Flurry of Ectopics

After almost 2 years of being symptom free from my first AF episode, I started having a cluster of weird ectopics that started on Friday. I was feeling unusually "edgy" and started having runs of PVCs (I can see in my Kardia ECGs) about 1 every minute for 5 to 15 minutes at a time. Then they go away for an hour or so, then come back. They seem to happen when my resting heart rate stays in the 85-95 bpm, which is unusual for me, since it is normally around 65 bpm. At most, I used to get 10 PVCs a month when on a monitor.

I've been staying on my Mag (400-600mg /day), K (as KCl about 1g/day), and Taurine (2g / day).

Has anyone had a similar experience or advice?

Thanks!

Hi FibbinAfib,

I have been experiencing many ectopics myself for the past 2 weeks. I'm struggling to get my head around how I can go from a handful a day to hundreds and for no apparent reason, so I know how you feel. But some people I've spoken to experience 1000s a day so they may be able to offer better advice. I'm currently just trying to pinpoint causes, which will no doubt be a fruitless task!

Had my first ablation in June 17 and after 4-5 months I'd gradually started feeling myself and did for about 6 months but they've picked up again lately. Far from an expert myself but the guys and girls on here are great and have helped me with advice and suggestions.

You might try stopping the potassium supplement for a while. Have you assessed dietary sources of K? Also, are your kidneys in good shape?

Fibbin - Do you know for sure that you have healthy kidney function? Tested within the past 6 months?

Jackie

This is my opinion. I know everyone is big on supplements and I know they help at times. I have been having months of crazy stuff after a pretty great year. By great I dont mean "great" I mean manageable. Id stop everything and reset. I was doing Magnesium around 600 mg day powder, Taurine and increased my Potassium like clockwork for over a year every day. When I stopped my Magnesium and increased Potassium it seemed to help me. Now im not doing any supplements and Im better than Ive been since Jan 1. So who knows? I did have Natale give me the slow release Potassium tablets 1500 mg. Ill take a half of one every four or five days, Even he told me when he cautiously prescribed them upon my request "you need to be careful taking these". Again and Ie mentioned this to others when I personally do a lot of magnesium sometimes it seems to highlight my ectopics (I maY IMagin that idk) My main point ........ Different things work for us individually otherwise we'd be cured. My ectopics are VERY bothersome. This time I laid down and just said to hell with it to my heart Do What Ya Gotta Do. Eventually it has lessened.



Oh and I forgot to mention my EP and Natale took me off the 50 mg Flecainide and 12.5 Toprol ER 2 months ago

Tim



Edited 1 time(s). Last edit at 05/22/2018 03:00PM by tsco.

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tsco

I have been having months of crazy stuff after a pretty great year.

Oh and I forgot to mention my EP and Natale took me off the 50 mg Flecainide and 12.5 Toprol ER 2 months ago

Tim

Curious as to what Natale recommended, if anything, regarding the ectopics.

Tim - You are absolutely correct. Everyone is different when it comes to which nutrients may be deficient in their body and then how they might respond to taking supplements to replete. Testing certainly helps guide supplementation but many patients don't have access to physicians who can order the appropriate, meaningful tests.

That said, however, it's about 99% sure that most afibbers are deficient in magnesium. Then, the challenge becomes which form will be most bio-available to their particular individual ability to absorb the magnesium since there can be various interferences that prevent efficient and sufficient absorption which (then) influences how quickly that individual repletes... or doesn't.

If there are gut issues that block absorption or damaged cell receptors that don't allow flow of magnesium into heart cells (for example), then that person won't notice improvement with magnesium until the areas blocked are also managed which takes time and supervision by a practitioner who understands that mechanism. This would be true with any targeted nutrient taken. If magnesium access is impaired, then the complementary nutrients such as potassium and taurine will also have access problems. Fortunately, that's not typically the case but it is a consideration or an alert when just the basic magnesium protocol doesn't seem to help.

Keep in mind that potassium definitely helps lengthen the refractory period which is the time between heart beats.
However, unless magnesium is fully optimized inside the heart cell (consistently), adding potassium can make the ectopics, PACs and/or arrhythmia worse.

Often, the gut lining and lumen are involved and need to be rehabbed as the initial start along with correcting the outer cell walls which could be damaged from bad fats like trans fats and also the oxidative stress or lipidperoxidation of fats.
Oxidative stress damage is common with endurance or heavy aerobic exercise.

