Pacs and afib

Who here has daily pacs? I had 1 event of afib for about 7 hours in April 2021. I dont think I have had another episode of afib since. Since my afib episode I have daily pacs that are so annoying. It bothers me daily. I take 400mg of Magnesium Glycinate daily which I dont know if it helps or not. I drink 1-2 cups of coffee in the morning and rarely drink alcohol. I sometimes get a few when running or lifting weights. I sometimes wake up in the middle of the night with them. Doctors dont care at all about them. They also have no answers or reasons why they all of a sudden started. All I get from them is “everyone gets them”. Well prior to my afib episode I didnt have any, felt like a million bucks everyday to now this. I dont get it. Can anyone relate? How do you deal with them?

I get PAC's & PVC's daily, but rarely notice them. I only know as I will wear a beat to beat heart rate recording device when I sleep and can see them in the data. How people experience them is very individual.

Gill (a woman from the UK), who is one of our members was ablated in 2003 in Bordeaux. Subsequently she's experienced a lot of PAC's (near 8000/day). Here is a search on her posts on the topic and here is one in particular. [www.afibbers.org]

I take magnesium to bowel tolerance and I also put 2 tsp of potassium citrate powder in a liter of water and consume over the day (my version of timed release). Suggesting electrolyte supplements assumes your kidney function is not impaired.

This member, AsympPACs, dropped his PAC's/day down to 50 from 5000 or so with diet changes, reducing carbs. He used a personal 24 hour monitor to figure this out. A search on his posts is here: [www.afibbers.org]

Quote
Bob Thorton
(...) Doctors dont care at all about them. They also have no answers or reasons why they all of a sudden started. All I get from them is “everyone gets them”. Well prior to my afib episode I didnt have any, felt like a million bucks everyday to now this. I dont get it. Can anyone relate? How do you deal with them?

Doctors don't care, because PACs are harmless. They say "everyone gets them", but it's untrue. Many people don't notice them, but those who notice (like me) know the difference between many ectopics, a few ectopics or no ectopics. I've never had ectopics nor afib till nov2015.
Some PACs are just some PACs. Lots of PACs are annoying. Runs of PACs are a bad sign. PACs all the time=afib.

I've tried lots of things. To no avail. PACs (and PVCs too, for me) come and go whenever they want, mainly at rest and while digesting.

Have you tried stop drinking coffee (caffeine) cold turkey as an experiment for a while to see if your PACs stop? It’s arrhythmic to some.

I tried quitting coffee for a few days with no relief. I drink once a month if that. No matter what I do the pacs happen. Are pacs associated with afib? I know “everyone gets them” But how often? What is the normal average for a healthy male? I have no past medical history besides 1 episode of afib in April 2021. Since then I get pac’s daily. I work out daily. I run 12 miles a week, usually 3 miles at a time. I also lift weights 3-4 times a week. I am very active and dont understand why all of a sudden I have these symptoms.

There is a period of time in the cardiac cycle called the effective refractory period or ERP. It exists both for the atria and the ventricles. During this time, a p cell firing will not propagate, so no PAC or PVC. If a p cell fires outside of this window, then the signal can propagate and you get a premature beat. You can also think of this as a "backup" system. In other words, if the heart has not had a beat in a while then some p cell will depolarize and cause the heart to beat. The thing is, ERP is not fixed. Things like autonomic tone, electrolyte status as well as on a longer time scale, age can change the ERP. So if the ERP gets shorter, you are more likely to get premature beats. For example, exercise can increase vagal tone in the autonomic nervous system. This can shorten ERP. I believe I responded to you in a previous thread about exercise. If your electrolytes are out of balance, this can also shorten ERP. This is why I linked Gill's posts above. Above, I mentioned AsympPACs had reduced his PAC's from 5000/day to 50/day with what he called a "diabetic diet." I presume that meant reducing carbs. I have a friend who's PAC's are so frequent, it dramatically reduces her exercise capacity. Her PAC frequency is also a function of carbohydrate consumption.

Some people can have lots of PAC's and no afib. 17 years ago, I reviewed a database of afib ECG's at MIT. The initiation of most afib episodes in the data were preceded by one or more PAC's. It is very individual.



Edited 1 time(s). Last edit at 02/01/2022 08:50PM by GeorgeN.

Hi Bob,

If you haven't yet get the book: The Afib Cure. Its likely the best and most update book I have found. Lots of info. about triggers for afib, and likely will apply to frequent PACs.

Good luck, it is a personal journey of discovery...

Jeff

Hi Bob

Coffee is a trigger for some, as is alcohol. But you really need more than a few days when you are trialing something. Just about everyone on this site has tried different things, It's a trial and error process. What suits one doesn't suit another.
You need to be patient and try some different processes. Over time, as hard as it seems, if you can be proactive, it is good for taking your mind off things.
I kept a note of everything I tried, and there were plenty of trials over the years. Some worked for a while, others didn't.

