Ablation, AF, PACs/PVCs, and Newman

Hi,

Further to folks here talking about PAC frequency and Newman getting ectopics after his ablation, it set me thinking......

The AF scenario is:
PAC/s + shortened EARP (effective atrial refractory period) + dispersion of said refractoryness = propogation of wavelets in atria = AF.

PACs typically originate in the lower portion of the pulmonary veins (PVs)just above the atria: hence PV ablation to stop transmission of rogue electrical impulses spreading down from the pulmonary veins to the atria.

Assuming Newman's PV ablation has been successfull, then the ectopics he describes cannot be PACs but are instead PVCs. In my own experience, PVCs are EXACTLY as Newman describes, whereas PACs tend to be 'less clean-cut' in their timing and are accordingly more chaotic/disorganised as regards how one perceives them. And in any event, for a PV ablation to be successfull, PACs should NOT occur, and in the absence of such, a shortened AERP and an increase in dispersion of refractoryness cannot on their own (without PACs) cause AF.

Are my thought processes as above on the money?

Mike F.

Mike: Although afib emits from pulmonary veins, I was unaware that PACs did as well. I believe PACs can come from anywhere in the atrial chambers and are generally always present post ablation. I wouldn't swear to that. Also, I don't think without a printed rhythm strip or ekg that one could distinguish PACs from PVCs from the sensation alone. I have both and cannot tell them apart. I also have had an ablation. Just guessing.

Pam

Pam,

You're indeed correct in pointing out that PACs CAN originate in the atrial chambers. It's just that so far as I'm aware MOST PACs (like most AF) actually originate from the PVs. But yes, I take your point that PACs originating from the atrial chambers can occur post PV ablation. Thanks for putting me right.

Mike F.