When are regular ectopics/palpitations considered to be intrusive?

Hi all,

I have now finally got to see a cardiologist after about 6 months of increased 'activitiy', (albeit, not yet afib).

I am now 2 1/2 years post ablation and I had about 6 months of bliss post ablation but since become ill about 18 months ago my heart has become more irritated.

For example, I took about 2 hours to get to sleep last night due to immediate ectopics and faster heart rate when I lay down. Woke up about 7:15 this morning and they kicked off again. Tried to go back asleep and ended up just dozing for a couple of hours.

The cardiologist listened to me yesterday and he was a nice chap but he said they'd fit a 7-day ecg (appointment pending) and then likely not do anything unless they become intrusive.

I'm sure many will disagree but regular ectopics are already massively intrusive. Every time I get one these days I feel faint and just.. off. Recently though the 'pauses' between beats when I experience ectopics are longer. About an hour ago there was a 'pause' of about 2-3 seconds.

Those ones are terrifying as it feels like your heart's stopped.

Anyway, have any of you guys ever been told yours are 'intrusive', and what level do they have to get to to be considered instrusive?

PS. as a side-note, I know what pacemakers are used for, but just out of interest, are they of any use to regulating heart-rate in terms of irregular heartbeat? Just something I was chatting about this afternoon.

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DavrosT
PS. as a side-note, I know what pacemakers are used for, but just out of interest, are they of any use to regulating heart-rate in terms of irregular heartbeat? Just something I was chatting about this afternoon.

Mostly a pacemaker will set a floor on heart rate, like 60 BPM. The pacer times the time since the last beat. If it exceeds a set level of milliseconds, it will send a signal for the heart to beat. Hence these will not take care of "fast" beats, i.e. PAC's or PVC's. There may be some new ones that act differently but don't recall the details.

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DavrosT
Anyway, have any of you guys ever been told yours are 'intrusive', and what level do they have to get to to be considered instrusive?

The standard cardiologists use to decide if PVCs warrant ablation is 20,000 per day, or about 13 per minute (every single minute of the day). To my knowledge, there isn't a comparable standard for PACs because PACs aren't easily found and ablated. I've never heard of an ablation being performed to deal solely with PACs. I went through a period in 2015 where I was experiencing bigeminal PACs. In other words, every other beat was a PAC. This would continue non-stop 24/7 for weeks at a time, meaning there were about 43,000 per day. My EP said attempting to ablate it would likely just make things worse. I finally got them under control with Tikosyn, and then Natale's ablation in 2017 ended them. But he didn't attempt to ablate PACs. He just ablated my sources of afib and flutter and the PACs were eliminated in the process.

A few years back they tried using pacemakers to override PACs to try and prevent them from initiating afib. The idea was when the pacemaker sensed a PAC it would pace the heart faster to try and become the dominant pacing source and "overrule" the ectopic source, but apparently that didn't work well.

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Carey
A few years back they tried using pacemakers to override PACs to try and prevent them from initiating afib. The idea was when the pacemaker sensed a PAC it would pace the heart faster to try and become the dominant pacing source and "overrule" the ectopic source, but apparently that didn't work well.

My Pacemaker has that algorithm and it seems to work well. I occasionally feel it kick in. It isn’t going to work all the time but it definitely helps Afib burden.

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Daisy
My Pacemaker has that algorithm and it seems to work well. I occasionally feel it kick in. It isn’t going to work all the time but it definitely helps Afib burden.

I remember you mentioning that and I think you're a lucky one. From what my EP said and what I've read, it wasn't successful enough to justify implanting in afib patients who otherwise didn't need one. But if you need a PM anyway, I can't see any reason not to try it. They can always turn off that programming if needed.

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GeorgeN

PS. as a side-note, I know what pacemakers are used for, but just out of interest, are they of any use to regulating heart-rate in terms of irregular heartbeat? Just something I was chatting about this afternoon.

Mostly a pacemaker will set a floor on heart rate, like 60 BPM. The pacer times the time since the last beat. If it exceeds a set level of milliseconds, it will send a signal for the heart to beat. Hence these will not take care of "fast" beats, i.e. PAC's or PVC's. There may be some new ones that act differently but don't recall the details.

Thanks, I knew I'd seen something about this some where. Wonder whether there's tech in the pipeline to affect PACs or PVCs. It seems a fairly obvious route to go. Would remove the need to ablations, drugs, etc. and the software could be changed if the situation worsens.

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Carey

Anyway, have any of you guys ever been told yours are 'intrusive', and what level do they have to get to to be considered instrusive?


