feel that I don’t have any limitations - I regularly run, climb, cycle and travel but ectopics are ever present to some degree.

I try to keep to the mantra - calm down, they are doing me no harm but sometimes it still gets a head of me. Very recently, I had an in clinic cardiology appointment and something just tripped. While doing the ECG by heart was bouncing around like ‘a rock in a tumble dryer’. I wasn’t unduly concerned, I’m glad they got the trace too but it was really my own doing. Got a grip and an hour later and my heart was back to normal NSR - 55bpm.

The mind is very powerful.

If you are concerned, I would get an opinion from your GP or cardiologist.

Best

[Samazeuilh2 in reply to AAJJTt]

“In the early days, before treatment, ectopics were always the harbingers of an Afib episode and my constant nemesis since. I am very wary of them.”

Yes, that’s one of the concerns. I’ve often been told that they originate in a different part of the heart from AF and are harmless, but on investigation I found they they can be a precursor to AF.

“ I did suffer badly from ‘ectopic storms’, which drove me ‘mad’, robbing me of sleep. Anxiety just enforced a negative feedback loop that descended into more ectopics. They were investigated by my cardiologist, the burden was actually not that high, less than 3% and he wasn’t overly concerned. It didn’t feel like that though! sat up and alert at 3am, slavishly watching 5+ pvcs on my Kardiamobile trace.”

Last year I had a 24 hour Holter and they were within an acceptable range, however I suspect they are more frequent now. Mostly they are not very noticeable. I have, to my surprise, been given an out of hours GP appointment this afternoon, but I’m not expecting to find out a great deal. The biggest worries are that there might be some AF at night which I am not aware of, or that this will lead to persistent/permanent AF.

[AAJJTt]

Ectopics being the Afib precursor was before treatment. After I started the daily maintenance dose of Flecainide, the Afib episodes stopped but the ectopics continued, to varying degrees.

As mentioned I have been Afib Free for 4+ years now. I use my Kardiamobile sparingly and have always found its Afib determination to be very reliable. Occasionally ectopic beats can fool it. If you get a number of them in row on a trace it might report Afib. On 6L version I can see the ectopics and make my of determination. Of course, I don’t solely rely on tech, my symptoms have always been distinct (fast irregular HR with RVR and the tell tale chest flutter), I bear all this in mind and make a judgement. This determines whether I need to take my PIP, and to date, I’ve never had too. The current status quo is ectopics but no Afib.

Good idea to discuss with your GP, if are concerned about nocturnal Afib. It might raise the question of your stroke risk and anti coagulation.

At the moment, I am not on an anticoagulant anymore, as I am below the threshold for it.