Morning. I’ve recently been back to my cardiologist as for the last 18 months or so I’ve been suffering with very frequent episodes of these eptopics.
I had a successful ablation in 2017 and have been clear of any episodes since but these episodes of eptopics are getting significantly worse more frequent and give off pretty much the same feelings as af, which comes with fatigue most of the time and can last a day or two at a time and most recently after I’ve finished a work out , or waking me up whilst I’m asleep .
Im 54 don’t smoke, avoid caffeine and work out regularly, and haven’t had a drink for several months . My cardiologist advises me that there’s two options ! Get used to living with it , or another ablation ( which he was too keen on ). Quite frankly this slightly concerns. How does anyone cope with living with theses episodes when they have quite a big impact on day to day life . I do take magnesium daily and have been advised diltizem is pretty much the only drug I can take due to my asthma . Any advice on this matter would be greatly appreciated
Thanks
Andy
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plaster71
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How old are you, and when do the ectopics occur? Is there a pattern such as at night or during exercise, or after exercise, or after a large meal?
I had PVCs after my first ablation in 2002, age 48, and nearly went back for another. My Cardiologist wanted another ECG with me off my meds, which were Diltiazem at the time, and when I stopped it, the PVCs stopped too. Turns out anything that lowered my heart rate, such as at night, and Diltiazem, allowed long enough gaps between beats for the PVCs to fire.
Hi cliff im 54 and currently not on any meds but have just picked up a prescription for diltizem. Pattern wise is usually after exercising or after a diner/tea , sometimes evens happens whilst I’m working , I’ve even cut down on portion size meals to make sure I’m not to full as that sometimes triggers it. I’ve stopped drinking alcohol and switched to non alcoholic drinks but I’ve had a few episodes with that as well . It’s very frustrating . That’s interesting to what you’re saying as the cardiologist mentioned pretty much the same thing but as I’m not on any meds yet he opted to give some a try !
Yours sounds like "vagally mediated", as mine always has been, pretty much same triggers, i.e. anything that slows the heart rate. It's recognised by some cardiologists, but many don't. Meds which slow the heart rate such as beta blockers and Diltiazem "can" make things worse, so keep an eye out, though everyone is different and it may do the trick for you.
Search the web for Prof Phillippe Coumel's work on this, also Dr Sanjay Gupta of York Cardiology, in particular the gastro-cardiac syndrome just one manifestation of it..
Hi cliff , your advice is very much appreciated. When ever I talk to my cardiologist I sometimes think he thinks I’m bonkers and come away empty handed with little to none advice
No problem. I think the trend towards EPs covering arrhythmias, instead of cardiologists, is a good one, even if you're not an ablation candidate (yet). My first ever cardiologist just didn't get it, my second did (as he had AF himself) but it was the EPs who did my first ablation who really understood, and a new EP more recently for another ablation and non-interventional follow-up
Sometimes I feel that doctors dont take into the psychological effect of these ectopics as well as the physical effect. I get them, sometimes for hours, often just a run of svt's. They are 'not harmfull' but I dont feel the same when they are on. I take 2.5mg of bisoprolol but was on 5mg at one point. Increasing the Bisoprolol was the cardiologists answer.
I too have mild asthma (on Fostair) but did notice on 5mg being slightly breathless, but didnt associate the two till a few years later
Sorry Mike I was referring to Plaster71's remark that even low alcoholic booze sets off his heart. The figures I quote relate to the % proof beers I drink. and the fact that even those as low as 0.5% or less, can trigger symptoms in me.
Hi cabinessence. As someone who grew up in my dad’s pubs and worked in them for years so I did enjoy the odd tipple or too here and there , so switching to non alcoholic drinks last year was a bit of a change . Tbh I’ve gone gone years without alcohol in the past due to af but You’re quite right though with low alcohol drinks that they can still have an effect as I found out when I first made the change . On one occasion I had just a couple of sips of a 0.5% ale and wallop, off goes my my chest again.
