Intense PAC's after Carioversion

June of 2016 I was diagnosed with AFib at the age of 34. Was working hard doing some insulation work in the middle of summer and knew right away something was up. Definitely never felt such an issue before so was very confident it was the first time. Went to ER actually thinking I had AFib without knowing much about it. Was awfully symptomatic and light headed with a HR around 180. ER sent me home and told me to return to see Cardiologist next morning if I did not convert. Next morning still there so went to Hospital and was Cardioverted successfully after maybe 24 hours or so in AFib. Actually felt pretty good upon discharge but that night I felt significant skipping beats. Thought maybe I was in AFib again. Next morning back to hospital and ECG showed PAC's, and received the typical yawn from all involved. I could call out every missed beat. Fast forward to now and thankfully have not been back into AFib but have PAC's ever since Cardioversion. I know they say maybe you are more aware of things after AFib and probably had missed beats before but my PAC's are rather symptomatic and often times in Trigeminy for several hours. Two 24 hour holters showed 800 one day and 1700 the next. I was actually very surprised how low the number was considering they seem to average 1:10 beats and many times Trigeminy for a bit. Total beats were both around 105,000 a day. I really thought I was going to be at 10,000 PAC's or so. PVC's non issue, maybe 5-7 in 24 hours. Echo showed normal structure. To me the randomness of my PAC's, the quantity, and the symptoms almost seem worse to me than the AFib. I am well aware that PAC's won't kill me and better to have them than AFib, but I have slight Pectus Excavatum and my heart simply pounds so hard its hard to concentrate on anything and be normal when they come. Typically now I have them for about 12 hours or so every few days. No pattern I can find at this point. I sometimes will go days non stop. Then I really get fatigued. Concern is that they haven't let up and without history of the AFib would probably learn to cope better, but the AFib will probably return with this level of heart excitement. My EP suggested PVI which I will not consider until I have more episodes of AFib. Is it possible my AFib event structurally changed my heart to now be an easy trigger for PAC's. Will letting myself have these PAC's make future ablation harder if I get more AFib? Has anyone been able to address these head on? I don't think ablation is worth it at this point until I show more history of AFib. Trying to do my homework because it definitely seems AFib will be back and want to be ready. Taking Fish Oil and Mg+ but have seen little improvement. These PAC's have stolen peace and quiet from me. When I am in NSR all I want to do is sit and relax and enjoy the bliss. I am 6'3" 200lbs. Not very active but trying to do moderate cardio during times when I am NSR. If I do cardio with PAC's it gets worse. No meds currently. Doc also suggested pill in pocket for PACs but thats scary to me considering how often I have big runs of PACs.



Edited 1 time(s). Last edit at 11/13/2017 10:48AM by Barbless.

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Barbless
Is it possible my AFib event structurally changed my heart to now be an easy trigger for PAC's. Will letting myself have these PAC's make future ablation harder if I get more AFib? Has anyone been able to address these head on? I don't think ablation is worth it at this point until I show more history of AFib. Trying to do my homework because it definitely seems AFib will be back and want to be ready. Taking Fish Oil and Mg+ but have seen little improvement. These PAC's have stolen peace and quiet from me. When I am in NSR all I want to do is sit and relax and enjoy the bliss. I am 6'3" 200lbs. Not very active but trying to do moderate cardio during times when I am NSR. If I do cardio with PAC's it gets worse. No meds currently. Doc also suggested pill in pocket for PACs but thats scary to me considering how often I have big runs of PACs.

No, a single episode of afib (or 20) won't structurally change anything, and the PACs won't make a future ablation more difficult. What you're describing sounds fairly typical, actually. PACs go hand in hand with afib, and you're right that they're likely to trigger another afib episode.

It's relevant that your afib episode began while you were working in hot weather. Dehydration and the electrolyte imbalances it produces are very much not your friends. Avoid dehydration like the plague. Good that you're taking the magnesium, but what you might try is adding potassium. Go buy some low-sodium (not regular) V8 in the large cans (12 oz) and when you start experiencing these PACs, drink an entire can, or even two. No promises, but you might find this helps.

