How to limit PACs/PVCs

I am sure this topic has been visited as nauseum so my apology in advance.

I am gonna sketch this out and hope some with more knowlege fill in blanks

1- electrolytes- namely K+ and Mg+ How much?

2- Taurine- 2-5 grams?

3- Omega-3- It may help- 2 grams

4- L- arginine?

5- not sure if carnitine, coQ10, or D-ribose helps here

6- decrease stress

7- maybe actually some exercise to get in shape and fit which inludes lose weight if needed

8- cessation of habits such as smoking and excessive drinking




Am I missing anything here and dosages uncertain in some. Thanks

Gregg, the only thing that i know about that is good for stopping ectopics is to raise your potassium intake to our government's RDA of 4700 mg each and every day, from foodstuffs and supplementation combined. Use the free nutrient calculator at www.fitday.com and supplement to make up any deficit. Do not use bananas or white potatoes as a K source, they both have enough glycemic load that the insulin your body is forced to make to deal with them uses up more K to make insulin with than they provide. Read the Conf. Rm. Proc. session where Hans describes getting ahead of the PACs after his Bordeaux ablation. It is called the PACtamer. You are not the first to deal with this problem. I cope with this a lot myself, and potassium supplementation is the only effective thing i have ever found.
PeggyM

Gregg,

The issue a shortened effective refractory period (ERP). For PAC's, obviously atrial ERP or AERP. This has been mentioned in the CR several times. See [www.google.com]

More background is here: <[scholar.google.com] effective refractory period&um=1&ie=UTF-8&sa=N&tab=ws>

To your list, I'd add - tight blood sugar control. Ideally, your Hba1c levels should be less than or equal to 4.5%. With a glucometer, fasting blood sugar should be less than or equal to 85 mmol/L (4.7 mg/dL). Testing 45 minutes after meals (generally the max after a meal unless there is delayed stomach emptying) should be no more than 100 mmol/L (5.56 mg/dL) or less. If you stick to these parameters, you will also reduce the probability of hypoglycemia. This tight blood sugar control will moderate K+ & Mg++ wasting. See Bernstein (http://www.diabetes-book.com/) for tight blood sugar control diet. Not all home glucometers are very accurate. The Bayer Ascencia Contour is one that has accuracy in the +/- 3 mmol/L range. These can be had inexpensively on eBay, as well as the test strips.

Additionally, I'd add poster George Eby's suggestion about testosterone. See [george-eby-research.com] <[www.afibbers.org]; & more of George's posts are here in this search [www.afibbers.org] George is really the PAC king as in addition to afib, he's been the subject of 1,000's of PAC's/day. He is very creative and has spent a huge amount of effort to control his condition.

"1- electrolytes- namely K+ and Mg+ How much?"

K+ = as Peggy suggests, 4,700 mg/day elemental in a combination of supplements and food. Potassium gluconate powder [www.iherb.com] is a common source around here as it is less prone to cause stomach issues. I also season my food with potassium chloride powder & use personally use potassium citrate as the citrate has been demonstrated to help prevent kidney stone formation.

Mg++ = up to bowel tolerance levels & back off. Mg has been a huge issue for many of us-me especially. Mg Glycinate is the most bioavailable form. MgCl2 in a supersaturated solution (magnesium oil) is good for transdermal application. To acquire this in bulk form, I went to the trouble several years ago of having a "Nigari" tested for heavy metals. Nigari is used by the Japanese to coagulate tofu and is 95% MgCl2. The brand I tested with a mass spectrometer is Mitoku nigari. The test results are here: <[www.afibbers.org]; Here is a source for the nigari [www.naturalimport.com]. Ideas on transdermal application are here: <[www.enzymestuff.com];

George

Gregg - Have you checked out Hans' recipe called PAC Tamer?

I shortened that to just using extra potassium gluconate because don't eat large enough quantities of food to get even close to 5 grams a day of dietary potassium. When I do not supplement, I have breakthrough AF.