Now I’ve found a great drink which is 0.0 Guinness, just a couple these over a weekend is great. I really appreciate this group with everyone’s comments and feedback as it’s very interesting to see and learn from everyone’s experiences
Yes Guinness is most like its bigger brother, which is fine if you like Guinness, but it’s never been my go to pint to be honest. But it is 0.05% , and because it tastes like a beer, it makes me at least think I’m drinking a pint🤣 Sad I know. There’s a bitter called Butcombe Goram, which is also available in many Butcombe houses on draught, if you’re down Bristol or Bath way ever, and it really tastes like bitter. But it’s 0.5%. Although I can chance a can or two and get away with it most times, as long as I then don’t touch it again for at least a couple of weeks. Estrella do a 0.05% lager which is really nice and I bumped into it on draught in Chiswick recently. Really felt like I was having a pint❤️. Might move to Chiswick🤣🤣 Finally my go to 0.05%, is San Miguel. Sorry to bore everyone on here who isn’t a drinker!!!
Just jumped on these comments to suggest you watch York cardiology on YouTube, he does a video on this subject, the relationship between heart and stomach.
Sorry I’m rubbish at links and things like that but if you search York cardiology and then go to his playlist there are tons of videos on Afib , palpitations and ectopics .
I live with loads of ectopics, both PVCs and PACs. I’ve gotten used to it. I’m not a candidate for ablation for any of my arrhythmias as mine originates from the sodium channels. I’ve just learned to accept them. I have no other choice.
Thanks for the suggestion. I don’t have an intolerance to gluten so see no reason why I would not eat it. Nothing will get rid of them. I have a genetic condition which killed my mother, grandmother, and 2 uncles. My brother also has it. I not only have ectopics but also a left bundle branch block, non-sustained ventricular tachycardia, supraventricular tachycardia, atrial fibrillation and bradycardia.
My EP explained that with a sodium channelopathy, the heart may be relying on alternative pathways of conduction. As you know, ablation is a procedure that scars parts of the heart to block pathways. Ablating even a small area may further reduce the pathways available.
I have progressive cardiac conduction disorder. My electrical issues are more widespread than isolated abnormal conduction circuits that most people have.
**Edited because I didn’t explain what the sodium channels are
For want of a better way of describing it, the sodium channels in the heart are a bit like the kitchen in a restaurant. Just as the kitchen prepares the meals that keep the restaurant running, the sodium channels help ‘create’ the electrical signals that keep the heart beating. So for most people they might have a waiter who is taking the food to the wrong table. An ablation blocks the path to the wrong table. In my case, it would essentially be the pathways being jumbled and the waiter finding the best way they can to get to the table. Sort of… haha I hope that makes sense!!
hi Andy, Iv suffered with ectopics for years and years and they are very annoying indeed.! They can last for two weeks at a time and I can quite honestly say they start messing with my head sometimes and are very mentally draining.
Hi forensic fairy . In 2018 after my ablation I noticed I was starting to get these eptopics and after a few checks was told I would have to get used to them . Since then they have significantly got worse , and in fact in the last few months have caused a little concern as the fatigue that has now crept in with it has lead me to believe I’m ever slowly creeping back into af. I’ve lived with this ok for the last 5/6 years but I guess as I get older it was bound to at some point get to this stage. It’s quite amazing how common this.
Yes, it is more common than people realise. My condition is progressive so today is much better than tomorrow. I just live for the day and enjoy it while it lasts.
I’m also very lucky in that I don’t really suffer from anxiety. I accept it is what it is. I also understand the ectopics and even AF won’t kill me. It’s the future of more dangerous arrhythmias and the fatigue which impacts me more than anything.
Hi Andy....I'm 67 and I have had ectopic skipped heart beats several years ago on and off and then all of a sudden they got bad and so I had a work up at an ER and then I went to my cardio and he put me on bisprolol. Now 99,9% of the time the ectopics are gone, knock on wood. It seems that if I don't drink enough water or if my bp is up then I get the ectopic skipped beats or if I didn't get enough rest or eat the proper foods.
I also don't drink or smoke and I try to eat healthy and I'm barely over on my weight range. When I get the skipped beats I try to figure out what might be causing it and then usually within a day they are gone!! I was already taking (2) 2.5 mgs of amlodipine per day and now I also take 1/2 of a 5mg bisoprolol.