So the bottom line is... just because you take a nutrient, doesn't mean it automatically and unequivocally reaches the target... in this case... inside heart cells. As with all cellular reactions, it's a process that needs certain, specific conditions and facilitators to make the end-result happen. Over a lifetime, various deficiencies - coupled with oxidative stress damage, fibrosis and such - can result in a variety of ailments because of impaired nutrient access inside the target cells.

Jackie

Could also be a side effect of ablation, in which case adjusting nutrients might or might not help

Jpeters, he pretty much said that's part of my make-up now. Kind of ignored it. Trust me I am very sensitive to them. My P waves
Are very slight and we went back and looked from several years ago and they were same then. The only thing we decided was for me to do a stress test
Due to some other pause issues i was having. I explained the potassium tablets I thought in my mind helped softened the ectopics and all he said was basically
He would give me more but to be very careful using them.

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tsco
Jpeters, he pretty much said that's part of my make-up now. Kind of ignored it. Trust me I am very sensitive to them.

I don't think EP's quite know what to do about them, and perhaps don't want to acknowledge ablation had anything to do with the problem.

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jpeters

Jpeters, he pretty much said that's part of my make-up now. Kind of ignored it. Trust me I am very sensitive to them.
I don't think EP's quite know what to do about them, and perhaps don't want to acknowledge ablation had anything to do with the problem.

Natale apparently knew what to do about mine. Completely eliminated.

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Carey



Natale apparently knew what to do about mine. Completely eliminated.

Good news to hear you don't have any ectopics. I wonder if there are any studies regarding side effects. I'm still on the fence about whether to ablate..In fact, seeing a local EP today, and Richard Hongo in San Francisco next month. I'm not having any symptoms, so won't rush into anything.

Hello everyone, sorry for not replying, but my notifications that there were replies were going to spam :/

Anyway, I appreciate the dialog. It seems the PVCs have slowed down to a handful a day again. They still come back for 5 minutes here and there, or I may get 3 to 5 sinus tachycardia beats in a row. But they seem to be slowly going back to "normal".

My kidneys were checked back in Oct, since I do loose a lot of K. Everything checked well within the normal readings. My doctor doesn't know why I do loose so much K, which they believe was the reason I went into afib the first time (the 2 a day energy drinks and sleep apnea didn't help, also).

I saw my cardiologist who did a quick ECG, caught a few PVCs over a couple minutes and said "When you hit tens of thousands a day, we will worry." And out the door I went, one copay poorer.

I guess for now I will just trudge on here. I have a more bleak post I began to write, but I will wait to make that a topic on its own at some point. Mainly how, with all these medical advances, it seems our methods to attack these arrhythmias is borderline archaic. I say that sarcastically, yes a lot of progress and innovation has happened, but at the end of the day, we are still left with some form of arrhythmia or patiently waiting for the day when the last procedure no longer holds the afib off.

Jpeters, I get what you are saying and in fact more conservative EPs will acknowledge the possibility or risk of causing other problems as a result of ablation.
I know this first hand I have damage and a condition I am convinced that is a result of ablation of a stubborn tach. That's what ablation does right? (Damages tissue).
Carey I'm so glad you are free of any burden ectopics, afib, etc. you are very very lucky and a very rare case. Not my first rodeo and for most of us it's not so cut n dry.
Fibbin afib I totally agree with your last paragraph it sums up my exact feelings. Well said

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tsco
Carey I'm so glad you are free of any burden ectopics, afib, etc. you are very very lucky and a very rare case. Not my first rodeo and for most of us it's not so cut n dry.

Very rare? Well, sort of. You're apparently unaware of my history. Trust me, I know all about failed ablations and partially successful ablations and drugs vs. ablations. We're talking about my sixth rodeo.

Met with an EP today who interned at the Cleveland Clinic when Natale was there. After some optimistic banter, I began asking questions regarding success rates, etc, and finally what happens after a few of his procedures fail and I'm left with scar tissue and a bunch of new symptoms. His next option was to send me for Convergent Ablation where they were getting much better results then he was. [a-fib.com]



Edited 1 time(s). Last edit at 05/25/2018 01:03AM by jpeters.

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jpeters
His next option was to send me for Convergent Ablation where they were getting much better results then he was.

Natale and other EPs of his stature get much better results than he does and does it without cutting you open. Maze isn't trivial surgery. It requires being put on bypass, and although it tends to be very effective, atrial flutter is a common side effect. I considered it but rejected it for those reasons.

