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Pacs lead to afib

Posted by johnnyS 
Pacs lead to afib
January 06, 2019 11:13PM
Hello everyone,

I've been visiting this forum for about a year now and I wanted to thank you all before I ask a couple of questions. This forum has been of great help to a lot of people and I am certainly one of them. In fact, it's the only place online I can think of where people go out of their way to help and inform one another.

About me; I'm 38 years old, now normal weight (lost 50 pounds), eat healthy eat plenty of potassium, magnesium and take supplements, no afib yet, some pacs (around 5-20 a day), which worries me. My dad got afib at 71 and then a stroke. He was obese, heavy drinker and lived a sedentary lifestyle.

I did notice however that bloating can cause me to have more pacs so when I started using HCL and eating smaller meals things improved. Any of you experienced this or is it all in my head?

My questions:

Needed some clarifications about pacs leading to afib. I do understand that im genetically predisposed but I wanted to know how some of you were first diagnosed with afib. I have seen some research, which states more than 30 pacs per hour leads to afib, another study said around 100 pacs a day leads to afib. Others argue that something should be done before it develops into afib.

[www.onlinejacc.org]

Questions;

1. Did you have pacs before your first episode of afib and how many?

2. If you had pacs before afib did you treat them and how?

Can this thing be beat before it turns into afib? My thinking is if pacs ultimately lead to afib, then why not do something about them before afib occurs and remodeling happens? Wouldn't that be the ideal cure/treatment of afib? Would you recommend I schedule an EP study?

I appreciate your help,

Thank you,

John



Edited 3 time(s). Last edit at 01/11/2019 04:49PM by johnnyS.
Re: Pacs lead to afib
January 06, 2019 11:53PM
Welcome here !
I don't remember having felt any ectopic before my first afib episode. This don't mean I hadn't some, but if I had, they never bothered me.
Having a few ectopics is perfectly normal, harmless and does not lead to afib. If things went like that, nearly everyone on earth would have afib one day.
The more you are tuned to your HR, the more you increase your stress, the more you have ectopics and feel them.
If we were better worrying about illnesses before their very first symptoms, we would run see doctors and pharmacists anytime anyday.
Ectopics are harmless for a healthy heart, even if you have ten thousand PACs a day, and this don't mean you'll have afib.
Keep a healthy heart : good food, exercise, no stress.
Enjoy life.
Don't worry. Be healthy.
Re: Pacs lead to afib
January 07, 2019 01:54AM
“Ectopics are harmless for a healthy heart, even if you have ten thousand PACs a day, and this don't mean you'll have afib.”

Are you referring to pacs or pvcs? I am aware that pvcs are harmless and you can have thousands, but I was under the impression that pacs are dangerous in higher number over time since the atria can trigger Afib. Is that not so?
Joe
Re: Pacs lead to afib
January 07, 2019 04:40AM
Best to see an EP if things get worse in spite of life style/diet changes.

Thinking back, i probably did have ectopic or something like that for quite some time prior to afib, but only occasionally.
The EP i saw told me that he does not worry if someone has up to 5% ectopics/24 hours.

BTW, how can you tell PACs and PVCs apart? Have you had a 24hr monitor?

Maybe i'm dreaming, but i feel when i have fresh vegetable juice a few times a week i feel my heart is 'quieter'. As i said, i have no recorded proof.
Re: Pacs lead to afib
January 07, 2019 06:31AM
Quote
johnnyS
Are you referring to pacs or pvcs? I am aware that pvcs are harmless and you can have thousands, but I was under the impression that pacs are dangerous in higher number over time since the atria can trigger Afib. Is that not so?

I have both. Ectopics are usually harmless if there's no other cardiovascular problem.
Some time ago, when I was monitored with thousands of ectopics, atrial as well as ventricular, bi and trigemini form, clusters... neither the cardiologist nor the EP worried about them. They reckon they were likely discomfortable (to say the least), but harmless.
Re: Pacs lead to afib
January 07, 2019 06:49AM
Quote
Joe
The EP i saw told me that he does not worry if someone has up to 5% ectopics/24 hours.