I need to qualify though and say that it's essential to know if your intracellular magnesium levels are at the higher end of the range. Exatest is the only known accurate measurement of IC magnesium. Otherwise, adding too much potassium with low IC Mg will just make afib/ectopy worse. Magnesium is the key as a base and then it's up to the potassium.

The salt factor should be mentioned as well...as stated previously...important to keep that sodium intake low and have at least a 4:1 potassium to salt intake.

After my two years of post ablation breakthrough... all driven by stress and low Mg and K+, I also added more carnitine, CoQ and ribose. Separately, so I'd know which might be most influential. Probably it was synergy, but I found the ribose to nail it for the stability factor. I used to have occasional runs of sinus tachycardia and that has virtually disappeared as well; now it's rare.

Since you are a runner, don't ignore the high antioxidant property of CoQ... The lower doses may not be adequate for you if you run every day and generate those damaging free radicals that keeps heart tissue irritated.

My regimen is
Mg - 600-800 daily divided doses magnesium glycinate (Albion chelate)
K+ - at minimum, 3 teaspoons K+gluconate powder = 540 mg/teaspoon.
More or less depending on food intake.
N-3 - 4 grams a day
CoQ - 200 mg along with the N-3.
Carnitine - Acetyl L Carnitine, 1000 mg, GPLC, 1000 mg
Ribose - 1 tsp. = 5 grams twice a day before and after exercise total 10 gm
B-complex... high dose.
Gamma E with the N-3 - 400 IU
Tocotrienol (specific form of E) - 100 mg evening or bedtime
Vitamin C 2000
Vitamin D3 10,000IU a day
Vitamin K2 45 mcg
Potassium iodide - 5 mg
Resveratrol 200 mg
NAC - 900 mg 3 or more a day
Essential oils from plants that are high in ORAC - antioxidant properties
Digestive enzymes and betaine HCl with every meal
Probiotic - high dose large range population 1 at bedtime
Nattokinase - 4000 IU divided doses

Plus... I take other supplements for thyroid, adrenal, blood glucose, handling and eye support that probably are also synergistic for heart health but too numerous to mention and I've probably forgotten something since I typed this quickly in response.

Jackie

Yeah, I knew I'd forget - Taurine 3 grams a day.

For some, digestion can play a big role. The whole issue of paleo diet addresses a number of items - potential food sensitivities like gluten/gliaden, casein and soy. Food additives such as MSG and glutamates and also blood sugar.

In my own case, though sex has never been a trigger, the vagal aftermath of sex can precipitate PAC runs that could initiate afib. My own experience has been that optimal magnesium supplementation will fix this problem.

More background Mg++/K+ & insulin information is here, with some interesting sections copied & reposted:

From [www.afibbers.org]

Autonomic Nervous System
Mg is required for activity by the cholinesterase enzymes(13). One of these, acetyl cholinesterase degrades acetylcholine, the neurotransmitter substance for the PNS and for the first part of the sympathetic nervous system (SNS), specifically the nicotinic receptors of the SNS. In fact, deficiency of magnesium and excess calcium both increase the release of acetylcholine. Deficiency of either magnesium or calcium prolongs the effect of acetylcholine(58). Mg deficiency translates to enhanced vagal tone further augmented by too much or too little Ca.

Catecholamine-O-methyltransferase (COMT) and monoamine oxidase (MAO) catabolize (break down) norepinephrine (NE), the neurotransmitter for the rest of the SNS. However, unlike acetylcholine but like glutamate, neuronal reuptake of discharged norepinephrine is a major mechanism for terminating sympathetic neurotransmission (see glutamate discussion above). MAO catabolizes this NE, while COMT is more active in catabolizing extracellular circulating (humoral) catecholamines secreted by the adrenal gland(30). Both are part of the SNS. COMT requires Mg as a cofactor(28,29). Neuronal reuptake also requires ATP (and Mg). Low Mg
translates to higher sympathetic tone(105). These enzymatic shortfalls might produce an exaggerated response of either the PNS or the SNS at transition or crossover points, a time when many VMAF episodes arise, e.g., lying down or bending over. The neurotransmitter substance or hormone secreted on each occasion is not degraded or removed, resulting in a prolonged over response. For example, cocaine blocks dopamine reuptake leaving more dopamine in the synaptic cleft, which results in over timulation of the D2 receptors (causing schizophrenic episodes)(106).