The standard cardiologists use to decide if PVCs warrant ablation is 20,000 per day, or about 13 per minute (every single minute of the day). To my knowledge, there isn't a comparable standard for PACs because PACs aren't easily found and ablated. I've never heard of an ablation being performed to deal solely with PACs. I went through a period in 2015 where I was experiencing bigeminal PACs. In other words, every other beat was a PAC. This would continue non-stop 24/7 for weeks at a time, meaning there were about 43,000 per day. My EP said attempting to ablate it would likely just make things worse. I finally got them under control with Tikosyn, and then Natale's ablation in 2017 ended them. But he didn't attempt to ablate PACs. He just ablated my sources of afib and flutter and the PACs were eliminated in the process.

A few years back they tried using pacemakers to override PACs to try and prevent them from initiating afib. The idea was when the pacemaker sensed a PAC it would pace the heart faster to try and become the dominant pacing source and "overrule" the ectopic source, but apparently that didn't work well.

Wow, so I am probably well away from that standard def then.

I'm probably experiencing only in the hundreds. They're just very abrupt and very, very disruptive.

I often wonder whether QOL is considered in these judgements, i.e. they're instrusive for this patient because they're stressful and disrupting their every day life.

That's scary though, 43,000 per day. I'm not sure how you coped with that. Kudos to you for coming through it.

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Daisy

A few years back they tried using pacemakers to override PACs to try and prevent them from initiating afib. The idea was when the pacemaker sensed a PAC it would pace the heart faster to try and become the dominant pacing source and "overrule" the ectopic source, but apparently that didn't work well.
My Pacemaker has that algorithm and it seems to work well. I occasionally feel it kick in. It isn’t going to work all the time but it definitely helps Afib burden.

That's pretty impressive and good for you, I'd imagine!

If I was offered the option of a pacemaker to sort out this irritated heart I have, I think I'd take it right now, in all honesty.

I think my PVCs are almost constant now with some rare runs of nsr. I can’t sleep because of the thumping in my chest. I dislike benzodiazepines so I sleep 3-4 hours broken up by waking up over 4 times a night. Sometimes by 2am or 3am I give up and don’t bother sleeping. I took a sleeping pill the other night because I awoken at midnight by the thumping and after the benzodiazepine I slept 6 hours broken up many times but I was tired enough to go back to sleep. I was hoping medicated sleep would lower my PVCs. Not a chance. Now I’m busy in my garden lifting river rocks installing a dry creek hoping the manual labor would tire me out to sleep. Problem with PVCs and exercise/lifting 8-15 pound rocks is it wears me out and after a short time I have to rest. No quality of life. I ran out of Netflix movies waiting to get enough strength to resume my dry creek project.

I will get another zio patch soon. The last one was for 14 days and I started out the first week with occasional PVCs and by the 13th and 14th day I had over 27% PVCs. So the 14 day average was 17.3% pvc burden.

To answer your question of this topic, nobody is concerned YET. My local EP wants an echo the end of March to compare if my heart is wearing some —6 months of post ablation of PVCs while at Natale office I have the option of getting another zio patch now or wait 6 months post ablation. I’m still hoping the PVCs are from inflammation. My labs at my oncologist office came back and I have a peak in one test that measures inflammation.

I was supposed to had a gallbladder surgery because my polyps grew to 1cm but with my PVCs the surgeon refused saying the risk of my current health outweighs a cancer risk. Same with a colonoscopy I was supposed to have that was postponed.

I am about 2.5 years post my 4th ablation (1st with natale). have been on no drugs since. I just wore a monitor for 7 days which picked up one PVC and 110 PAC's and one tachycardia run of 145BPM that lasted 4 beats.

I have had a few of the short Tachycardia runs over the last few months, some lasting maybe 10 to 15 seconds. What that will evolve into is just a wait and see at this point but as of now nothing to do per St. Davids.

PAC's are increasing and I can feel them more. Natale crew says nothing to do at moment but will wear a monitor again in another 3 months. I can taks occassional Kardia strips which are 30 seconds and have none and in some I will throw 4 or 5. Just depends. My heartrate is not jumping up though as a reult of them. Interesting I used to get more PVC's and not getting any of those now.

On my last 7 day monitor in February it only recorded 110 PAC's in 7 days, if I were to extrapolate random Kardia taking right now I could be as high as a few thousand per day. Quite bothersome. Seems to ebb and flow right now though where I will have housrs I notice small amount and some more. So until actual 7 day monitor we won't know for sure.


Past week I have had a lot and there seems to be more of a vagal connection to posture and eating again which I have not had since my successful Natale Index ablation. Time will tell I guess at this point if this is my new normal and for how long or what it evolves to.



Edited 1 time(s). Last edit at 07/04/2020 06:01PM by Fibrillator.