I also never eat or drink anything with caffeine because it causes the skipped beats. I hope you can figure it out. I know how you feel. When I get the atrial ectopic beats it drives me crazy. Maybe see if you are having the skipped beats because your bp is a little high? I hope you can find an answer!!! I truly think most of the time it's due to my bp being a little high and I stay on top of my bp really well so most of the time my skipped beats are under control. Also I try to keep my stress levels down and stay calm and relaxed!! Let us know how you are doing.
My mom has a pacemaker for over 10 years and now on her second pacemaker and has had cardioversions and one ablation done and she is 89 now and knock on wood, doing very well and she's always been quite active. All the best to you!!!
Hi - your story sounds very much like mine. My consultant was reluctant to go down the route of a second ablation in an attempt to chase down the cause of my frequent ectopics which he described as benign. So I agreed to just go away and get on with life and still keep exercising - often a gentle run would temporarily stop the ectopics. This went on until maybe August last year then guess what? Everything suddenly settled right down and haven’t had any ectopics for around 4-5 months now. So thought I would share some positivity! The only 2 things I thought may have made a difference were stress levels and I started eating Keffir yoghurt regularly as I had a sense that my gut was connected in some way. As most on here know, AF is so unpredictabl! Good luck!
You very much sound like me. I started getting daily ectopics that went on for hours several months after my PVI ablation in 2022 and symptoms were draining. My EP kept telling me they wouldn’t likely go away as believed they were stress related so had to try focus on my mental health. At this time I cut all the bad stuff out my diet, no sugar, artificial sweeteners etc and took up yoga and walking. Still no help. Had ablation for them which failed so took 3 months off work which helped. Went back to work, but pressures caused increase again and after 7 months I walked away for a bit. 10 months later after lots more EP and occ health review, work have allowed me to change my role slightly and have support of 2 more people so 3 months back at work now 20 hours a week I feel much better, get them a few times a week but they don’t last long enough to cause the fatigue. So my advice is watch for the stress in your life and act on it. Think we are prone to these ectopics so limit the cause of them. Take care
Hi, I found upping my plain water intake has reduced these considerably. It worked within a few days of me doing it after years of them. Lots of loo trips though. Good luck.
Hi, I’ve had ectopics for 10 years now. Originally only a few a day which have gradually increased resulting in a Holter 2 years ago. This resulted in a diagnosis of PAF aswell at the ectopics. I’m not on any medication except for Bisoprolol as a pill in pocket should I have an excessive heart rate, which I never have had so I’ve not taken a single tablet in 2 years. I also have a resting heart rate of 50 so don’t want to lower it any more. My PAF is very rare and only last a few seconds if that’s what it actually is.
My ectopics though have escalated and like yours can last hours; sometimes 24 hours of bigeminy. I didn’t realise until I did a bit of research, that bigeminy can sometimes result in a missing p wave on ecg.
An echocardiogram showed a normal heart so my cardiologist wasn’t interested when I showed him the Kardia results. The word ‘ablation’ never came out of his mouth and he basically said, they were benign and nothing to worry about even if I had 1000s of them a day.
I’m 61, don’t smoke, nor do I drink alcohol or caffeine. My BP is normal and BMI is good. I do quite a bit of walking in the Lakeland fells so am pretty active.
I have noticed certain food stuffs do seem to bring an onset of ectopics or if I start to move around straight after eating.
When I do get anxious I sit down, do some deep breathing and get on YouTube to watch a couple of Dr Sanjay Gupta videos! I would highly recommend looking at his videos, they are a great relaxant.
As a couple of others have said, I just have to get on with it and try not to let my imagination get the better of me. When I’m relaxed about it, I find the episodes don’t last as long.
Easy said, but do try and relax when these happen, do something to take your mind off them and don’t focus on all the bumps going on in your chest. I focus on the fact my cardiologist isn’t concerned and this tends to keep me calm together with Dr Sanjay of course.
Hi I picked up on a couple of comments by yourself & others .I started getting increasing ectopics about 12 months after ablation.I spoke to the Arrythmia nurses as I was concerned that I felt just as bad as in AFand sent copies of readings.Very sympathetic but said often the treatment for ectopics can be worse that the ectopics.However as it got worse I created a spreadsheet to show the increasing frequency.We agreed to stop Diltiazem . It was possible that this could increase my BP and I would need to increase my BP meds.I agreed to monitor this.