I agree with not rushing into an ablation after a single episode, but I don't agree with avoiding the PIP your doc offered. Many of us use a PIP approach or have used it in the past. Nothing to be afraid of.

Barbless - A couple of questions. How much magnesium are you taking daily and what is the form.. meaning is it magnesium citrate or gluconate or the amino acid chelate, etc. ? And, most importantly, how long have you been dosing consistently at your current rate?

I've worked with numerous early-stage afibbers who became dehydrated in hot weather and began to have afib symptoms. It takes some time to get enough magnesium stored inside your cells consistently to reduce the tendency. And, definitely, as Carey indicates... avoid becoming dehydrated... without fail. Be aware that if you are very deficient in intracellular magnesium, then adding potassium can make the afib worse. And also, while potassium is extremely important as a core nutrient for electrical stability, evaluate your sodium intake as well to be sure potassium is not being overpowered by a high-sodium dietary intake from commercially-prepared foods or adding salt.

On the hydration issue... what is your main water source? Municipally-treated tap water? Sometimes, the chemicals added contribute to various imbalances so if you can use a filter or have access to pure spring water, it can be helpful.

It can be tricky to get all this stabilized consistently without a solid base of intracellular magnesium (magnesium is the calming mineral), and it takes a bit of time and commitment. Better to stabilize this now so you can look at Afib in the rear-view window!

Send me an PM if you'd like some help with your dosing, etc.

Jackie

Mostly Magnesium Citrate...but trying Glycinate lately. About 800mg. Which seems to be bowel tolerance. Water is mostly Poland Spring. Before AFib and looking into things, I never drank water, like ever. I still could drink more, but keeping up with it. Poor sleep is my biggest trigger and lately after meals in evenings, which of course then makes for bad sleep.The worst part for me when they come on, which I am sure is the same for AFib is the "how long are these gonna last for" feelings. Hours or days. When they go for days I go more and more mental with each day. Is the Exa Test worth the hassle? Or do folks supplement regardless?

A doc who used to post here regularly did a long piece on Pectus Excavatum (which he had) <[www.afibbers.org]

May be worth a read for you.

For many years, I've used beat to beat sampling such as is described here <[www.afibbers.org] and <[www.afibbers.org] . Today I use a bluetooth strap with a phone app & then transfer the data to old Polar software for review. I will monitor fo 24 hours if you want.

I initially used it to correlate supplements I was taking or lifestyle changes with PAC counts. If you want more detail on what I do, PM me and I'll post it here.

The original moderator came up with this concoction to reduce his PAC's, you could see if it helped you <[www.afibbers.org]



George

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GeorgeN
The original moderator came up with this concoction to reduce his PAC's, you could see if it helped you <[www.afibbers.org]

That's the article I read three years ago that led me down a path to being able to completely control my afib/flutter for almost two years with no drugs at all. Although I'm sure it's tasty, I think it's overly complicated for using daily. The only active ingredients in the recipe are potassium and magnesium (no surprise), so if you don't feel like putting that concoction together, you can do the equivalent with supplements or foods like LS V8, coconut water, etc.

Are their any good EP's in New York State? When one leaves the state how does insurance typically handle that? Having a hard time finding that info on the forum. Thanks

Hi Barbless,

Yes, in New York City there are a few experienced ablation EPs including especially Dr Natale’s longest running consecutive 10 year protege Dr Luigi DiBiase who worked side by side with Dr Natale for a decade while being director of St Davids world’s largest AFIB ablation research center under Dr Natale, and Dr DiBiase is now Director of AFIB ablation at Montefiore Medical Center and is a Professor and Director of AFIB Ablation at Albert Einstein Medical College. Also, Dr Vivek Reddy at Mount Sinai is, like Dr DiBiase, also a very bright EP and rising thought leader in the field.

Shannon

At the beginning of my stuff I took a magnesium supplement called "calm" that is a hot lemonade-like powder. I'm not sure of the form of magnesium, but my palpitations got worse with it. There is information on this site of the best form (I can't remember). I have been taking a product called "jigsaw" that I got from a naturopath and it has helped. Also look up supplementing with Taurine. Hope things calm for you soon!