PACs instead of AFib?

so after 12 yrs of on and off AF I had noticed my recent episode June 10th (first one this year) did not feel as "bad" as they had in the past which was confusing and lasted for approx 6hrs.Then 2 weeks later I had another episode which lasted only 3hrs and I took my pulse and HR was only 112 (normally when I have an episode its going to fast to even get a reading). Then on July 9th 6am-9am HR only 90. Last one July 11th 5am-7am and when I took my pulse was only 70. In all these episodes HR was erratic but not wild. I called cardiologist on the 11th and the nurse told me what I was having was PACs and looking back at each of these episodes they apparently all were PACs. Cardiologist told me to start taking my 25mg Metoprolol extended release daily again (haven't done that for several years as just taking a 25mg metoprolol tartrate at start of AF has been doing the job) so I have started taking it again at bedtime. Just wondering what is going on?? Is this a bad sign or a good sign? I take magnesium/taurine/CoQ10 daily and have added D-Ribose. I am on a plant based diet/slim/fit 83yo altho was dx with some blockage in one of my carotid arteries recently which I am hoping my strict diet per Dr Caldwell Esselstyn will help.

I don't know about PACs as far as indicating failure. I will say (I'm just out of 2nd ablation- 6 weeks ago) I was getting what I thought was afib. But were PACs. We were following a very similar diet (Vegan but I did do oil). for me PERSONALLY I stopped eating grains and beans for a bit and I do better. Although I think grains and beans are very very good for you. (I was mostly Blue Zone to be honest). Also, and I think this part is b/c it is post ablation, I have had some reflux and so acid foods were bothering me including fruit- sadly- because fruit is delicious and also nutritious! I guess I'm just saying that you could fool with your diet a bit. Or even don't fool with it but track what you are eating. I know "success" means we can do what we want and not have to concern ourselves with afib but if there are one or two triggers we can avoid I see that as a win. (Even cold water has set it off in the past for me but I recently tried it again and it was fine ).

PACs and AFib have in common the fact that some cells are firing erratically in the atria.
Some PACs now and then are just PACs. They're benign.
Repeated (consecutive) PACs are runs of PACs. The longer the runs, the more they resemble AFib.
When there are more PACs than normal beats on an 1 min EKG tracing, and those PACs aren't organised (say, like in a bigeminal or doublets pattern), we're close to afib.
I'm used to call this "unsustained AFib". It's mostly AFib with some normal beats appearing now and then.
My understanding is what generates PACs can generate AFib. Their root cause is likely common.



Edited 1 time(s). Last edit at 07/15/2022 06:41AM by Pompon.

I have had similar problems in the past post suc. Ablation in 2018 + have cured them by taking the CORRECT COMBINATION (for me that is anyway) of Mag.....MALATE/TAURATE/GLYCINATE....early morning + just before bed. Previously lets say in the last 10 years before my own feb. 2022 MAG. MIRACLE i tried every Mag. out there on an Ind. basis to some positive results but nothing like this 3 way combo. I take the KAL brand of the 3 in the morning 1/4 of each 400mg dose for 300 mg total=3/4 of a daily dose total then do the same before bed for a total of 600mg which is 50% more then the recommended daily dose.....or at night i take 1 Natural Rhythm Triple Calm Mag. ( same 3 mag. in 1 pill instead of the 3 Kal brands) that you can buy online at NaturalRhythm.co or on amazon (that is double the price there) along with my Kal x3 in the morning + it has kept me out of PAC jail for 6 months now along with improving my Quality of sleep sig. Now that's me....i would suggest if you try this + at the doses i spelled out + don't get the results your looking for then up your dosage according to hopefully get the job done.

GL

How many PACs are considered problematic?

My at-home continuous ECG from Wellue indicates

• SESSION 1 (18-hour period) 17 PAC Couplets
• SESSION 2 (18-hour period) 5 PAC Couplets
• SESSION 3 (11-hour period) 14 PAC Couplets
• SESSION 4 (8-hour period) 709 PAC, 9 PAC Couplets

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Que
How many PACs are considered problematic?

My at-home continuous ECG from Wellue indicates

• SESSION 1 (18-hour period) 17 PAC Couplets
• SESSION 2 (18-hour period) 5 PAC Couplets
• SESSION 3 (11-hour period) 14 PAC Couplets
• SESSION 4 (8-hour period) 709 PAC, 9 PAC Couplets

Even Session 4 is less than 90 an hour or 1.5/minute average. Not a big deal. How are the distributed? Widely spaced or grouped together, or does the Wellue give you that info?

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Que
How many PACs are considered problematic?

No matter the number, it's only problematic from a quality of life perspective. They cause no physical harm and EPs generally won't treat PACs or PVCs with anything other than drugs until they're in the 20K per day and above range. They might then attempt to ablate PVCs in some cases, but rarely PACs.

