Persistent Increased PACs after ablation?

For those who have had an ablation, did you end up with more PACs after it than you had before the ablation? I understand that there will likely be more during the blanking period while your heart is healing. I’m hoping to hear what you experienced long term, after the blanking period. I’ve heard a few people say they feel like they traded their afib for PACs and I’m wondering how common this is. And what kind of numbers per day? 100s? 1000s? Is there any way to predict? Thanks—any experience you can share is much appreciated!

From what I've seen it's all over the place and there's no way to predict how it will go. Some people experience few, if any, while others experience numerous. It's one of the most discussed subjects here so plenty of history to search through but I wouldn't expect to find any revelations. They often respond to the same things afib does, such as magnesium and high potassium diets.

Thanks, Carey. Appreciate the response. That was the impression I was getting, but I thought I’d ask. It makes for a hard ablation decision when you have relatively few arrythmias to begin with but want to get ahead of the likely progression.

Posted too soon by accident… I was wondering if there is any correlation with the timing of the ablation, like early ablations tend to have fewer post-ablation PACs? I’ve read (and can’t verify accuracy) that AF can “mask” existing PACs that then turn up after PVI—like they find that there were areas outside the pulmonary veins “firing” and causing PACs all along. Does that make any sense medically?

Yes, it does.

I am one that had a large amount of PACs/PVCs after my ablation and had to continue taking medications for a while. I am currently 2 years past my ablation and the ectopic beats have finally reduced to just a few occasionally. While I haven't had AFIB since January 2024, and I am starting to feel much more like myself. Truthfully, I have been more the exception to the rule than the norm, I don't think it is something that happens for more than a few months for most. If I had to do it all over again, I would have my ablation done much sooner than I did, but I would never think about not having it done.

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Nancy9
I’ve read (and can’t verify accuracy) that AF can “mask” existing PACs that then turn up after PVI—like they find that there were areas outside the pulmonary veins “firing” and causing PACs all along.

I would say that persistant afib can “mask” existing PACs. However, for someone with paroxysmal afib, When not in an episode, PACs would likely show up if the propensity toward them existed.

When I first had afib, over 20 years ago, one track I created towards a remission solution, was to build a setup that would capture and examine beat to beat time duration differences (RR time) and predict afib sufficiently in advance to give me enough time to take a med that could ward off the episode. The prediction piece was very difficult and I never succeeded at it. I studied data from an MIT RR time database created from Holter data of people with paroxysmal afib. One thing I recall from this study was that nearly every afib episode was preceeded by one or more PACs. However not all PACs led to afib (in fact, far from it).

A few years ago, one of our members asked me to coach him on acquiring and using the system I use for long duration (10 min to 8+ hours) monitoring for PAC, PVC and afib frequency. Pre ablation, he was having some PACs plus the afib. After ablation #1 (cryo, if my memory is accurate), he was in NSR but had many PACs (I pulled up one recording and counted 51 in 10 minutes). He got ablation #2 and everything was quiet till a month or so ago. Now seeing 20 PVCs/hour. This is maybe 18 months after the second ablation.

A second track I created 20+ years ago was to modify my exercise training to exclude long duration, high intensity activity. Also add magnesium, potassium & taurine supplements. Lastly use an on-demand dose of flecainide to convert if I did get afib. When I was originally doing this I hypothesized I could target minimizing PAC counts per hour as a way to optimize supplement dosing. I did this and have had a long term range of 6-9 PAC's/hour during sleep as the lowest I could get to. This track was pretty successful and I still follow the basic outline today. I recently found that removing what I thought was an unrelated molecule supplement trippled my overnight PAC rate and adding it back in lowered it back to the long term baseline.



Edited 1 time(s). Last edit at 08/11/2025 04:48PM by GeorgeN.

Thank you! It’s really encouraging to know that your PACs did settle down eventually. I am in this place where I’m obsessing about everything that could possibly go wrong. 😑. [Meant to reply to ksliving. On my phone and I’m awful at texting. 🤦‍♀️]



Edited 1 time(s). Last edit at 08/11/2025 06:29PM by Nancy9.

George, I’m so impressed with your systems! I use a Wellue 24-hour monitor, which gives me a count of PACs and of course other arrythmias. With the exception of a handful of instances when I’ve had runs of them (lasting 5 minutes to an hour or so) I tend to have few PACs and was fearing that the ablation could cause me to have more than I have now.

