What counts as a 'breakthrough event'?

Evening all (if you're in the UK too).

I'm literally a day away from hitting 12 weeks post ablation and just had a query about what is considered a breakthrough event.

I've had various instances of short runs of premature beats, etc. over the past few months. Seemed to have mostly started to calm down barring the odd 5-10 second run when I lay down of an evening.

But today I've had premature beats every 20-30 beats for pretty much the whole day. That isn't approximate but seems about average. My HR at the moment is in the low 90s. However, I should point out that I ate a fairly large meal about 45 minutes to an hour ago so my hr could still be a bit high due to that. Over the course of the day, it's averaged out at 86 all day.

Is this indicative of a breakthrough event; something I should be concerned about?

I would like to know also. I'm having palpitations tonight and last night. No rapid pulse though. I'm 2 months out from a flutter ablation. My guess is it's nothing to worry about but I don't know. Good luck!

PAC's normally are not considered a breakthrough event. You are still in NSR when having PAC's. Atria is not Fibrillating, hence no increase in Stroke risk. In general if you have PAC's you are at more risk of getting AFIB, but the Ablation if successfull, would stop that process. A PAC every 20-30 beats is nothing and many people with no AFIB ever have PAC's at this frequency. My understanding is that Ablations stop AFIB, not PAC's. It's something to monitor and avoid what makes it worse, but not something to worry much about.

Cindy I don't know how bad your Palp's are, but I don't think these count as an Breakthrough event. It is a sign that you are at increased risk of Arrythmia, but maybe not a big worry. Beta Blockers and Calcium Channel Blockers can help with these acute episodes.

Thanks for your response, Anti-Fib.

I think that because many of the doctors/consultants treating these issues rarely go deep into the details, it's never made clear that it's the afib that is being stopped, not PACs, etc. too. I'd understood that all irregular activity would be halted. Not that I remember anybody specifying this to me, so I suppose that's just my own assumption.

The most disappointing thing for me is that I'd never had PACs at this sort of regularity prior to my ablation. I had runs of an hour or two (at this current rate) every other day or so but never for a full day. My biggest issue was that I'd had 3 huge episodes of afib and, at my age, my doctor was happy for me to go along with an ablation. Hopefully my heart is still healing, and I guess I need to start keeping a closer eye on any triggers.

My understanding is that Ablations stop AFIB, not PAC's

True - and the key to eliminating PACs is the combination of optimizing the intracellular supply of: ... first magnesium... and then potassium. Potassium helps lengthen the time between beats. BUT... just adding potassium before magnesium is optimal can make things worse.

Potassium is easy to get from food sources. Magnesium (Mg) is more difficult as there isn't a lot in food and that which is supposed to have Mg may not measure up because of soil depletions, etc. Thus, most people find it necessary to supplement... and often with quite high amounts... as George notes for his requirements.

I've had 3 ablations and I think because of my attention to maintaining the IC magnesium and potassium consistently... (helped also by the balancing with taurine), post ablation, I've not been bothered with PACs with any of the ablations.

During the blanking period...which can actually extend longer than 3 mos. for some, a certain amount of 'unrest' in the heart is normal as it all settles down from all the inflammation caused by the burns. I used small amounts of anti-inflammatory herbals ...cautiously because of the warfarin and later the Eliquis.

Jackie

Hi Jackie.

I've been supplementing potassium, magnesium, taurine and fish oils now for about 10 weeks. I didn't realise though that you were supposed to raise magnesium levels before potassium. Perhaps I've been overloading on potassium? I started slowly with around 300mg mag and 400mg potassium per day. Compared to many on here, that doesn't seem a lot of either, but I didn't want to go in heavy-handed from the start.

Perhaps I should seek a bit more advise about my supplements..

Prior to yesterday, I'd only experienced really short runs of PACs for like 5-10 seconds at a time and primarily after lying down of an evening. I had the odd misplaced premature beat through the day but that's all. Since Wednesday it's been pretty consistent.

Davros:

Have you had your Potassium level run to know what it is? My Potassium is usually at the high end of the lab scale, at one time I tried taking Potassium supplement as most seem to take it on this board, well for me that was not good. I started getting small runs of AF, I quit the supplement and those runs went away. I wouldn't take a Potassium supplement until I know what my blood level of it is.

Liz

Davros - I'm glad the activity has become significantly less.

As I commented in my response, it's easy to get your potassium from foods and that should be your first choice unless you can't seem to increase it......which would be rare. Work on the magnesium via supplements. If you take too much supplemental potassium.... or even get too much from food sources...and that's fairly easy to do ... and especially if your magnesium inside the cells is still on the low side, you'll get the PACs.

Yes... about the optimizing magnesium first... it's in most any of the directions we discuss here. Lots to read so you probably missed it.

That said, after my last two ablation procedures and while still in the hospital, they gave a fairly high dose of potassium to help get rid of the water accumulations from the procedure. Apparently my magnesium levels were good because that extra potassium didn't cause any problems or PACs and flushed the excess right out.