Sexual activity triggers some episodes for many afibbers(72). In addition to MAO breakdown of dopamine within neurons (neuronal reuptake) COMT breaks down circulating dopamine, an important hormone produced at this time. The dopamine no doubt triggers automaticity (associated with beta-1 receptors) in ectopic foci with a resulting increase in PACs (see EP discussion below)(107). The over responding vagus causes a shortening of the AERP. Mg deficiency in this scenario (independent of K) may be causative in bedtime episodes and even some more typically adrenergic episodes.

GERD
The “alkaline tide” precedes the start of any meal. This is caused by gastric cell secretion of H and Cl into the lumen for digestion of food and simultaneous extrusion of K and HCO3 into the blood. This more alkaline blood causes bicarbonaturia (HCO3 in urine) to lower this pH (blood pH is tightly controlled between 7.35 and 7.45). Unfortunately, K(54) as well as Mg(104) are cations lost in the urine (kaliuria and magnesuria respectively) along with the anion HCO3. This lowers blood K, although not necessarily below lower limit of normal. Furthermore, there is evidence that high vagal tone may sustain basal gastric acid hypersecretion in some persons and temporary hypersecretion during stress in others(49). Some cases of GERD (gastroesophageal reflux disease) and non-ulcer dyspepsia (NUD) probably result in transiently low K via the constant steady alkaline state (in plasma) that accompanies the slightly hyperacidic state (in the stomach). The K/H pump also rectifies this increase in blood pH. H goes into the blood and K comes into the cells. Again this requires cardiac muscle cells to maintain their intracellular K concentration against a greater gradient. Also, greater concentration of K within renal tubule cells contributes to increased renal secretion of K into urine. Normally the concentration of K within heart muscle cells is 150 millimoles/liter (v. four mm/l outside the cell), a considerable gradient (almost 40:1) to maintain(9). Ingested protein stimulates more HCl secretion (and a stronger alkaline tide and greater kaliuria).

Other suggested mechanisms for GERD related episodes of LAF include stimulation via irritation of the vagus nerve during episodes of reflux and/or gastric distention. Some VMAFers associate their episodes with GERD(72). Curiously, many of them prefer to sleep on their right side (right lateral decubitus position). Vagal tone is increased while in this position(67). This is because the heart is slightly higher (v. the left side position) relative to the carotid baroreceptor. This pressure receptor in the neck senses more hydrostatic pressure and signals the vagus nerve to increase tone (bad for a VMAFer). However, the preference may be because this position promotes gastric emptying (our stomachs pass their contents to the right and dump them into the duodenum) and possible relief for a GERDer.

Dysinsulinism
Those with impaired glucose metabolism hyper respond with insulin (produced by the beta cells of the pancreatic islets) to a carbohydrate meal (target cells are insulin resistant). The ensuing hypoglycemia (low blood glucose) stimulates release of glucagon (produced by alpha cells of the pancreatic islets) and catecholamines with consequent hyperglycemia (high blood glucose) with a kind of yo-yo effect(72). Catecholamines but especially glucagon stimulate glycogenolysis (breakdown of glycogen, the storage form of glucose) and gluconeogenesis (release of glucose from cells that store glycogen), most notably from the liver. Gluconeogenesis involves enolase and magnesium is required as a cofactor(91). In fact five of the other eight steps in gluconeogenesis also require Mg(94). It appears that Mg is critical to the proper function of glucagon and catecholamines in this area.