I’m using the “reply” button—looks like I should be using “quote”? Sorry for the technical ineptitude—it’s been one of those days….

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Nancy9
Thank you! It’s really encouraging to know that your PACs did settle down eventually. I am in this place where I’m obsessing about everything that could possibly go wrong. 😑.

I understand, I have been there. Like I said I am the exception not the norm. My AFIB was persistent and just wouldn't let up with any of the medication I tried. I had ectopic beats with it and only about 50% chance to fix everything at once. So I feel fortunate that it turned out as well as it has. Maybe not perfect, but I am starting to feel like my old self. Just make sure your doctors are first class and do your own diligence to make your life better.

I waited too long for my ablation--about 9 years after diagnosis--because my EP didn't believe in them and convinced me to just stick with medications. In the end I self-referred to Natale, my ablation was complex, but I have not had a problem with PACs afterwards.

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Daisy
I waited too long for my ablation--about 9 years after diagnosis--because my EP didn't believe in them and convinced me to just stick with medications. In the end I self-referred to Natale, my ablation was complex, but I have not had a problem with PACs afterwards.

Thank you, Daisy! That’s great to hear! I appreciate the reassurances from everyone. ☺️

Hi Nancy,

I'm at the end of my blanking period after my first ablation (PVI) and am just starting to have what I consider a normal amount of energy, which is so wonderful. I haven't really noticed an increase in PACs, although I do have some. The main difference I'm having to adjust to is the brief rapid pulse I get when I stand after sitting or lying down. I had been relatively fit and active, but my afib had really worsened in the last year. While I am so happy for the major improvement I've experienced, my recovery has taken nearly a full 3 months. I guess there's no way to predict outcomes, but I am very glad I had my ablation. I wish you the best!

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CindyS
Hi Nancy,

I'm at the end of my blanking period after my first ablation (PVI) and am just starting to have what I consider a normal amount of energy, which is so wonderful. I haven't really noticed an increase in PACs, although I do have some. The main difference I'm having to adjust to is the brief rapid pulse I get when I stand after sitting or lying down. I had been relatively fit and active, but my afib had really worsened in the last year. While I am so happy for the major improvement I've experienced, my recovery has taken nearly a full 3 months. I guess there's no way to predict outcomes, but I am very glad I had my ablation. I wish you the best!

Thanks so much for the kind words. Funny, changes in posture or position that seem like they compress the heart area (like slouching) are what often sets off brief runs of SVT for me now. Glad you’ve reached the end of the blanking period and are starting to feel more energy! Here’s hoping that that trend continues!

For me, slouching and squatting and bending over still triggers arrhythmias. I think each of us are individually different.

That said, i developed a high 33% PVC burden after two of my ablations-about 6 weeks afterwards. I was instructed by my EP to try an experiment, which stopped my PVCs cold turkey. He suggested Tenormin. It’s difficult to get so maybe the generic Atenolol would work. Maybe it’s something to discuss with your EP.

I was highly frightened a year ago (war zone bombing and my bomb shelter door wouldn’t close) so I developed a 42-43% burden. When calmly asleep I was in nsr. If during a sirens I took a Valium I could remain in nsr but i can’t be drugged all day so my PVCs returned. I tried Tenormin brand from Germany and remained in nsr for 6 weeks. For me stress will trigger PVCs.

I now added extreme pain can increase my PVC burden. I was bedridden after 3 leg surgeries for a melanoma and my body’s enzymes ate through all the 12cm stitches to my bone causing 7 weeks of extreme pain and required me in bed with my leg above my heart. My PVCs thrived on me laying on my back. I’m still bandaged up and it’s painful unless my leg is up. I had a holter monitor before my surgeries and it was around 23% burden. After my surgeries I repeated the monitor and it jumped to 32% so perhaps pain and lack of sleep increased my PVCs. I’m back home now so I’m curious if my burden will further increase. However I can sleep through the night so I’m testing if getting enough sleep affects my PVCs.

So perhaps change your sleep pattern and position and see if you can reduce your PACs. I found sleeping on my right side better and not on my back.

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susan.d
For me, slouching and squatting and bending over still triggers arrhythmias. I think each of us are individually different.....

Susan, so sorry for all the pain and difficulty. I hope that you are safe, and I'm wishing you better times ahead.