I woke at 0130 this morning and discovered I was in PAF (the first episode for about 12 weeks). I’d posted earlier about lots of ectopics over the past week or so, particularly at night. The PAF seemed to terminate after several hours, as indicated on the Kardia, but I still feel lots and lots of ectopics, with the Kardia indication “Sinus Rhythm with Supraventricular Ectopy” now showing. This indication has been showing for several hours now. This is not usual for me. Typically, I usually come out of PAF episodes fairly cleanly, i.e. the PAF just stops. I still feel a “butterfly” sensation in the chest and am getting a “skipped” beat roughly every 3 beats. Has anyone experienced this or know what might be going on here? I’m also worried I might be moving from PAF to a more persistent form of AF.
Sinus Rhythm with Supraventricular Ec... - Atrial Fibrillati...
Sinus Rhythm with Supraventricular Ectopy after PAF episode.
Good morning Samazeuilh2
Thank you for your post on the Atrial Fibrillation support group.
Hopefully a member will be able to advise you on the forum, if it carries on being persistent we would suggest seeking medical advice.
Kind regards
SamAdmin
Thanks for your replies-I went to A and E yesterday as advised by 111.
Dear Samazeuilh2
We hope they were helpful in A and E.
Kind regards
SamAdmin
They were thanks!
I used to be like you, but this year has been a decline to what you are experiencing, with far more ectopics.
I think people who revert swiftly to NSR are the luckier ones.
Steve
I was advised by 111 to go to A and E yesterday and managed to see an excellent consultant (not a cardiologist). He discharged me to GP care and recommended another 24 hour Holter test. My troponin level was 14 (on the borderline) but he insisted this was fine as ectopics can, apparently, cause a very slight elevation; hence there was no need for a retest; “troponin levels should be read in conjunction with other data, not in isolation”. He thinks the problem is a conduction problem which is metabolic in origin and proceeded to deliver a long , highly technical talk which made me realise how little I actually know about AF. The long and the short is that he thinks it can *probably* be handled by an adjustment in medication (which should be addressed at my annual Barts review due in two weeks). He said that it is absolutely impossible for any consultant to predict AF progression, but advised that exercise and weight loss reduce the likelihood of this. He reiterated that ectopics are not themselves a problem even if fairly frequent unless they are regular and continous for over ten minutes (basically like the beating of a clock)- then they need immediate attention and would probably result in chest pain. He’s not in favour of “leaping into an ablation” and favours intervention at the lowest level which will deliver the desired result. There seems to be a change of view on ablations -a few years ago early intervention was favoured, whereas now they are reluctant to do them unless the patient is symptomatic (or so it seems). Another point he made which might be of interest is that magnesium supplements and bisoprolol can occasionally make ectopics a bit worse.
I’m sure you’ll be fine. He sounded an unusually good doctor. I’m not sure what continuous ectopics for over ten minutes means though?
I hadn’t heard of any change of opinion on ablations and thought they were more and more seen as the best option.
Steve
I wasn’t sure either initially. He explained that he meant that the ectopics would be regular, for example : beat-ectopic-beat-ectopic-beat -ectopic….(bigeminy). This would eventually cause chest pain and means that the heart isn’t clearing blood from the heart efficiently. It may also lead to more serious arrhythmias such as ventricular tachycardia or ventricular fibrillation. He said to call 999 if this occurred.
I have read here of some who live with persistent bigeminy. Goodness knows how. If the heart is structurally sound, however, I gather it is still considered "benign". I think only where there's existing heart disease that VT is a possibility.
Steve
I was also told the same by the cardiologist at Yeovil hospital that ablations are not done until AF becomes a real problem and only when medication is not helping.
Yes. There seems to have been a change in approach, however. 6 years or so ago, they favoured intervening early with ablations, and said that it was best to tackle the arrhythmia before the heart was remodelled too much. I can’t help wondering if this has something to do with capacity in the NHS, but perhaps I am being over-suspicious.
The cardiologist I see in Leicester suggested it's my choice. I asked him how I could make such a choice and what he would do if he were me. He said he couldn't answer that and that it must be up to me to decide. But how can I know? Medicine seems to have entered a new era where the patient can "choose" - but on what basis?
Steve
Yes, the patient needs enough information to make an informed decision. I remember when I was first diagnosed with AF I was offered the choice of Sotalol or Flecainide. When I asked what the difference was I was told they were basically the same (which isn’t really true). I opted for Sotalol arbitrarily. So I chose my own medication knowing virtually nothing about its properties!
My doctor offered a pacemaker to allow an effective dose of bisoprolol (as I have some bradycardia), or flecainide - or wait a year for an ablation. He said he didn't like sotalol.
Steve
Sotalol is an old drug which can be risky if taken above a certain dosage , so many here don’t like it. I found it effective in addressing AF. Because I’ve had a bypass I cannot now take sotalol or flecainide. So if bisoprolol fails I have limited options. After having almost no ectopics all day, I ate sardines and salad with brown bread with some fruit (which seems healthy enough) about an hour ago. I then noticed ectopics which are occurring roughly every 10-q15 beats. So the the must have triggered them, yet it seems innocuous good.
That’s interesting. I can’t link my ectopic beats to any cause at all. Sometimes they come on at breakfast, sometimes when I’m in bed, sometimes they are there all the time. They are difficult but I supposed I am slowly getting used to them.
Steve
Interesting. Different NHS areas seem to have totally differing policies. I certainly can’t get an ablation until my condition has significantly deteriorated. No choice.
Yes, I've had runs of these ectopics, also called PAC - premature atrial contraction. They can be blooming uncomfortable as the beat following the premature one can come with a thump. My EP explained that this type of ectopic is - unfortunately- AF trying to sort up. I once had a run for almost 16 hours on and off. If you are taking anti arrhythmic meds (I have as PiP) then these should help.
I have runs of ectopics that can seem nigh on permanent and they are, in their way, worse than AF, which I get maybe once a fortnight. I've been offered flecainide for mine but taken daily rather than PiP. Do you find it works for ectopic beats, Singwell?
Steve
Well tbf that long run of PACs only happened the once. I think my thyroid was out of whack. But I called my GP after 14 hours of the nonsense and she said - for gods sake take the Flecainide and stop struggling. I waited it out hoping it'd go when I went to bed. Buy it disturbed my sleep so I took 50mg and the PACs were gone in 20 minutes. So, yes, the Flecainide did the trick for me. When I saw my EP and checked it out with him he was on board with the decision. I never felt so bad with ectopics before that, so I hope it was a one off. But you never can tell with heart arrhythmia can you?
I used to get lots of ectopics, I mean all day, all night, including bigeminy etc and little quick runs of afib that showed on the holter, but I didn't notice amid all the other thumping and butterfly activity in my chest. My doc said not to worry. Anyway, I could usually snap my heart out of bigeminy and trigeminy episode by hopping around a bit, though they would soon come back. A few times I even stopped a few afib episodes with mild aerobic exercise.
When you decide to lose weight (as I did eventually), you could try focusing on sugar and sweeteners. After 3 or 4 really hard few days, without sweeteners, eating what I chose to eat instead of reacting to food habits became much easier.
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