Afib and PAC's

Hi. Two years ago I had a big afib episode. I was treated at the ER. A cardiologist put me on Eliquis and Metoprolol. This year I have had a few arrhythmias. They feel very much like the afib that landed me in the hospital. In fact, I had one in the cardiologist's office while taking an ECG. But the cardiologist called it a PAC, not afib. He said PAC's are benign. They sure feel uncomfortable. The PAC episodes may last a while but eventually subside.

I am wondering, what's the actual difference? And how can you tell if you're having one or the other?

I have heard that the beta blocker is keeping the PAC from turning into something worse, like afib. Any truth to that? Is it like a PAC is actually an afib trying to break through but the Metoprolol is blocking it?

If any members can clarify this for me, I will be most appreciative. Thank you.

Fibrillation is several 'quivers' per beat, maybe just an extra one, or two, or three, and they happen between each T wave. This goes on for several beats in succession, even lasting hours or days. PACs are an extra beat, a single usually, that happen prior to the normal depolarization phase of the left atrium which the P wave signifies on an ECG readout.

The medical community is not averse to dealing with PACs when their 'burden' becomes oppressive and begins to seriously erode quality of life. If you can't relax, you can't sleep. Your condition begins to affect your relationships because you have so much less room to deal with those when you're feeling awful or anxious. That said, the medical community is also not especially keen to deal with PACs when the burden is under, say, 5% (I'm not sure about the actual number) because you can live with PACs as much as you can live with AF. Maybe not peachy, but you can live.

Your physician/specialist should know very soon if your quality of life suffers unduly, and you're the judge. It's incumbent upon you to let them know you need more help.

Thanks for clarifying that. Can you feel the 'quivers'? How do I distinguish a PAC from an afib without an ECG?

PACs are single, isolated beats. Although you may experience multiple PACs, there will be normal beats between them. Afib, on the other hand, is a continuous arrhythmia. Every beat is abnormal, not just some of them. Diagnosing afib without an ECG is surprisingly easy: Just feel your pulse. Feel it for about 20-30 seconds, and if what you feel is completely lacking a coherent rhythm, with the timing of each beat completely unpredictable from the last, that's afib. It's an completely irregular heartbeat with no discernable rhythm.

Feel your pulse while you're sure you're not in afib. Notice how there's a rhythm? You can tap your foot in time with the beats. Afib isn't like that. You can't tap your foot to it because when the next beat will occur is completely unpredictable.

Or you can spend a few bucks and get a Kardia device and it will tell you.

I get it. Thanks for explaining it so well.

And also... now that I know what I'm experiencing are PAC's, I'm wondering why I'm getting episodes of them that last, sometimes, for hours. I can't sleep, my heart is pounding and I feel like I drank 3 espressos (I don't use coffee). Is this afib trying to break through? Is this because I'm getting older (79)? Should I take an extra beta blocker? Should I worry?

No, you should not worry. PACs present no risk to you whatsoever.

Talk to your cardiologist about what you can do about it. Increasing your beta blocker dosage might be an option but be careful about doing that on your own.

By the way, is your cardiologist an electrophysiologist (EP)? If not, you might want to consider finding a good EP. They are cardiologists with additional training in treating arrhythmias, which is what you have. General cardiologists often aren't so good at keeping up with the current science and medical guidelines on afib.

Mel-O

It really kind of depends on how frequent the PAC's are. In this file are a lot of heart rate vs time graphs (NOT ECG's) that a member from the UK sent me years ago.

I'll try to visually show what Carey is saying.

In this graph, there are many PAC's (which show as fast beats) and most are followed by slow beats or compensatory beats. These are actually normal beats, but show as slow as they start "early" as the PAC is fast. Not all PAC's are followed by a compensatory beat. If you are feeling this with your pulse, it might still feel pretty random. Marked with arrows, there are some completely "normal' beats.



In this graph, afib is shown on the right, along with one isolated PAC and an isolated PVC. You can see how random it appears.


Even with an ECG, unless you plot out the beat length times, it can sometimes be hard to see just looking at the ecg. If there are more normal beats than what is shown in my example above, it is easier to see (or feel) the more isolated PAC's.

Yes, you can feel the quivers...or at least I do. They're commonly called 'palpitations'. They seem like a flutter or a nudging in the left chest wall. People say they're having palpitations as if they are the fibrillation or the flutter. Palpitations are the sensation only, and only a fair indicator of an arrythmia. You can also have quivers or spasms of the intercostal muscles, the muscles between the ribs.

You may have noticed that the better, more empathetic, and helpful, physicians actually pointedly ask you how you feel, and what you feel when you're having fibrillation. This is a BIG part of holistic medicine...finding out what the effect is on the patient. Doctors do try to alleviate symptoms, and if you are having a lot of palpitations, and if they interfere with your life, then by all means let a competent physician know.

There are a couple things you might try to manage your PACs :
- Sometimes, lowering your carbohydrates intake may help.
- Calcium in excess (what is "excess" is individual) can be bad. Reducing it (milk, cheese...) is worth a try.
- Magnesium supplement may help too.

I wouldn't increase the dose of BB.

Many thanks for all the helpful comments here. I am finding the forum very informative.