BTW, how can you tell PACs and PVCs apart? Have you had a 24hr monitor?
.

They would worry for 20%, maybe 15%.
But they know 5% may be hard to bear when one is very symptomatic. After all, only 1% still represents more than 1000 ectopics a day... Go figure.

Telling PACs and PVCs apart is relatively easy once you've learnt how they feel. They feel different.
PVCs in bi and trigemini form are unmistakable, they're awful.
PACs are usually "lighter".
Re: Pacs lead to afib
January 07, 2019 07:35AM
" did notice however that bloating can cause me to have more pacs so when I started using HCL and eating smaller meats things improved. Any of you experienced this or is it all in my head? "

Well if it's in your head it's also in my head. Mine can definitely be triggered by bloating, eating too much etc. Took me a while to figure that out but since I did and now eat less my pacs etc have almost disappeared. My two biggest triggers were not drinking enough water, especially on days I exercised ( even though I never thought I was thirsty), and digestive issues.


"BTW, how can you tell PACs and PVCs apart? Have you had a 24hr monitor? "

They feel different. To me PVCs feel like your missing a beat and the next one comes with a bang. Pacs feel more like your heart is just out of rythm. I learned the difference by getting a kardia and watching them. And pacs do seem to precede any AFib events for me.
Re: Pacs lead to afib
January 07, 2019 10:39AM
Hi everyone, Markus from Italy here!
I am lurking since a long time in this forum. Thank you all for the knowledge of you guys. It really makes a difference in battling the drumming gorilla in our chests!

It highly depends where in the heart the PACs have their origin as far as my understandig goes. PACs from the pulmonary veins are your enemy. They usually lead into afib.
I've got PACs since my childhood. With 27 I had my first afib or flutter episode. Can't remember. Fast forward four years and 5 more episodes aswell as a trip to the ER later, I decided to do the ablation. That was in March 2018, so 9 months ago. Besides some short bursts my heart is now quieter then ever. Prior the ablation I went to sleep and my heart went into PAC-mode daily. I am talking about hours of PACs every third to tenth beat. Now, there is just sinus-rhythm when I go to sleep.

Now keep in mind, that PACs can come from every region in the left and right atria and according to some studys less then 50 PACs per day are absolutely normal, so you should be fine. Just keep weight down and your health level up!
And don't worry too much about your heart. Enjoy life instead smiling smiley
Re: Pacs lead to afib
January 07, 2019 12:43PM
Thank you Pompon, so you had many pacs and pacs before afib eventually began. I am asking because if you were to minimize them via supplements what difference would it make or are we all just destined to afib given genetics? I feel like having them daily is a constant reminder of things to come.

Quote
Pompon

Are you referring to pacs or pvcs? I am aware that pvcs are harmless and you can have thousands, but I was under the impression that pacs are dangerous in higher number over time since the atria can trigger Afib. Is that not so?

I have both. Ectopics are usually harmless if there's no other cardiovascular problem.
Some time ago, when I was monitored with thousands of ectopics, atrial as well as ventricular, bi and trigemini form, clusters... neither the cardiologist nor the EP worried about them. They reckon they were likely discomfortable (to say the least), but harmless.



Edited 1 time(s). Last edit at 01/07/2019 12:45PM by johnnyS.
Re: Pacs lead to afib
January 07, 2019 12:52PM
Quote
Joe
Best to see an EP if things get worse in spite of life style/diet changes.

Thinking back, i probably did have ectopic or something like that for quite some time prior to afib, but only occasionally.
The EP i saw told me that he does not worry if someone has up to 5% ectopics/24 hours.

BTW, how can you tell PACs and PVCs apart? Have you had a 24hr monitor?

Maybe i'm dreaming, but i feel when i have fresh vegetable juice a few times a week i feel my heart is 'quieter'. As i said, i have no recorded proof.

Most EPs have no clue about the pacs/afib connection other that the stating "it's benign." That's why I'm looking into research data out there and it pretty much confirms my suspicion of how afib begins.

[www.drjohnm.org]

[www.onlinejacc.org]



Not 100% sure but pacs feel like a subtle skipped beat followed by a thud, while pacs are stronger and feel like a sudden kick to your chest.



