Ectopic Heart Beats

Hi All,

I am sure this has been answered a million times, however I cant find anything specific in the search. I had a DC Cardioversion in October last year (2020) and was deemed a success. I have been in sinus rhythm since. :-)

I do however get what I have been told are ectopic heart beats and I would get hundreds (every couple of minutes) in a day. I have been told that they are harmless and aren't doing me any damage. However I am skeptical, mainly because I don't know what they are or why they are happening. My GP and Cardiologist seem to have just brushed them off and I haven't had a chance to go back to ask more questions now I have had some time to think.

They seem to happen when I am at rest and not during exercise, I would say my perceived stress levels are low and I have a relatively good diet (plant heavy, low processed foods etc - apart from a chocolate or ice-cream blow out every now and then)

Does anyone have any really good, trusted resources that I can read (or watch/listen to) to get more information on what they are, why they are happening and possible treatments?

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Merckx
Does anyone have any really good, trusted resources that I can read (or watch/listen to) to get more information on what they are, why they are happening and possible treatments?

Ectopic beats are either premature atrial contractions (PACs) or premature ventricular contractions (PVCs), depending on where they originate.

A search of our site on PACs is here: [www.google.com]
A search of our site on PVC's is here: [www.google.com]

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They seem to happen when I am at rest and not during exercise,

There is a thing called the atrial effective refractory period (AERP) and there is a ventricular one, too. Here is a search [www.google.com]

and a search just of our site on AERP [www.google.com] There are some good articles and posts on this, as I recall.

Generally (and I'm doing this from memory, having looked at this ~15 years ago), there are pacing cells in the atria that fire and then everything else follows from this. The atrial cells will depolarize, the signal will travel to the atrioventricular (AV) node between the atria & the ventricles then go on to the ventricles where they all fire. There is a "backup" system, where if a beat hasn't happened in a certain period of time, the refractory period, then one of the cells will fire on its own and all the others will fire, like dominoes. The refractory period isn't static, and I believe can be a function of the autonomic nervous system status as well as electrolyte status. When you are at rest, your heart rate is lower (i.e. there is a longer time between beats), so it is more likely the time between beats is longer than the refractory time, therefore one will fire on its own and you get an "ectopic" beat. In the cardiology world, a few hundred a day would not be cause for concern, though you may not enjoy them. There are PVC ablations, but nobody would do one (assuming the ectopics are PVCs) for a few hundred a day.

You might address electrolytes. I'd start with slowly upping magnesium to bowel tolerance, then back off a bit. After that, you might try adding 2 tsp potassium citrate powder to a liter of water and drinking this over the day (a version of "timed release"). 2 tsp is about 4 g elemental potassium. If you take a bunch of potassium all at once, you'll just urinate it out. This suggestion assumes you have good kidneys. Healthy kidneys will excrete excess potassium and magnesium. Unhealthy ones won't and supplementation can be dangerous. That being said, I've supplemented with multi gram quantities of both mag & pot for many years, but am very healthy.

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GeorgeN
there are pacing cells in the atria that fire and then everything else follows from this.

Amplifying the above, the signal starts (or should start) in the SA or sinoatrial node. This animation shows a "normal" heartbeat [www.youtube.com]

This is a PAC animation [www.youtube.com]

To clarify my first post. During the refractory period, the atrial and ventricular cells won't fire on their own. Once this period is over, any cell can fire, leading to a premature or ectopic beat.

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Merckx
I do however get what I have been told are ectopic heart beats and I would get hundreds (every couple of minutes) in a day. I have been told that they are harmless and aren't doing me any damage. However I am skeptical, mainly because I don't know what they are or why they are happening. My GP and Cardiologist seem to have just brushed them off and I haven't had a chance to go back to ask more questions now I have had some time to think.

Your doctors are right. They really are harmless.

In general, doctors won't even treat PACs and PVCs until they're extremely frequent, like over 20,000 per day (that's 14 per minute, every minute of the day). If they're below that level but really bothering you, they might prescribe a beta blocker like metoprolol, which may or may not help, but that's about it.

I have been in normal rhythm since ablations in January 2003, ie over 18 years. I get a lot of ectopics every day, almost 8000 on a 24 hour Holter several years ago, but magnesium, potassium, taurine and d-ribose dampen them down so I hardly notice them.

That works most of the time but about once a month they are uncomfortable. EP says they are a nuisance but not dangerous so I take 1.25mg of bisoprolol as he instructed and that calms everything down. So much better than persistent AF!!

Gill

Carey, at 14 ectopics per minute wouldn't it just be the same as afib? What makes it different?

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JDfiB
Carey, at 14 ectopics per minute wouldn't it just be the same as afib? What makes it different?

Afib is variably variable. Ectopic beats can occur around an NSR baseline. See my post here: [www.afibbers.org]

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JDfiB
Carey, at 14 ectopics per minute wouldn't it just be the same as afib? What makes it different?

Ectopics are strange. 14/min does not mean they are evenly present the whole minute.
One may have a couple of short runs, or ectopics in a regular pattern, or fully random ectopics. The latter, when they are numerous, may feel like afib. Ectopics in regular pattern, like bi or trigemini, are easy to recognize and awful to bear.