I too get PACs fairly regularly, but I tend to ignore them. Sometimes they are a nuisance, especially if I'm trying to get to sleep, but I just put on some soft music, or listen to a regular heartbeat on YouTube, to take my mind off them. The heartbeat also used to help me when I was in rapid and chaotic AF.

[www.youtube.com]

Joy

I have PAC's all the time but mainly when moving or eating. Once i sit down for a few minutes they go away. They have progressively gotten worse over the last 5 years. At one point i ended up getting AFIB which lasted 3 days. Soon after i had an ablation. I have been 3 years no afib since ablation but the PAC's are worse than they have ever been. I actually just got back from my GP today to talk about blood pressure. I was 150/95 in the office today and was having loads of PAC's. Once i got home i noticed they subsided so i check my BP again and this time I was at 121/79.

I have tried triple calm magnesium supplements and have changed my diet to avoid salt as much as i can however, it doesnt matter. Once i get up and move around the PAC's return. On average i get a PAC ever 2nd-4th heart beat. Its dreadful, especially when exercising because it feels almost like i am in afib.

I think its BP related though and the doc says he sees patients improve once they get their BP under control. So i am going to be trying a new medicine for BP. I have been on 25mg metoprolol succinate ER once a day but i am going to be switching to a calcium channel blocker to see if it helps.

Weird thing, isn't it?
It's quite the opposite for me: ectopics mostly appear when I'm quiet (sitting or lying down); standing up and moving around make them subside.
I may have a mix of PACs and PVCs (in bigeminal pattern) in the minute I'm down and quiet in bed. If I move a little (my arms or legs, or change position), they disappear. Motionless again, and they're back in the minute. I can't sleep at all till they subside, but they usually don't last more than an hour or two.
They're unpredictable: some days they're present, other days not. I've not yet been able to relate them to anything. I've normal BP (~110/60), normal weight...
They're no fun at all, but they're harmless.

I have daily PACs. They are almost always totally asymptomatic unless I'm trying to feel them by putting pressure on my chest.
I did not know I had PACs until I had my 3rd Pfizer COVID shot and then HS Troponin I enzyme test indicated heart inflammation in Nov 2021.
Since then my daily PACS rose to as high as 16000 per day.
Docs said if you don't feel them, don't worry about them.
I have not had any known episodes of AF, but I would rather figure out if I can avoid it.
Since the end of December 2021, I have used continuous ECG monitoring using Wellue AI-ECG. ($255)
I average about 23 hours of data per day. Most important metric for me is hours without PACs.
I was diagnosed as prediabetic 4 years ago but my A1c had varied between 5.2 and 5.8.
The circumstantial evidence is when I control my glucose and get at least 2 hours a week of HR zone 2 exercise then my PACs are less than a few hundred a day.
To control my glucose, I had to change the time of day of when I take 40mg of Atorvastatin from late evening to lunch time.
(Some statins impact glucose processing).
I also reduced sugar and refined grain intake.
I also now test my glucose one to three times a day with Contour Next glucose test kit.

I'm going with the hypothesis that sugar can remodel the atria and hopefully, I am at the early stages.

"Is glucose metabolism in the atria in patients with atrial fibrillation due to inflammation or remodeling?"

[link.springer.com]

16000/day is a very high count.I wouldn't like going back to the days I had about 15000 PACs+PVCs/24h (but I was very symptomatic). It may be easier not worrying about them when you don't feel them...

I always come to this website because it’s good to know you’re not alone. My PACs started after my ablations. Up until then, I had none…just the occasional “twice a year” a-fib. For me, the PACs hit when I’m resting and even though my EP says they are harmless…it’s like someone unplugging me and plugging me back in. My entire body shudders and I feel like I just got rebooted. The PACs are annoying as hell and I wish I could figure out my trigger. I’ve done everything, cut out alcohol, caffeine, etc…nothing seems to have a direct correlation. My EP just put me on Flecanide a few days ago so we will see if this helps because even after two ablations—I still get episodes of a-fib. I guess it’s just something we have to deal with as we age. Ugh.

i have read posts such as yours whereby after an ablation, people seem to get more Pacs. There are burns to the heart and probably it will take time to heal, then your pacs could subside.

Quote
sisyphus222
I have PAC's all the time but mainly when moving or eating. Once i sit down for a few minutes they go away. They have progressively gotten worse over the last 5 years. At one point i ended up getting AFIB which lasted 3 days. Soon after i had an ablation. I have been 3 years no afib since ablation but the PAC's are worse than they have ever been. I actually just got back from my GP today to talk about blood pressure. I was 150/95 in the office today and was having loads of PAC's. Once i got home i noticed they subsided so i check my BP again and this time I was at 121/79.