Edited 1 time(s). Last edit at 01/07/2019 12:53PM by johnnyS.
Re: Pacs lead to afib
January 07, 2019 01:16PM
Quote
johnnyS
Thank you Pompon, so you had many pacs and pacs before afib eventually began. I am asking because if you were to minimize them via supplements what difference would it make or are we all just destined to afib given genetics? I feel like having them daily is a constant reminder of things to come.
.

No, not at all. I never said that.
Here's what I wrote here above : "I don't remember having felt any ectopic before my first afib episode. This don't mean I hadn't some, but if I had, they never bothered me. "

For me, afib came out of the blue. I never had (or felt) ectopics before.
Even after my first afib episode, I still never had ectopics. I was in NSR (most of the time) or in afib (15-20h ; 1 or 2 times a month). It's likely I had no ectopics because a single PAC was probably enough to trigger afib.

I only began having PACs and PVCs after my first ablation (PVI). It's quite common having ectopics after an ablation. It's during the two months following my PVI that I had so many PACs and PVCs. Things gradually improved week after week, but premature contractions never disappeared.
Re: Pacs lead to afib
January 07, 2019 01:40PM
Quote
Pompon

Thank you Pompon, so you had many pacs and pacs before afib eventually began. I am asking because if you were to minimize them via supplements what difference would it make or are we all just destined to afib given genetics? I feel like having them daily is a constant reminder of things to come.
.

No, not at all. I never said that.
Here's what I wrote here above : "I don't remember having felt any ectopic before my first afib episode. This don't mean I hadn't some, but if I had, they never bothered me. "

For me, afib came out of the blue. I never had (or felt) ectopics before.
Even after my first afib episode, I still never had ectopics. I was in NSR (most of the time) or in afib (15-20h ; 1 or 2 times a month). It's likely I had no ectopics because a single PAC was probably enough to trigger afib.

I only began having PACs and PVCs after my first ablation (PVI). It's quite common having ectopics after an ablation. It's during the two months following my PVI that I had so many PACs and PVCs. Things gradually improved week after week, but premature contractions never disappeared.

Oh I see, I was quoting your second post, I do appreciate your clarification, thank you.
Re: Pacs lead to afib
January 07, 2019 03:58PM
Quote
johnnyS

Most EPs have no clue about the pacs/afib connection other that the stating "it's benign." That's why I'm looking into research data out there and it pretty much confirms my suspicion of how afib begins.

I wouldn't say that. Any competent EP certainly knows that PACs precede AF. They will tell you that PACs are benign, because in the EP world if the PACs aren't leading to AF then there isn't really anything they're going to do about it. At most you could be prescribed an anti-arrhythmic but even that's overkill in most cases. They can't ablate PACs, it's just not an option.

As for me, I first noticed PACs when I was about 25 years old. At the time I wore a monitor and was told they were PACs and to ignore them, so I did. I went into full-blown AF at age 41. So there's some relation but it took years to get there. I wouldn't assume that just because you experience PACs that AF is right around the corner. You should be vigilant in risk factor management, such as diet, exercise and electrolyte supplementation.

And PACs are not more harmful than PVCs. If anything, the opposite may be true. Lots of PVCs in bigeminy or trigemini could be a precursor to v-tach which is life threatening. AF is not.
Re: Pacs lead to afib
January 07, 2019 04:41PM
Quote
wolfpack


Most EPs have no clue about the pacs/afib connection other that the stating "it's benign." That's why I'm looking into research data out there and it pretty much confirms my suspicion of how afib begins.


I wouldn't say that. Any competent EP certainly knows that PACs precede AF. They will tell you that PACs are benign, because in the EP world if the PACs aren't leading to AF then there isn't really anything they're going to do about it. At most you could be prescribed an anti-arrhythmic but even that's overkill in most cases. They can't ablate PACs, it's just not an option.

As for me, I first noticed PACs when I was about 25 years old. At the time I wore a monitor and was told they were PACs and to ignore them, so I did. I went into full-blown AF at age 41. So there's some relation but it took years to get there. I wouldn't assume that just because you experience PACs that AF is right around the corner. You should be vigilant in risk factor management, such as diet, exercise and electrolyte supplementation.

