Sinus rhythm with Supraventricular Ectopics???? What the heck??

[Doggiemomma]

This started yesterday, double beats, off and on, going into normal sinus rhythm without double beats. I also broke out into a sweat the first time. I took a couple of Kardia readings (which I will attempt to post here). I woke up with Normal Sinus Rhythm with ectopics (those double beats).

I take Flecainide with a blood thinner twice a day, and extended release Metoprolol once before bed.

What the heck is going on?

Should I be worried?

Does anything help to get me back & stay in normal sinus rhythm?

I don’t drink or smoke or drink coffee or tea or soda, I don’t eat red meat or processed food, I don’t ever add salt to food & while I am overweight, I’m dieting successfully (the extra weight is very sloooow to come off!).

My Electro-physiologist always wants to do ablation and it seems that he’s pushing it on me. This makes me uncomfortable because I truly believe I am not a good candidate for a number of reasons.

I’m getting a second opinion from a top-notch Electro-physiologist who is NOT quick to ablate, but that appointment isn’t until mid September.

[Doggiemomma]

Here’s another Kardia reading—it looks scary to me!

Another look with advanced Kardia of a segment, I guess. I’m new to the advanced Kardia.

[mjames1]

While you're only showing 7 1/2 seconds of the ekg, it's just showing normal sinus rhythm with a few ectopic beats. This is pretty normal.

The second graphic you posted is not an EKG but a chart, so again not to worry.

That said none of us here have medical training nor know your history so you should really show it to your EP for professional opinion.

Jim

[Doggiemomma in reply to mjames1]

Thanks Jim! It’s Saturday & the EPs office is closed. I was wondering if anyone else had this kind of supraventricular ectopics and if they always resolved only to show up again, or if they always resolve to not show up again, or if they didn’t resolve for a while. As I’m sure I’ve mentioned before, the stuff is scary and it’s good to know I’m not walking alone.

[Espeegee in reply to Doggiemomma]

I have the 6 lead Kardia and I had a run of supraventricular ectopy, most days for a week or two. It’s an unpleasant feeling, for me it hits my stomach. It went away on its own, it has revisited a time or two but not in such long duration. I suspect it’s stress related. If you look it up it seems to be regarded as both fairly normal and non threatening.

[Buffafly in reply to Espeegee]

The same

[etheral]

Ask about Tikosyn.

[mjames1]

wondering if anyone else had this kind of supraventricular ectopics and if they always resolved only to show up again, or if they always resolve to not show up again, or if they didn’t resolve for a while.

I've had similar ekg's from time to time and all of the scenarios you just mentioned can happen, although rare never to have ectopic beats because most of us get them from time to time even if you don't have any other arrhythmia problems

Jim

[Sixtyslidogirl]

I certainly get those ectopic beats every day, more or less depending on who knows what. Magnesium really helped to decrease them. They are not rare and cardiologists tend not to worry about them.

[maurice2]

I've had similar for a couple of years after a cardio version which deal with the AF. I just take the anti coagulant (apixaban) now and ignore the ectopics (mostly an early beat...then a long pause then normal for a few beats). Doesn't stop me exercising and I think this is important - if you can't exercise and keep fit then there's a danger ectopics can start to wear you out (cardiomyopathy or similar but I'm not up on the details). But if you're fit and functioning, I wouldn't take much notice of them unless an expert has identified an need to do something about it. You can live a long and healthy life with some arrhythmias.

[JOY2THEWORLD49]

Hi

Good for you.

Get your weight down and wait and see.

Your heart is all over the place and no wonder why you are sweating.

I had sweating uncontrollable on any exertion with Metoprolol. 186 Day and my 47bpm Night but it gave me pauses.

Sounds like the Flec a risky anti-arrhymic med plays you up and AFers are better on Bisoprolol and I was changed by my heart specialist.

BBs didn't control my heart rate only my BP.

I've been on

120mg AM CCB Diltiazem for heart rate control (has a 1/2 Day life. Now 60s Day/47bpm Night no pauses.

2.5mg PM BB Bisoprolol for BP control. Just took it 125/75 at 6pm and I take my Biso at 8pm.

Hope yhis helps.

cherio JOY. 75. (NZ)

[Ppiman]

The "premature beats" you can see on the Kardia trace are called "ectopic", meaning "out of place". This name is given as the beats occur from elsewhere than your heart's natural pacemaker (a small bundle of cells high on the top right of the heart's atrium, called the sino-atrial or "SA node"). Instead of the SA node setting off the heart beat (i.e. a contraction of the ventricles at the bottom of the heart), other cells in the heart wall set off a heart beat. This is normal and every person has it happen occasionally. Having many, as I have, can be uncomfortable, but is still generally safe or, as doctors call it "benign". This separates ectopic beats from AF which isn't benign since it has the potential to cause blood clots which give the risk of a stroke. This is why AF requires, often, treatment with an anticoagulant.

It is because ectopic beats often come in prematurely that the heart's second natural pacemaker, the atrioventricular, or "AV" node, delays the next normal beat to resume normal timing ("NSR"). This causes a "compensatory pause" that you can see as a delay after each premature beat. This then causes extra blood to arrive in the atria which brings the valves to shut rather more forcefully and which we feel as a "thump", sometimes in the throat, or as "palpitations".