There was a period in my life when I was experiencing bigeminal PACs continuously 24 hours per day for weeks at a time. So if my average heart rate was, say, 74, that means 37 PACs per minute x 60 minutes per hour x 24 hours per day = 53,280 PACs per day. My EP was unconcerned and the only thing I was offered was sotalol, which had no effect.

I've had 15000/day, both my cardiologist and EP said they were benign. I had less for some weeks with the help of flec and bb, but those meds had serious side effects.
Two touch-up ablations helped. I'm meds free. I've still some ectopics or afib episodes, but far less numerous and self-ending.



Edited 1 time(s). Last edit at 07/20/2022 10:29AM by Pompon.

Thanks all, that is reassuring.

Here's the PAC data

• 11 am (0 PAC, 1 Couplet)
• 12 pm (33 PAC, 2 Couplet)
• 1 pm (82 PAC, 0 Couplet, 2 Trigeminy)
• 2 pm (232 PAC, 1 Couplet, 4 Trigeminy )
• 3 pm (91 PAC, 1 Couplet)
• 4 pm (82 PAC, 2 Couplet)
• 5 pm (131 PAC, 1 Couplet)
• 6 pm (58 PAC, 0 Couplet)
• TOTAL: (709 PAC, 8 Couplet, 6 Trigeminy)

BTW: I've just completed a 23-hour session, and there were:

• 1 PAC, 9 couplets of PACs, 0 Bigeminy, 0 Trigeminy

So, much fewer.

Here's the device for anyone interested. I'm wearing it simultaneously as my Boston Scientific Mini Guardian to cross-reference.

Wellue ECG Recorder with AI Analysis

Que, how are the tracings while you're moving ?
Usually, body motion induces lots of artifacts in the recordings...

Hi Pompon,

Sorry, I don't have any information on how it performs while moving.

All the best,
Ryan

Thanks for your answer.

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Pompon
Que, how are the tracings while you're moving ?
Usually, body motion induces lots of artifacts in the recordings...

Years ago (maybe 14?) I borrowed a Holter monitor from a friend here who had his own. I recall wearing a tight fitting t-shirt during exercise to minimize artifact in the recordings. There are a number of papers on the topic of artifact during Holter recordings. With my Polar H10 strap, Polar does not recommend recording R-R (beat to beat) while doing exercise and using their watch to record. Recently a member here asked me to coach him on using the H10, a phone app that will record R-R and ancient Windows software from Polar to view the data for longer duration recording. He's getting few PAC's PVC's (or what could be artifact) on recordings while quiet. Many more during activity. It is hard to tell the difference. For myself, I almost always only sample during sleep or meditation with the Polar, when I'm interested in PAC's & PVC's. If I'm seeing a lot of PAC/PVC's, I will also sample my pulse manually as I can also feel them in this context.

Pompom, this image shows my beat to beat heart rate vs time recording (recorded with a Polar H10 strap & Heart Rate Variability Logger app) during four 20 second as hard as I could, 10 second easy cycles on my fan bike this morning. Though I can't prove all the ectopics are artifacts, I have a strong suspicion they are. I didn't do anything to try to minimize them, like tightening the chest strap or using electrolyte gel instead of water on the contacts. The hard cycles start at 3:00 minutes and end at 4:50.





Edited 1 time(s). Last edit at 07/23/2022 04:17PM by GeorgeN.

I'd like being able to take some tracings while exercising, even on a static bicycle, but the results are always nearly unreadable, unless I stop moving the time to record something, of course. No big deal, but sometimes a little frustrating.

So, Carey, what has been your history after the period of intense PACs that your mention?
There is no additional afib risk from PACs?
If so, how is this known? thanks.

(I experience 20k-30k a day and increasing.)

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swhanson
So, Carey, what has been your history after the period of intense PACs that your mention?
There is no additional afib risk from PACs?
If so, how is this known? thanks.

(I experience 20k-30k a day and increasing.)

I never said PACs aren't an afib risk and would never say that. But there are a lot of people out there who live with PACs every day who don't have and maybe never will have afib. That's why cardiologists tend to wave it off.

My history is rather long and complex, but between the intense PACs that I mentioned I underwent an ablation that completely eliminated all my atrial arrhythmias and PACs (I also had flutter). So I'm not a good comparison to your situation.

PACs and afib are certainly closely related, and you could even say that PACS are afib in the sense that if the cells producing the PACs begin exciting adjacent cells, afib will probably be the result. PACs are like little afib engines that aren't exciting their neighbors (yet).

I would be very concerned about any Dr that "waves" off Persistent and Chronic PAC/PVC, or any other arrythmia. Newer research has shown that these are not necessarily benign. Precursor to AFIB. Or in my case as soon as I got a run I immediately went into AFIB and later on developed flutter. I was very symptomatic. I suppose if you are not symptomatic that would not be an issue. I would look for someone who takes this seriously.