And PACs are not more harmful than PVCs. If anything, the opposite may be true. Lots of PVCs in bigeminy or trigemini could be a precursor to v-tach which is life threatening. AF is not.


Do you know how many Pacs were you having daily on average, prior to your first Afib episode?
Joe
Re: Pacs lead to afib
January 07, 2019 06:19PM
Thanks Pompon, Brian, Johnny for the PAC/PVC feeling the difference.
Re: Pacs lead to afib
January 07, 2019 07:19PM
In 2004, I was looking into creating a hardware/software (pattern recognition) setup that would predict afib. My plan was to have enough lead time to take an adrenergic agonist like Sildenafil (Viagra) or Tadalafil (Cialis) to ward off my vagally triggered afib. I studied many ECG's (my own and in the data) to work on this problem (I was slightly movtivated to solve the problem and put afib in remission). I convinced my GP to give me Cialis to play with this, but never got to the point of being able to being able to take the med.

My conclusion - most afib is preceded by one or more PAC's. However there are many PAC's that are not followed by afib. Hence people can have plenty of PAC's without afib.

Fortunately I came up with my low tech approach as I never solved the afib prediction problem (and I quit working on it when the other approach worked).

George



Edited 2 time(s). Last edit at 01/07/2019 07:22PM by GeorgeN.
Re: Pacs lead to afib
January 07, 2019 09:36PM
Quote
johnnyS

Do you know how many Pacs were you having daily on average, prior to your first Afib episode?

No, but it couldn’t have been very many. 10 or so. Tough to count them when you’re asleep, so that number could be bigger. Point is, I was very sensitive to them (and still am). I always know when one occurs while I’m awake.
Re: Pacs lead to afib
January 08, 2019 03:23AM
I'd say that how likely PACs are to lead to AF depends on many factors not least fibrosis.

I've had lots of PACs since my mid-20s (now 57 yrs old) and have had PAF for the last 20 years and am still paroxysmal rather than persistent or permanent. And I mean a lot of PACs like hundreds or even a thousand or two a day a lot of the time. Over the last 20 years I'd say a good day is less than 50 PACs.

Interestingly, I can have a riot of PACs for minutes but no AF, but conversely on occasion I've noticed that 1 PAC would precipitate AF - although the latter only set against a backdrop of (for me) MSG and alcohol for example.

When I had an ablation (my first) at Bordeaux last August, I asked Prof Jais what I 'looked like' as regards fibrosis and he said he no noticed no low voltage areas (fibrosis) at all during mapping. So whilst my genetics predispose me to PACs and accordingly some AF they don't, thankfully, predispose me to fibrosis it would seem.

Lots of folks can get hardly any PACs but still get AF. Then there's those like me who can get lots of PACs but relatively little AF. Yes there'll be many other factors in play but I'd say for whatever that's worth that fibrosis is the most critical.

As for me 4.5 months post-ablation, I still get a lot of PACs and the odd few-second run of ectopics but thankfully no AF. That said, I am fully prepared to have a further touch-uo ablation if required. Shannon told me to expect to require 2 ablations and be mighty pleased to only need one rather than simply to expect that one would be enough, and I think those are wise words. I still don't feel like my heart has fully settled post-ablation: I personally think that that takes more like 6 months than 3. Your heart has, after all, effectively had 20+ minutes burning with a 40W soldering iron....just because you don't see or feel it doesn't mean it hasn't happened!

Mike
Re: Pacs lead to afib
January 08, 2019 08:12AM
WolfPack :

"And PACs are not more harmful than PVCs. If anything, the opposite may be true. Lots of PVCs in bigeminy or trigemini could be a precursor to v-tach which is life threatening. AF is not."
_________________________________________________________________________________________________

Yes I agree, PVC's are much more of a potential danger, as if it progresses to V-Tach, then that is terminal unless you are are in a Hospital, or somewhere that a defibrillator is available.