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Carey

His next option was to send me for Convergent Ablation where they were getting much better results then he was.

Natale and other EPs of his stature get much better results than he does and does it without cutting you open. Maze isn't trivial surgery. It requires being put on bypass, and although it tends to be very effective, atrial flutter is a common side effect. I considered it but rejected it for those reasons.

Convergent is far less invasive than Maze. Just two small slits. Very fast recovery time. An option if regular ablation fails.

Is it considered normal having ectopics after an ablation ? I've read about this a handful of times. And, apparently, EPs are glad you're now afib free and don't seem to worry about your ectopics, saying they're not dangerous.
True, but PACs and PVCs may be as awful to bear as afib.

Yes, it is common. Think about what’s happened. The ablation has changed the electrical substrate of your heart. It’s going to behave differently than before. It may not be able to sustain AF bit still experience many ectopic beats. EPs will label that a success. If it’s not going into full-blown AF anymore then there isn’t really a surgical option. You can ask your EP for a low dose anti arrhythmic if they are particularly bothersome.

I still experience ectopic beats, but have been able to keep things very well under control in my opinion with careful hydration and electrolyte supplementation. Until, of course, I had an AF breakthrough one month ago. Nothing since. The key is not to panic, understand that this is a progressive (albeit slowly) disease and “up your game” when circumstances require it.

I'm in my blanking period, so it's uneasy telling what's good or not so good to help me feeling better. I take Mg for two months now, but I can't say if it's useful. Maybe too soon to tell... I've taken K citrate for some weeks, but I've recently stopped it. I'd had two bad nights with lots of ectopics and, even if K was not responsible for it, I found better stopping this supplement. I'm used to eat lots of fruits and green vegetables, so this may be enough.
I'm still taking flec, but I've just reduced bisoprolol, as my BP was often as low as 85/60 and, in bed, my HR went sometimes below 60bpm (making easier the start of ectopics ???)...
I know I'm testing lots of variables in the same time, which does not help separate the good from the bad!

What is the form of magnesium? Bisglycinate chelate is the best for oral consumption. There are also skin oils. I have not tried those.



Edited 1 time(s). Last edit at 05/25/2018 08:17PM by wolfpack.

Yeah, it's bisglycinate. No issue with it. I've not yet taken more than 1g/day. I'm planning reducing gradually flecainide until using it as PIP. Maybe increasing Mg in the same time ?

They are terrible for sure. Flec seemed to help mine for years. I don't take that now and the thing I noticed most that at least dampens them is hydration and potassium
Mine are def worse if my heart rate is lower. Jackie may be able to help with that also, she's really knowledgable on supplements

I take the magnesium and taurine supplements and usually a couple of cans of low sodium V8 a day as well as additional vegetables and a banana or 2. I also just recently added burberrin supplement for glucose management. My AC1 is on the high side of normal.

I'm 2 weeks from my1 year anniversary Dr. Natale ablation and the ectopics come and go, but have been much less frequent the past 6 months. And my physical activity has been off the charts - walking 30-35 miles a week, plus all of the home improvement projects that got tabled last year.

tsco and Pompon... I'll give you some magnesium tips ...and ideas. I'll try to get it done soon.

Jackie

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Jackie
tsco and Pompon... I'll give you some magnesium tips ...and ideas. I'll try to get it done soon.

Jackie

Nice, Jackie. Your advices are always precious.

In addition to my earlier response to this post… 5/23/18…

Here are additional considerations for magnesium (Mg) supplementation success.

While there are many forms of magnesium supplements, the one that is most likely to successfully reach heart cells is the amino acid chelated version… identified as made and patented by Albion Labs with the TRAACs ® designation on the label. This form survives the stomach acid without breaking down and if the portals in the GI tract’s ie intestinal lumen are functioning properly, it’s delivered to the outer cell wall’s receptor sites. Many other forms can be useful but there’s no guarantee how much actual magnesium reaches the cell receptor sites… meaning while you may think your dose of say, 800 mg daily sounds like a generous amount, perhaps only half of that magnesium ends up at the receptor site; instead is bound to other components which may not arrive there or is not able to cross into the cell.

If you can tolerate larger doses of other forms of magnesium to make up for the dissociation factor, then, great. If not
then sticking with the true chelated form offers the best chance of success. Everyone is different so you just have to experiment. Some people are so Mg deficient, it takes longer to become repleted and others have lifestyle influences that deplete magnesium rapidly and continually… such as high stress – emotional, physical, endurance exercise, alcohol consumption – so it makes it a challenge to get to the repletion stage quickly… often taking 2 months or longer.

