Re: Very frequent PAC's

Here is my story on PACs-
Caucasian male- age low 60s- never heard of PACs before Nov2021. BMI hovers 25.5-26.0 for 20 years. A1c for past 5 years, 5.8 to 5.2 to 5.8 (prediabetic).

In early Nov, got third dose of Pfizer Covid- felt a flutter about 1/2 hour later.
3 days later, I woke up from a short nap and was dazed and light headed- My PulseOximeter indicted good o2 but my pulse had premature beats.
Heart disease runs in my family so I went to ER where they saw my HS Troponin-I was elevated. CT and stress ECG were negative.
6 days later my cardiologist prescribed a 7-day 1-lead holter.
Quit caffeinated coffee and alcohol, Started Mediterranean diet. Lost 6 pounds and gained 2 back.
No PACs detected by PulseOx thru mid-December.
Added metoprolol in December after holter and CAC score (800ish) came back. (holter results for early Nov indicated 3000 PACs a day early in the week and 500 late in the week)
I read that 3000 PACs a day is quite high and often coorealated to developing AFib over time.
Wellue ECG with 1/2 hour logging ($60) started showing PACs increasing from 1 per minute to 10 per minute. I stopped the metoprolol since it seemed to correlate with the rise in PACs
For Xmas, I bought myself Wellue with 24-hr logging and AI batch processing ($255).
As of 10 days ago, I was getting 12000-16000 PACs a day. 300-800 every hour.
Only time I didn't get PACs was if I got my heart rate over 90 bpm.
Cardiologist said to ignore them if I don't have significant symptoms.
I decided maybe inflammation was part of the issue and knew that lowering glucose might lower inflammation.
I changed from Cherrios with honey and walnuts to Oatmeal with walnuts (no honey). For the first day in weeks, I had two hours that my pulse rate was under 80 and got Zero PACs between 10am-12pm- but after lunch they came back but then subsided for a couple hours before dinner.
It was an Aha! moment when I reviewed the results the next day.
I then found this article:
CaMKII activation in early diabetic hearts induces altered sarcoplasmic reticulum‑mitochondria signaling [www.nature.com]

I then decided to get more strict into a diabetic friendly diet.
I also notice if I ate something very sweet, the PACS come back in less than 30 minutes.
Two days ago, I was down to 3000 PACs a day.
Last night I gave up my 8pm snack and got down to 500 PACs a day which now are occurring in the 2 hours when I first lay down to sleep.
BMI is now just under 25.

My point is, for me, the PAC trigger seems to be glucose. My physician and cardiologist never suggested that PACs could be so correlated to glucose.
I had never heard (or at least never processed) that pre-diabetes could be damaging organs including my heart. 1/3 of adults have prediabetes!
I will be giving this update to my cardiologist over the next few weeks if the pattern holds.
In hindsight, the increase in PACs that seemed to correlate to the introduction of metoprolol may have been more related to the increase in consumption of sweet holiday food with family and friends. I plan to work to assure I am never prediabetic again.

My other point is having access to automated counting of PACs across 24 hours and being able to review it the next day is potentially good way of finding the correlation to the right trigger. For some, glucose related PACs are most likely to occur overnight when glucose is highest and heart rate is lowest. But unless you have been put on a ECG Holter, you likely would never know they were happening until they had done enough damage to your heart for a cardiologist to recommend a Holter: but three weeks later trying to look at the data would be very difficult to correlate PACs to particular activities.

I've sometimes wondered if my ectopics and afib weren't carbohydrates related, since I mostly have them after meal and between 2-5 AM, which could be moments when my blood glucose is high or low.
I've checked for that, but it's like everything else : normal.
But the "normal" range is just a norm. If you're slightly out of range, most doctors would not say it's serious, for the norms are conservative. Nevertheless, we're all different, and our personnal range can be narrower than average.

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AsympPACs
Here is my story on PACs-
Caucasian male- age low 60s- never heard of PACs before Nov2021. BMI hovers 25.5-26.0 for 20 years. A1c for past 5 years, 5.8 to 5.2 to 5.8 (prediabetic).