Edited 1 time(s). Last edit at 01/08/2019 08:25AM by The Anti-Fib.
Re: Pacs lead to afib
January 08, 2019 08:24AM
Quote johnnyS:

"Most EPs have no clue about the pacs/afib connection other that the stating "it's benign." That's why I'm looking into research data out there and it pretty much confirms my suspicion of how afib begins. "

Quote Wolfpack:

"I wouldn't say that. Any competent EP certainly knows that PACs precede AF. They will tell you that PACs are benign, because in the EP world if the PACs aren't leading to AF then there isn't really anything they're going to do about it. At most you could be prescribed an anti-arrhythmic but even that's overkill in most cases. They can't ablate PACs, it's just not an option."
_______________________________________________________________________________________________

I agree here also, EP's know that PAC's are one of the main things that have to happen simultaneously in order to trigger AFIB. They are just giving you a simplistic answer. If they were talking to one of their colleagues, the answer would be much more sophisticated. If all of the conditions are right then a single PAC can trigger AFIB, likewise if the conditions are not right, then 1000's can be relatively benign and not trigger an episode.



Edited 1 time(s). Last edit at 01/08/2019 08:25AM by The Anti-Fib.
Re: Pacs lead to afib
January 08, 2019 09:49AM
Quote
The Anti-Fib
WolfPack :

"And PACs are not more harmful than PVCs. If anything, the opposite may be true. Lots of PVCs in bigeminy or trigemini could be a precursor to v-tach which is life threatening. AF is not."
_________________________________________________________________________________________________

Yes I agree, PVC's are much more of a potential danger, as if it progresses to V-Tach, then that is terminal unless you are are in a Hospital, or somewhere that a defibrillator is available.

Just to reassure any readers here who've had short documented episodes of NSVT, V-Tach if nonsustained (defined as less than 30 seconds duration) is usually regarded as not too much of a problem in a structurally normal heart. See:[www.cardiacep.theclinics.com]
"Nonsustained ventricular tachycardia (NSVT) may trigger concern, particularly in patients with known congestive heart failure, structural heart disease, or prolonged QT interval. When NSVT occurs in patients with normal hearts, it usually has a benign prognosis."
Re: Pacs lead to afib
January 08, 2019 11:03AM
Quote
The Anti-Fib
Yes I agree, PVC's are much more of a potential danger, as if it progresses to V-Tach, then that is terminal unless you are are in a Hospital, or somewhere that a defibrillator is available.

V-tach is potentially fatal, but only potentially. People commonly experience v-tach without dying, even sustained v-tach. But yes, it's definitely an ominous rhythm that demands immediate attention. Not sure how we got from PVCs to v-tach, though. I'm pretty sure JohnnyS is in no danger of v-tach.
Re: Pacs lead to afib
January 08, 2019 01:34PM
Quote
The Anti-Fib
If all of the conditions are right then a single PAC can trigger AFIB, likewise if the conditions are not right, then 1000's can be relatively benign and not trigger an episode.

This is precisely the way I understand vagal afib.
The only trigger for vagal afib is vagal tone, and vagal tone is mostly induced by resting positions.
As soon as I lay down or sit down and relax, I'm sure to feel ectopics. Sometimes, afib follows quickly. It's when conditions are right. When I'm receptive to afib. It's when I'm weak, very tired, sick... It's when I've a hard time digesting something, when I've had a big or late meal, when I've drunk some alcohol... or if I'm more than one week afib free.
But if I don't rest, nothing happens. The problem is that when I'm weak, I need to rest. I need to sit down and relax. I need my bed.
When I'm fine, I'm done with just some ectopics which come in the first minutes I lay down in bed.
Re: Pacs lead to afib
January 08, 2019 02:10PM
Quote
The Anti-Fib
Quote johnnyS:

"Most EPs have no clue about the pacs/afib connection other that the stating "it's benign." That's why I'm looking into research data out there and it pretty much confirms my suspicion of how afib begins. "

Quote Wolfpack:

"I wouldn't say that. Any competent EP certainly knows that PACs precede AF. They will tell you that PACs are benign, because in the EP world if the PACs aren't leading to AF then there isn't really anything they're going to do about it. At most you could be prescribed an anti-arrhythmic but even that's overkill in most cases. They can't ablate PACs, it's just not an option."
_______________________________________________________________________________________________

I agree here also, EP's know that PAC's are one of the main things that have to happen simultaneously in order to trigger AFIB. They are just giving you a simplistic answer. If they were talking to one of their colleagues, the answer would be much more sophisticated. If all of the conditions are right then a single PAC can trigger AFIB, likewise if the conditions are not right, then 1000's can be relatively benign and not trigger an episode.


