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johnnyS
I guess for those with early PACs and no Afib are at the mercy of this thing and there’s nothing we can do to alter our genetic course other than lifestyle and supplementation.
John

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johnnyS
I was assuming that since they ablate PVCs, why couldn’t they ablate PACs?

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Carey

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.

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wolfpack
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.

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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.

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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.

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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?

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Carey
Not sure how we got from PVCs to v-tach, though. I'm pretty sure JohnnyS is in no danger of v-tach.

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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

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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.

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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.

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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.

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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.

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johnnyS

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

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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.

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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.

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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.

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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.
.

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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.