Premature atrial and ventricular contractions detected on wearable-format electrocardiograms and prediction of cardiovascular events

[academic.oup.com]

This information did not surprise me at all. More and more information that these ectopic heart beats may not be as benign in some people. I know they are not benign for me.

Benign or not, they are not pleasant.

They are most assuredly not benign. The 'normal' heart does not have perfect rhythm. There are pauses and extra beats now and then, a very few each day. But when one gets runs of several beats, and this happens three or four times each hour, this is a sure sign that there is disorder. I wasn't aware that I had ectopics except for AF, but after my first ablation in July of 22, I had many, many, PACs, and it was most unpleasant and unnerving. My blanking period was fraught with more AF, and it settled down to PACs. That can't be a salutary development, not the way my history shows. Second ablation, the EP watched my heart go into NSR after treating the third pulmonary vein...he didn't have to do any more, and he didn't have to cardiovert me, which according to him would be his normal practice. And, happily, no more PACs either. I feel they must be related.

This study makes perfect sense to me as well. I have always had PACs and have had a steadily increasing ectopic burden from 3%, to 13%, and now up to as much as 26%. As the burden increased, I began to have more sustained SVT, and now probable atrial flutter and maybe AF (waiting on official results). Seems connected. I agree!!

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MeganMN
This study makes perfect sense to me as well. I have always had PACs and have had a steadily increasing ectopic burden from 3%, to 13%, and now up to as much as 26%. As the burden increased, I began to have more sustained SVT, and now probable atrial flutter and maybe AF (waiting on official results). Seems connected. I agree!!

26% is a lot ! What's your EP's opinion about that ?

I still have to follow up sometime this week. My last Holter showed an average if 19% with hourly variations up to 46%. He will want another ablation but I am not sure what else.

One of my issues is with the title of the study, "Premature atrial and ventricular contractions detected on wearable-format electrocardiograms and prediction of cardiovascular events." I think a more accurate title would be, "Premature atrial and ventricular contractions detected on wearable-format electrocardiograms and association of cardiovascular events. The basic format is subjects got a 15 second, single lead, ECG, if there was one or more PAC's or PVC's, then that was marked as a positive. No PAC's or PVC's was a negative. Then they associated the positive and negative readings with events over the study period & calculated association probabilities.

A 15 second ECG sample is pretty short. The unstated assumption is if you happened to have one (or more) ectopics during that time, there is a high probability you have many more/day than someone who has a clean 15 seconds. I don't think that having one ectopic during the 15 seconds indicates you are going to get any of the events. Now it may be a low cost way to decide who should be tested for ectopics over a longer period (multi-day Holder or such) and perhaps testing for afib over a longer sampling period.

Starting around 19 years ago, I assumed that more ectopics were an indicator of the heart's "happiness" and that lower was better. Using R to R (beat to beat) recordings over 8 hours or so (normally during sleep to minimize artefact in the data), I could quickly count ectopics. I would use these counts as objective measures to tweak my afib remission plan. I did have one friend I coached and taught how to do this and she associated eating lots of carbs with a high PAC count. In her case, the high PAC count negatively impacted her physical output during intenser levels of exercise. For example skiing up to a hut above 11,000' or 12,000' elevation up a steep grade and with heavy gear. She found that restricting her carb intake lowered the PAC count materially and allowed her to function much better in these conditions. I'm certainly not suggesting this is anyone else's issue, but the concept of measuring and trying something different may be useful.

I have actually just recently made an association with gluten and have cut out gluten. At least for the last four days, my heart has certainly been less irritable. I will see how it goes, but it certainly doesn't hurt anything to try!!

George, maybe the statistical analysis they're hoping to use will show predictive validity in the measure, and not just 'association'. A simple regression analysis should do this, but they might have other plans in mind.