There are several forms of magnesium.supplements. The citrate form is typically used as a laxative and while some can tolerate higher doses, many do not. Again, just be aware. Other forms include Magnesium malate, chloride, orotate, sulfate, oxide and carbonate. The Oxide form is the least absorbable and is often used as filler in magnesium supplements to economize and make the label look good for magnesium content, but the bottom line is that the efficacy of that product may be somewhat less than one that doesn’t have the filler because mentally, you limit the daily dose. You still can use the product, you just have to ignore the milligram count and go for the bowel tolerance effect as a signal for optimization.

I have read that the magnesium chloride can cause stomach complaints … it’s the chloride irritation and not the bowel issue from magnesium….so just be aware.

Also, easy and economical and highly beneficial is the is the home made version of Alkaline Magnesium bicarbonate water… which we named WW or Waller Water for Erling Waller who perfected the recipe for making it. Many benefits from keeping the system alkaline and definitely a good source of magnesium as well. I’m still using it continually the importance of alkalizing tissue continually cannot be ignored. Go here for the background and the easy-to-follow recipe for making your own at home. Just be sure you use Seltzer water and not Club Soda which may have other ingredients as well. [www.afibbers.org]

Another good option is Epsom Salts (magnesium sulfate) baths or foot soaks. It’s relaxing and economical. Just takes time – so a combination is some oral supplements and then soaking with Epsom Salts at least once a day as well..can help.

There is also the topical form or “transdermal” – magnesium chloride – which is often called magnesium “oil” or “gel”…. The original successes were made from magnesium chloride salts harvested from the Ziechstein ancient sea beds – which are pure and without other contaminants.

These oil or gel products are absorbed through the skin quite rapidly. A good test is on a sore muscle. The ‘oil’ is applied and in less than 20 minutes, there is typically significant pain relief. I’ve used it and found that to be true every time. So that means you are definitely absorbing magnesium. The downside is that (to me) the gel or oil leaves a tacky feeling so it’s not just apply and go…you have to wait then wash off….whereas the supplement is both portable and quick. But a combination of both is certainly an option.

Learn more about this form from Mark Sircus. He’s the expert on this topic.
[www.google.com]

Then… once you’ve reached the repletion stage…signaled by a lessened tolerance for higher Mg doses –(bowel tolerance)…… the potassium you take in from dietary forms and supplements if you need to, will become effective in slowing down or eliminating the PACs or ectopics. If they rev up again, it’s a signal that you not keeping up with the magnesium.

Long ago there was a study offered here for review that discussed what lies behind the electrolyte imbalance that supports ectopic beats or PACs…. Not sure I can locate the study but the finding was that magnesium must be optimized inside the cells before potassium can work as it should to lengthen the refractory period or the time between heartbeats. It said that adding potassium too soon would make the ectopics worse.

There are other mechanisms involving the sodium/potassium pump mechanism… Go to this report… It’s classic information that every afibber …. current or former .... needs to keep in mind about electrolyte balance and repletion. [www.mgwater.com]

Also here’s a review post from 9 years ago that is a trove of useful information that every afibber… active or ablated should never forget. Take the time to review this carefully.

Back to the Basics - Magnesium and Potassium
[www.afibbers.org]

Hope this helps,
Jackie

Thanks again, Jackie.

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(...) Long ago there was a study offered here for review that discussed what lies behind the electrolyte imbalance that supports ectopic beats or PACs…. Not sure I can locate the study but the finding was that magnesium must be optimized inside the cells before potassium can work as it should to lengthen the refractory period or the time between heartbeats. It said that adding potassium too soon would make the ectopics worse. (...)

Maybe the issue I've had...

from: [peoplesrx.com]

"Orally, magnesium citrate is the best absorbed form (but it’s bonded to a big molecule so there is a smaller amount of magnesium by weight)".

"Magnesium amino acid chelate is usually bonded to a variety of amino acids, which are all larger molecules. In this form there is less magnesium by weight but the individual amino acids could all be beneficial for different things. Every formulais different so if you need both Mg and a particular amino acid, then this could be the way to go."

Great read by Dr Chambers, Jackie.

I was surprised by the left-handed link. I’m a “southpaw” myself. I could seriously be creating Digoxin inside my brain? Wow!