In early Nov, got third dose of Pfizer Covid- felt a flutter about 1/2 hour later.
3 days later, I woke up from a short nap and was dazed and light headed- My PulseOximeter indicted good o2 but my pulse had premature beats.
Heart disease runs in my family so I went to ER where they saw my HS Troponin-I was elevated. CT and stress ECG were negative.
6 days later my cardiologist prescribed a 7-day 1-lead holter.
Quit caffeinated coffee and alcohol, Started Mediterranean diet. Lost 6 pounds and gained 2 back.
No PACs detected by PulseOx thru mid-December.
Added metoprolol in December after holter and CAC score (800ish) came back. (holter results for early Nov indicated 3000 PACs a day early in the week and 500 late in the week)
I read that 3000 PACs a day is quite high and often coorealated to developing AFib over time.
Wellue ECG with 1/2 hour logging ($60) started showing PACs increasing from 1 per minute to 10 per minute. I stopped the metoprolol since it seemed to correlate with the rise in PACs
For Xmas, I bought myself Wellue with 24-hr logging and AI batch processing ($255).
As of 10 days ago, I was getting 12000-16000 PACs a day. 300-800 every hour.
Only time I didn't get PACs was if I got my heart rate over 90 bpm.
Cardiologist said to ignore them if I don't have significant symptoms.
I decided maybe inflammation was part of the issue and knew that lowering glucose might lower inflammation.
I changed from Cherrios with honey and walnuts to Oatmeal with walnuts (no honey). For the first day in weeks, I had two hours that my pulse rate was under 80 and got Zero PACs between 10am-12pm- but after lunch they came back but then subsided for a couple hours before dinner.
It was an Aha! moment when I reviewed the results the next day.
I then found this article:
CaMKII activation in early diabetic hearts induces altered sarcoplasmic reticulum‑mitochondria signaling [www.nature.com]

I then decided to get more strict into a diabetic friendly diet.
I also notice if I ate something very sweet, the PACS come back in less than 30 minutes.
Two days ago, I was down to 3000 PACs a day.
Last night I gave up my 8pm snack and got down to 500 PACs a day which now are occurring in the 2 hours when I first lay down to sleep.
BMI is now just under 25.

My point is, for me, the PAC trigger seems to be glucose. My physician and cardiologist never suggested that PACs could be so correlated to glucose.
I had never heard (or at least never processed) that pre-diabetes could be damaging organs including my heart. 1/3 of adults have prediabetes!
I will be giving this update to my cardiologist over the next few weeks if the pattern holds.
In hindsight, the increase in PACs that seemed to correlate to the introduction of metoprolol may have been more related to the increase in consumption of sweet holiday food with family and friends. I plan to work to assure I am never prediabetic again.

My other point is having access to automated counting of PACs across 24 hours and being able to review it the next day is potentially good way of finding the correlation to the right trigger. For some, glucose related PACs are most likely to occur overnight when glucose is highest and heart rate is lowest. But unless you have been put on a ECG Holter, you likely would never know they were happening until they had done enough damage to your heart for a cardiologist to recommend a Holter: but three weeks later trying to look at the data would be very difficult to correlate PACs to particular activities.

It’s crazy that you noted this. I too am starting to wonder if it’s glucose related. I was noticing the PAC’s a lot after eating sweets (which there was a big uptake of over the holiday break). For the last two days I have cut out sweets. However, after dinner yesterday I was totally miserable. My kardiaband thinks I’m in afib every I walk around the house. It certainly feels like a a pac every 2-3 heartbeats and is very annoying.

The other thing I’ve noticed is I feel like I get a short burst of afib for like 2-3 seconds every once in awhile. It’s happened like once a day for the last three or four days. Doesn’t feel like the typical one off pac. I’ve gotten these from time to time since the ablation but seems like an uptick in frequency. I am so frustrated right now.

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"The other thing I’ve noticed is I feel like I get a short burst of afib for like 2-3 seconds every once in awhile."

Those are likely short runs of PACs.

My PACs are down to under 50 a day for the past three days!
In my case, I definitively think it was glucose related. I've added to my daily exercise from light intensity brisk walking or 1.5-3 miles to also include 30-90 minutes of exercise bike riding at 100-120 bpm.
[www.exerciseismedicine.org]
My own doctor thought walking 1.5-3 miles a day was likely sufficient.

There is much recent literature on glucose and arrhythmia, including [www.researchgate.net]

My conjecture is if I keep improving my exercise, I'll be able to deviate from the diabetic diet without the PACs coming back.
(I might even get to drink a glass of wine and maybe a cup of real coffee.)

If I didn't have the Pulse Oximeter- I would have never known I was having heart issues.
My yearly checkup probably would not have caught them since my heart rate at the Dr's is typically high 80s to low-90s.
My heart probably would have continued to get damaged by daytime hyperglycemia and nighttime hypoglycemia until significant symptoms appeared at the doctor's office months or yearly later.

Without the Wellue AI ECG 24-hr, I wouldn't have been able to figure out what was causing the PACs.
Continuous monitoring and reviewing the results the next day is the only reasonable way to try minor experiments and see if you can figure out a root cause. You don't have to think about it and take time out to make many measurements throughout the day.

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AsympPACs
(I might even get to drink a glass of wine and maybe a cup of real coffee.)

Dr. Mandrola, in "The Haywire Heart" referenced data suggesting caffeine is not an issue with afib. From being on this board for 17+ years, I can say that some folks who thought they had a coffee issue found that organic coffee solved the problem. So it could have been pesticides. Of course mold can also be an issue with coffee.