I have tried triple calm magnesium supplements and have changed my diet to avoid salt as much as i can however, it doesnt matter. Once i get up and move around the PAC's return. On average i get a PAC ever 2nd-4th heart beat. Its dreadful, especially when exercising because it feels almost like i am in afib.

I think its BP related though and the doc says he sees patients improve once they get their BP under control. So i am going to be trying a new medicine for BP. I have been on 25mg metoprolol succinate ER once a day but i am going to be switching to a calcium channel blocker to see if it helps.

I am starting to believe mine is bp related as well. I think I am a "reverse dipper" it is called. As long as my bp is under control, i have no problems. At least so far. Have you thought of trying an ACE Inhibitor? Supposedly its the best way to directly manage bp, but i could be wrong as i am not a doctor. I will talk to my doctor in awhile about it myself and see what he thinks.

I’m a reverse dipper too.

Quote
adamh

I have PAC's all the time but mainly when moving or eating. Once i sit down for a few minutes they go away. They have progressively gotten worse over the last 5 years. At one point i ended up getting AFIB which lasted 3 days. Soon after i had an ablation. I have been 3 years no afib since ablation but the PAC's are worse than they have ever been. I actually just got back from my GP today to talk about blood pressure. I was 150/95 in the office today and was having loads of PAC's. Once i got home i noticed they subsided so i check my BP again and this time I was at 121/79.

I have tried triple calm magnesium supplements and have changed my diet to avoid salt as much as i can however, it doesnt matter. Once i get up and move around the PAC's return. On average i get a PAC ever 2nd-4th heart beat. Its dreadful, especially when exercising because it feels almost like i am in afib.

I think its BP related though and the doc says he sees patients improve once they get their BP under control. So i am going to be trying a new medicine for BP. I have been on 25mg metoprolol succinate ER once a day but i am going to be switching to a calcium channel blocker to see if it helps.

I am starting to believe mine is bp related as well. I think I am a "reverse dipper" it is called. As long as my bp is under control, i have no problems. At least so far. Have you thought of trying an ACE Inhibitor? Supposedly its the best way to directly manage bp, but i could be wrong as i am not a doctor. I will talk to my doctor in awhile about it myself and see what he thinks.

I have my next appointment with the EP next month. I am going to talk to him about other BP options in lieu of metoprolol and see what he suggests. My GP basically deferred the decision to the EP.

I can tell you this, when i am super stressed out at work, the PAC's come on with a vengeance - even just sitting at my desk. The more i calm down the more they subside. Obviously, with exercise, your BP increases which may explain why my PAC's increase in frequency during phyiscal activity.

What is a reverse dipper?



Edited 1 time(s). Last edit at 02/21/2022 12:50PM by sisyphus222.

Quote
sisyphus222
I have my next appointment with the EP next month. I am going to talk to him about other BP options in lieu of metoprolol and see what he suggests. My GP basically deferred the decision to the EP.

I can tell you this, when i am super stressed out at work, the PAC's come on with a vengeance - even just sitting at my desk. The more i calm down the more they subside. Obviously, with exercise, your BP increases which may explain why my PAC's increase in frequency during phyiscal activity.

What is a reverse dipper?

I talked to my cardiologist and he said i have to stay on Metoprolol for now. He said since i had one episode of AFib (so far the only) this past January and i have episodes of hypertension, its best to stay on that. I am getting a Nuclear Stress test done next week. I do a follow up with him afterwards and we will see what happens.

Also, i adjusted when i take my Metoprolol to earlier in the evening. I use take it like at 8 or 9 at night and now I take it at 6. Thankfully I haven't had any issues since changing. Only Caveat being if I eat something with super high sodium, like huge dish of Chinese food, my body doesn't handle well anymore. I am assuming i am more sodium sensitive in evening and just try to be more careful.

for reverse dipping info, check this out:
[www.nature.com]
and maybe here
[www.ncbi.nlm.nih.gov]

it was hard to find an easy to read doc to share, sorry. Basically your blood pressure should measure normal when you wake up, increase throughout the day, then by evening begin to fall back down to normal as your body/brain prepares for bed. This is a normal "dipper"(dips in bp) type that most people experience. a reverse dipper on the other hand just keeps going up in BP and doesn't go down. The natural up and down dip of your bp doesn't happen. For me and for many years, i use to not be able to get to sleep and use to think i was just weird. Actually, i figured out it was my BP was really high and i didn't realize it. I guess my heart had enough one day and i popped this past January. I had an AFib episode and here i am. This hasnt been proven yet by my doctor though. I just think that is what happened to me.