The second Kardia reading simply shows the timing of the heart beats and is irrelevant. The only trace that is helpful is the top one ("Lead I"). On this, there should be a regular series of large peaks representing the pulse (i.e. the "R" wave), preceded by a tiny blip representing a beat from the atrium (i.e. the "P" wave - which can often be barely visible on a home ECG). In AF, the P wave is missing and the R waves are irregular and often rapid.

Steve

[Tellingfibs in reply to Ppiman]

You have explained all that for Doggiemama really well Steve. I have SVEs seemingly nearly constantly so you have also explained things for me too ! I get the odd Afib result from my Kardia and sometimes a NSR, but mostly SVEs and I have wondered if they are a clot risk too. I’m on Warfarin anyway, but I can’t help worrying about the damage they might be doing to the heart. You always sound very knowledgable……

Annie

[Ppiman in reply to Tellingfibs]

Hi Annie

Thank you for the kind words. I spent over twenty years working alongside doctors in the pharmaceutical industry and part of my job at times was to re-write medical studies into layman's language so I picked up a lot of medical knowledge along the way. I would dearly have loved to become a doctor. Still - a little knowledge can be a worrying (if not dangerous) thing for me, I find.

I have SVEs persistently these days, with them having worsened, along with my AF, during this year. The home ECGs I use (mostly, I am told, thanks to my "left bundle branch block") become easily confused, so can even show as ventricular in origin. My specialist gave me a 48-hour Holter monitor and a cardiac MRI recently and that reassured me that he was right and that I should ignore anything from my home ECGs that sounds nasty! On Friday and part of yesterday, my heart was all over the place but not with "proper" AF (see the trace below).

I gather that there's some evidence that persistent and frequent atrial ectopics can carry a stroke risk but your warfarin will keep you safe and sound!

Steve

Contec PM20 ECG trace showing multiple ectopic beats.

[Tellingfibs in reply to Ppiman]

It’s such a relief to hear someone who has almost continual SVEs is not automatically heading for catastrophe ! ( if anti-coagulated ). Always, until your post, when I’ve mentioned my fairly constant SVEs, I get responses like “ a few ectopics won’t hurt you “, or “ everyone gets ectopics now and then, don’t worry “, and I feel like shouting “ But I keep telling you all - they are nearly all the time ! “ I can cope with a few Afib results, and I can’t tell you the relief I feel when I see my Kardia announce - Normal Sinus Rythmn - pathetic isn’t it 🙄 So, thanks again Steve !

Annie

[Ppiman in reply to Tellingfibs]

Actually Annie, I have only recently worked something important out about this illness and this particular forum - or at least those who write in. There must be two "types" of PAF: one that comes but then reverts to NSR when it's gone; and then the one we have which are, essentially, a wider problem of atrial conduction issues, which create lots of heavy ectopic beats, of which PAF is one "type".

Those with the former likely do get some level of palpitations but can write of them as of little consequence, or as being "benign" or whatever and respond to "a few breathing exercises", etc.. For those of us who get "proper palpitations", well, it's a whole different story and, well, they can be as bad as AF, if not worse because they rarely let up. Of course, there are some with persistent AF, which can be symptomless but can be awful, from what I read.

Steve

[CDreamer]

Good advice above. Many of us have or have had ventricular and/or atrial ectopics which means skipped beats or extra beat. They always made me feel uncomfortable but they were not considered dangerous and usually went away with breathing techniques and relaxation and eventually I stopped feeling them.

If you are very symptomatic over a long period, then maybe consider treatment options but Lifestyle first, including breath techniques and relaxation. They help many. Magnesium supplementation sometimes helps. The important thing is you are in NSR and not flipping into AF, which ectopics can occasionally trigger when we get stressed.

[Tellingfibs in reply to CDreamer]

I can’t seem to get my breathing technique correct enough to make any difference. If I take a deep breath, my ectopics worsen for several beats. My lifestyle is good with a healthy diet, although I suppose I could exercise more. My heavy dose of Bisoprolol ( 5 mgs twice daily ) makes me feel sleepy when I sit and relax - or maybe it’s laziness. I’m 74 and tell myself I can’t expect to have the energy of a 30 year old, but that in itself is a lazy attitude 😄 I don’t often get an NSR reading these days, but at least I only slip into Afib briefly. I have been wondering if my SVE results on Kardia are actually Afib, because if I use the more usual way of using it - with two fingers on each pad - I get more Afib results that if I use the more unusual way of holding one pad in right hand with the other pad on my left knee. If this is the case, then I am in Afib most of the time, rather than SVEs !

Annie

[lawspear]

Pay for a Kardia analysis if you are worried and show your cardiologist too.

[Sixtychick]

I had an ablation last September and was getting ectopic beats, so took an ECG of them and when I went for my follow-up appointment in February, I showed the Doctor the ECG readings and he said they were nothing to worry about and everyone gets them from time to time.

[Pommerania78]

Perhaps you need more sodium.

[Doggiemomma]

Thank you all for taking the time to ring in here! Your kindness is much appreciated!