Stopping the Diltiazem worked.
That was May.
I use a Kardia equivalent called Emay.I can export to phone & create a report.
Hi! Although ablations are a very successful procedure, sometimes they need to be repeated. I’d be inclined to have the ablation instead of lots of meds.
I've had some PAF and ectopics. They seeemed to partner each other at times (like the ectopics were a precursor to the AF).. Fortunately, I seem to have got both under control. As you will know, causes are varied and hard to pinpoint.
Alcohol and indulgent eating were clearly major contributers for me but so was stress. Stress can be elusive to address as it can be self-perpuating, but I had an NHS telephone based course from a GP referral. This really helped. It was some pragmatic with easy to follow concepts around breathing and thought patterns but it worked for me. And now if I'm getting ectopics I practice the concepts and it seems to nip it in the bud.
one thing that is very important is to have a blood check to see your magnesium levels? If it is too high then quite possibly it’s the magnesium causing it. It is known that too much magnesium can cause heart irregularities. As can being deficient in magnesium,
is there an option to use flecainide to stop the ectopic? I genuinely have no idea if it works with ventricular ectopic but I guess you could ask the cardiologist ? It can work well with AF
I had an ablation for Atrial Tachycardia in 2010 and another ablation for Atrial Fibrillation in 2011. Nine years later in 2020, I began having continuous ectopic heartbeats, mostly Premature Atrial Contractions (PACs). My cardiologist initially put me on Flecainide 100 mg twice daily and and then reduced it to 50 mg twice daily. It has been successful in stopping the ectopics most of the time.
However, the cardiologist should make sure you are a good candidate for Flecainide as it can be proarrythmic (causing more serious arrythmias). Usually the patient beginning Flecainide is closely monitored, sometimes even in a hospital, to make sure no serious side effects or dangerous arrhythmias occur. Also, it may not be indicated for patients with coronary artery disease (CAD) as there are risks involved. The cardiologist may run tests to see the extent of a patient's CAD before starting them on Flecainide.
Your cardiologist should also determine the type of ectopics you are having Premature Atrial Contractions (PACs) or Premature Ventricular Contractions (PVCs). My electrophysiologist (EP) told me a high percentage of PVCs, I think over 30 percent, is more serious as they can lead to cardiomyopathy. PACs are more benign and the EP said he does not usually do an ablation for PACs unless the patient is very symptomatic with them.
since my ablation I have been working to avoid further arrhythmias. I am on 12.5mg metoprolol and finally got off flecainide. The things I have done to try and avoid further arrythmias which have happened post ablation are: pray, drink 1/2 my body weight in water every day take at least 800mg magnesium everyday, read James Nestor book breath and learn breathing patterns, I removed my amalgam fillings(mercury) with a wholistic dentist, consciously only breath through my nose not my mouth, stop eating after 6 pm, quit extra sugars-cookies, candy, no caffeine, no alcohol, walk everyday 3-5 miles, hum and sing when it works, and recently sauna to detox 3-5 times a week for 15 minutes. Hope some of these help. Seems like we r never out of the woods but I believe God made our bodies to heal themselves if we keep working at it
not sure where my response went. Post ablation I have done a number of things to avoid further arrythmias-pray, drink filtered water 1/2 my wt in pounds to ounces daily, 1/8 t. Mineral salt everyday, no caffeine no alcohol walk 3-5 miles a day read James Nestor breath and learn breathing patterns, hum and sing when it works, spray my throat with xclear am and pm , removed amalgams(mercury) under a wholistic dentist this past year, recently added sauna to detox 3-5 times a week for 15 minutes, recently added chiropractor adjustments 3 x a week for eight weeks with decreasing amounts to change the sympathetic/parasympathetic pattern I’m in, avoiding extra sugars in cookies candies and pops. Praying to keep arrythmias away. Seems we have to keep working at it
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Magnesium and eptopics? 
Pre Syncope and AF
Paroxysmal afib more frequent episodes, but less symptomatic, and shorter lasting