Just wondering, do you know anyone having thousands of pacs and no Afib? Seems to me that eventually high number of pacs find new areas and create a rotor action which then spreads and Afib starts.
Re: Pacs lead to afib
January 08, 2019 02:17PM
Quote
mwcf
I'd say that how likely PACs are to lead to AF depends on many factors not least fibrosis.

I've had lots of PACs since my mid-20s (now 57 yrs old) and have had PAF for the last 20 years and am still paroxysmal rather than persistent or permanent. And I mean a lot of PACs like hundreds or even a thousand or two a day a lot of the time. Over the last 20 years I'd say a good day is less than 50 PACs.

Interestingly, I can have a riot of PACs for minutes but no AF, but conversely on occasion I've noticed that 1 PAC would precipitate AF - although the latter only set against a backdrop of (for me) MSG and alcohol for example.

When I had an ablation (my first) at Bordeaux last August, I asked Prof Jais what I 'looked like' as regards fibrosis and he said he no noticed no low voltage areas (fibrosis) at all during mapping. So whilst my genetics predispose me to PACs and accordingly some AF they don't, thankfully, predispose me to fibrosis it would seem.

Lots of folks can get hardly any PACs but still get AF. Then there's those like me who can get lots of PACs but relatively little AF. Yes there'll be many other factors in play but I'd say for whatever that's worth that fibrosis is the most critical.

As for me 4.5 months post-ablation, I still get a lot of PACs and the odd few-second run of ectopics but thankfully no AF. That said, I am fully prepared to have a further touch-uo ablation if required. Shannon told me to expect to require 2 ablations and be mighty pleased to only need one rather than simply to expect that one would be enough, and I think those are wise words. I still don't feel like my heart has fully settled post-ablation: I personally think that that takes more like 6 months than 3. Your heart has, after all, effectively had 20+ minutes burning with a 40W soldering iron....just because you don't see or feel it doesn't mean it hasn't happened!

Mike


Mike,

That’s exactly what studies are concluding; no fibrosis no Afib. Now, wouldn’t the obvious next step be to screen for fibrosis and determine the likelyhood of Afib? I mean isn’t it easier to ultimately ablate individual sources of PACs then Afib with remodeling?
Re: Pacs lead to afib
January 08, 2019 02:35PM
Quote
Carey
Not sure how we got from PVCs to v-tach, though. I'm pretty sure JohnnyS is in no danger of v-tach.

My fault. I posted upthread about PVCs being a little bit more dangerous than PACs in my opinion, because they could be a sign of tendency towards v-tach.

If you have 4 or more PVCs in a row (and you'll need a monitor to catch that, you can't judge by feel), that's where the concern starts to rise for v-tach risk. The OP is complaining of PACs as I understand it. So, no, v-tach is not in his future.
Re: Pacs lead to afib
January 08, 2019 02:46PM
Quote
johnnyS
That’s exactly what studies are concluding; no fibrosis no Afib. Now, wouldn’t the obvious next step be to screen for fibrosis and determine the likelyhood of Afib? I mean isn’t it easier to ultimately ablate individual sources of PACs then Afib with remodeling?

AF can certainly occur in a heart with no fibrosis. It did in mine. Fibrosis is a risk factor, not an outright cause.