Something you could test.

There is research out there showing that caffeine is actually beneficial for afib. I've posted links to it before but don't have them handy right now. If anyone wants to see them let me know and I'll dig them up again.

I think caffeine is the biggest false bogeyman of the cardiology world. It was demonized by cardiologists decades ago purely out of a sense of "it's a stimulant so it must be bad for afib" rather than any actual evidence, and it's been handed down as a truism ever since both in folklore and medical school. It's so ingrained in people's thinking that my sister spent 30 years in permanent afib avoiding caffeine the whole time because that's what her cardiologist told her to do. She missed it, and so when I asked her why she was avoiding it since she was in afib 24/7 for the rest of her life anyway, she drew a blank. She resumed drinking regular coffee shortly thereafter and never looked back.

I'm sure there are some paroxysmal folks that caffeine can help trigger, but I don't think it deserves the rap it gets and I think a lot of people wrongly identify it as a trigger because they drank it every day and therefore it was bound to be perceived as a correlation.

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AsympPACs
My PACs are down to under 50 a day for the past three days!
In my case, I definitely think it was glucose related. I've added to my daily exercise from light intensity brisk walking or 1.5-3 miles to also include 30-90 minutes of exercise bike riding at 100-120 bpm.

I have a friend to is a Wolff-Parkinson-White (WPW) syndrome ablatee. With exercise she would get so many PAC's that it materially degraded her exercise capacity. She found that they were very much glucose related. When she restricted carbohydrate intake, the PAC frequency decreased such that she maintained her exercise capacity. Her story was reported on the afibbers site here about 10 years ago. [www.afibbers.org] This continues to this day.

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Carey
There is research out there showing that caffeine is actually beneficial for afib. I've posted links to it before but don't have them handy right now. If anyone wants to see them let me know and I'll dig them up again.

I think caffeine is the biggest false bogeyman of the cardiology world. It was demonized by cardiologists decades ago purely out of a sense of "it's a stimulant so it must be bad for afib" rather than any actual evidence, and it's been handed down as a truism ever since both in folklore and medical school. It's so ingrained in people's thinking that my sister spent 30 years in permanent afib avoiding caffeine the whole time because that's what her cardiologist told her to do. She missed it, and so when I asked her why she was avoiding it since she was in afib 24/7 for the rest of her life anyway, she drew a blank. She resumed drinking regular coffee shortly thereafter and never looked back.

I'm sure there are some paroxysmal folks that caffeine can help trigger, but I don't think it deserves the rap it gets and I think a lot of people wrongly identify it as a trigger because they drank it every day and therefore it was bound to be perceived as a correlation.

That's good to know, unfortunately for me caffeine was absolutely a trigger. It may be that caffeine brought on PAC's which in turn would spark my flutter/afib episodes. All i know is that for 20+ years i cut out the caffeine and i didn't have a single flutter or afib event in that time. Take my experience as just a helpful anecdote.

I wish i understood why my PAC's have become almost debilitating at this point. Have multiple doc appointments coming up to test my various hypothesis:

1. pre-diabetes?
2. high blood pressure that is worsening over time?
3. afib creeping back?
4. heart disease beginning?

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sisyphus222
That's good to know, unfortunately for me caffeine was absolutely a trigger. It may be that caffeine brought on PAC's which in turn would spark my flutter/afib episodes. All i know is that for 20+ years i cut out the caffeine and i didn't have a single flutter or afib event in that time. Take my experience as just a helpful anecdote.

I wish i understood why my PAC's have become almost debilitating at this point. Have multiple doc appointments coming up to test my various hypothesis:

1. pre-diabetes?
2. high blood pressure that is worsening over time?
3. afib creeping back?
4. heart disease beginning?

I said in my post that caffeine can be a trigger for some people. I simply think it's vastly over-identified as a trigger because "that's what everyone says."

But I think you're barking up the wrong tree looking for explanations for your PACs with items #1 and #4. By all means rule them out but items #2 and #3 are most likely, and #2 should be easy to exclude all on your own with a BP monitor.

Afib is a progressive disease, so #3 is the most likely explanation. Although PACs aren't afib, they are closely related and you may be headed in that direction. I would focus on hypothesis #3.

There are likely several mechanisms that could be involved with development of arrhythmias.
I found this figure from an NIH article interesting...
[www.ncbi.nlm.nih.gov]
My own PACs are back around 5000s again but I've fell off the diabetic diet and started more frequent exercise.
My glucose today was 103 after fasting. (Bought an Contour Next Glucose meter).
I'll be going back to the diabetic diet and stay with the more frequent Zone 1.5 to Zone 2 exercise.
Trying to get to 10K steps a day consistently.
Taking 1/2 a Centrium silver 50+ vit twice a day.
I'm also on 40mg Atorvastatin.
I've have 25mg metoprolol in reserve- but not taking it.