If you want me to help you look at your daily potassium intake equivalencies from food, send me a PM and we can work on it so you can focus on that rather than supplementing with it. And definitely, keep working on the magnesium.

Jackie

Liz - You've always posted that you have a high intake of potassium from your wonderful veggie garden so it's not surprising if you had palps/AF when you supplemented with extra potassium. Could be you are lower in IC magnesium than you realize. If you recall TomC who introduced us to the CardyMeter... always said he found when he "ate well" on vacations, he's have some runs of arrhythmia and PACs...thus he got the meter so he could monitor and cut back on the potassium. But since there is no way to measure the magnesium by a handy meter, he could have unintentionally triggered the activity if he was low mag and hi K.

I've often wondered if taking extra sodium when too much potassium is suspect would help balance it out. Since I didn't have that problem, I wasn't able to experiment. The sodium-to-potassium ratio is important ... as has been discussed in CR 72 in the archives.

Jackie

Hi Jackie,

Thanks again for your response, it's very helpful. I had clearly missed the part about upping magnesium intake first. I'd been dutifully taking all of them day after day. I think we may have a (or at least one of) the culprits there.

I actually had my potassium levels checked about 6 weeks ago after I'd been supplementing it for a while and it was at a good level. I'm eating plenty of bananas, etc. too so will do that for a while.

'Touch wood', the PACs seem to have lessened somewhat today so hopefully this will gradually help as well.

Thanks for your responses, guys.

Davros:

How do you know that you never had PAC's before the Ablation? You had to have had some, as a PAC is one of the things that has to happen to start AFIB. Perhaps you feel them more now, or are paying closer attention. In any regard your Heart is still healing, so what is going on now may not persist. A few PAC's don't effect most people adversely. I for example aren't negatively effected unless I get a PAC at least every 2-3 beats. I exercise often, and if I am getting PAC's every 4-5 beats I really can't tell, but since I never got an Ablation it does concern me when I get that many PAC's, as I am at increased risk of AFIB.

I would worry more about sustained AFIB lasting more than several minutes.

Anti-Fib,

I didn't say I'd never had them, just that I'd never had them with this regularity. Prior to ablation, when I did get them they were fairly minor and didn't feel as pronounced. They also weren't so frequent. i.e. 1 or 2 every 5 minutes. I could usually pinpoint a trigger, in most cases too and once I stopped doing what I was doing (i.e. drinking too much caffeine, etc.) they tended to pass.

The PACs that I'd been having the last couple of days were every 10-20 beats in most cases. I understand that people that get them more regularly are probably thinking 'that's nothing to me' but bear in mind that when you've never had them that often they can really give you a scare.
Also, I have had 2 major afib eps since the start of the year (that instigated the ablation) and both were preceded by shorts runs of PACs, hence my big concern yesterday when I first posted.

You've all been helpful in explaining and advising though, so thanks all for your advice again guys!

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DavrosT
But today I've had premature beats every 20-30 beats for pretty much the whole day. That isn't approximate but seems about average. My HR at the moment is in the low 90s. However, I should point out that I ate a fairly large meal about 45 minutes to an hour ago so my hr could still be a bit high due to that. Over the course of the day, it's averaged out at 86 all day.

Is this indicative of a breakthrough event; something I should be concerned about?

No, it's not a breakthrough event because it's not a sustained arrhythmia (afib, flutter, etc). Trust me, I know how tiresome and annoying PACs can be. PACs can also trigger afib so they're not as harmless as doctors like to tell you, but still, what you're describing isn't afib or flutter so it's not a breakthrough and there's nothing to worry about. I hope they stop for you.

How many PACs do you have to have to trigger a fib, or how close together do they have to be? And what causes PACs?

Thanks
Ben

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Starwarsfan
How many PACs do you have to have to trigger a fib, or how close together do they have to be? And what causes PACs?

A single PAC ultimately triggers the afib so the answer is one. How close they are together probably doesn't matter much. Everyone is different so you're not going to find simple answers that explain how PACs relate to afib. I don't think it's even true that a PAC always initiates an afib episode.

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Starwarsfan
And what causes PACs?

Same thing that causes afib. Irritated electrical substrate in the atria. That can be fibrosis (scar tissue) or electrolyte imbalance. If you're young, bet against fibrosis and follow the sage advice of electrolyte supplementation (magnesium and potassium). I've been doing that for going on two years now and PACs are thankfully fading away. Days if not weeks go by now without one.

How much mag and potassium do u take in per day? I'm trying to get about 600mg of mag per day, but my potassium is varying due to my low carb diet... I've noticed more pac's since starting it, and before I did I was getting 4500+mg of potassium a day, but it's a little tougher on low carbs, especially bcuz I have to take in a lot of sodium to balance things out with it...... is there a magic minimum amount?

Potassium is easy to add. A single 12-oz can of low sodium V8 (not regular) packs 1180 mg of potassium. Plenty of other easy ways.