There isn't an easy way to screen for fibrosis. Delayed enhancement MRI can estimate it, but that is a costly procedure and often times done as an exclusion protocol for ablations by some centers or practitioners who don't believe anything outside of PVI (pulmonary vein isolation) ablation works or should be attempted.
Re: Pacs lead to afib
January 08, 2019 02:53PM
Quote
The Anti-Fib
Quote johnnyS:

"Most EPs have no clue about the pacs/afib connection other that the stating "it's benign." That's why I'm looking into research data out there and it pretty much confirms my suspicion of how afib begins. "

Quote Wolfpack:

"I wouldn't say that. Any competent EP certainly knows that PACs precede AF. They will tell you that PACs are benign, because in the EP world if the PACs aren't leading to AF then there isn't really anything they're going to do about it. At most you could be prescribed an anti-arrhythmic but even that's overkill in most cases. They can't ablate PACs, it's just not an option."
_______________________________________________________________________________________________

I agree here also, EP's know that PAC's are one of the main things that have to happen simultaneously in order to trigger AFIB. They are just giving you a simplistic answer. If they were talking to one of their colleagues, the answer would be much more sophisticated. If all of the conditions are right then a single PAC can trigger AFIB, likewise if the conditions are not right, then 1000's can be relatively benign and not trigger an episode.



Actually I must disagree here, competent EPs will not use the word benign and will explain both sides of the argument, PACs with or without Afib are trigger areas and eventually if you have an ablation top EPs will ablate them as well, however competent EPs are a rare find and they aren’t a majority of EPs or even close to a significant number. Competent EPs like Natale, Biasi, Mandrola, Horton, Mourouche and few others have great stats of successful ablations and continually evolve in their research and methods, while the rest of your local and poorly trained EPs are pretty much everywhere botching ablations and never discuss their stats. For example, a local EP told me PACs are meaningless regardless of the number, told me to consider Xanax, while someone from Bordeaux sent me research studies explaining exactly the opposite of benign. But maybe yours and mine definition of competent is different. Pick up the phone and see how many local EPs will share their stats, I called around Idaho and Utah and found only 3 EPs out of 50 who were bragging about their numbers which by the way was only in the double digits.
Re: Pacs lead to afib
January 08, 2019 03:13PM
Quote
wolfpack

That’s exactly what studies are concluding; no fibrosis no Afib. Now, wouldn’t the obvious next step be to screen for fibrosis and determine the likelyhood of Afib? I mean isn’t it easier to ultimately ablate individual sources of PACs then Afib with remodeling?

AF can certainly occur in a heart with no fibrosis. It did in mine. Fibrosis is a risk factor, not an outright cause.

There isn't an easy way to screen for fibrosis. Delayed enhancement MRI can estimate it, but that is a costly procedure and often times done as an exclusion protocol for ablations by some centers or practitioners who don't believe anything outside of PVI (pulmonary vein isolation) ablation works or should be attempted.


That’s interesting, how can Afib be sustained without fibrosis? I understand anyone can have Afib if they binge drink or get low on potassium but that’s usually easy fix and Afib doesn’t occur again. Maybe I’m missing something.
Re: Pacs lead to afib
January 08, 2019 04:09PM
Fibrosis alters the electrical substrate of the atria. Think of perfectly healthy atria as a wire - electricity can flow uniformly through a wire. Now dip the wire in acid so it corrodes and gets lots of pitted and oxidized areas. Now electricity can't flow uniformly through the wire. It has to find a way around the bad spots. That's what fibrotic tissue in the atria is doing - stopping the uniform flow of charge across the atrium that allows it to contract in an organized fashion. The charge that makes your atria contract originates on the right side in the sino-atrial (SA) node. If it experiences extra delay because of fibrosis on its way to the left atrium then that increases the chance that another autonomous region (all heart tissue is autonomous) can discharge itself first because the "domino effect" of the SA node didn't make it there in time. Now you have disorganized contraction. If enough of that occurs, you can get sustained AF. So fibrosis raises the risk of this happening. Fibrotic tissue in itself isn't arrhythmogenic - it's dead.

To answer your question about AF being sustained without fibrosis - easy. You just need the refractory period (time when heart cells can't contract) to get short enough that areas other than the SA node will start to "fire". Yes, low potassium will do that. Also low magnesium, as potassium needs magnesium in order to get across cell membranes. Excess calcium will do the same thing by allowing more sodium to get into cells, displacing potassium (potassium + sodium = constant in a cell, so if one comes in the other goes out and vice versa).

So it's the electrolytes that are at the heart of all this (pun intended). smiling smiley
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