There is an epidemic of overweight/obesity in the Western world, especially here in America. Syndrome X (or Metabolic Syndrome = includes high blood pressure, obesity, diabetes, high blood insulin and triglyceride levels) represents the far end of the spectrum of this disorder of carbohydrate metabolism. Useful laboratory tests include serum hemoglobin A1C, which will detect large swings in blood glucose levels over the preceding three months. Fasting blood glucose and then an OGTT (oral glucose tolerance test) are the best tests to diagnose impaired glucose tolerance and diabetes mellitus. Mg deficiency plays an important role in this process (see
insulin section above).

Postprandial (after a meal) reactive hypoglycemia (PRH) is defined as low blood sugar (less than 3.3 mmol = 60gm/dl) concurrent with symptoms (dizziness, depression, sweating, weakness, hunger, anxiety)(82,83,89). LAF has recently been added to this list(84,85,86). Although the oral glucose tolerance test (OGTT) is not abnormal

WOW great stuff guys. Jackie my Mg was 2.1 when last checked( I know not exatest) and my K was 4.3. Both of these were before I started either Mg or K. Yes I am using Taurine too. It seems that at 99mg of K in store, impossible to achieve it that way. Better to do tamer maybe.

"Better to do tamer maybe" or just the K gluconate powder linked in my post above - the very simple answer. In addition, if your stomach doesn't care, KCl powder is readily available in the spice section of the grocery. If you go this route, make sure it is just KCl - some store brands have glutamates & other stuff in their product. Also, the pure NOW brand KCL powder is available here:
[www.iherb.com]

As you point out the serum Mg is really not of great use. Jackie also always points out to start with Mg and then add K, as the K needs the Mg.

Gregg - Lots of posting history here about the fact that serum magnesium is not reflective of intracellular levels and most likely, yours was serum. Extracellular Mg accounts for only about 1% of total body Mg. It's the intracellular magnesium that helps with the cardiac function and keeps us out of afib. Even the Red Blood Cell magnesium is not fully useful for our needs here.

That leaves the Exatest. (see www.Exatest.com) and go into the research for the description. A number of afibbers have Exatest and virtually all tested low....so we are just assuming most afibbers are low; hence the supplementation. Testing would be good, though, to learn if you are making any progress with the supplementing because without a good IC level, the potassium won't function 'as advertised' for your ectopy.

The Exatest is expensive, although some insurance plans covers it, and it's a hassle to find a doctor to order and do it, but since you have the inside track on that, you could order it and do it yourself. I did my own cell scraping collection but ordered it through my chiropractor who was a Medicare participant at the time. Just do a search here for the word Exatest and you'll pull up a number of posts on this topic or email me if you like.

Testing aside, one of the magnesium researchers I follow says to just assume that most patients will be magnesium deficient (based on typical magnesium deficiency complaints or conditions) ...she doesn't have access to Exatest because she's in Canada... and she just treats her patients with magnesium glycinate ... starting with low dose and titrating up until the tissues are saturated. The cardinal sign of tissue saturation with low and slow dosing is reaching two soft bowel movements a day. Too much, too fast yields diarrhea which does not mean you are optimal intracellularly.

Now to clarify any confusion, serum potassium is the one to measure.

I'd order the bulk powder potassium gluconate here from Hans - you won't easily find it in stores.[www.iherb.com]
It's easy to use unless you are dining out and then you just have to carry 6 tablets with you. That's what I do. Otherwise, the bulk powder is handy.
I filled an empty salt shaker with the potassium powder and add that to food as it is slightly salty and I get a bit more that way as well.

Jackie

LAF forum- FREE

Kguconate 4 pounds- $42.24

INFO from Jackie, Hans, George, others- PRICELESS

Gregg,

You may be interested in this abstract from the May 2009 issue of The AFIB Report:

"Afibbers are magnesium-deficient
HARTFORD, CONNECTICUT. Magnesium (Mg) is an enormously important mineral being a cofactor in over 300 enzymatic reactions continuously taking place in the body. Magnesium is also a vital component of the skeletal structure and about 65% of the body’s magnesium stores are found in bone, another 34% is found in transcellular fluids, and the remaining 1% is found in extracellular fluids such as blood. It is thus clear that measuring magnesium in blood serum is not likely to be a very accurate measure of the body’s overall magnesium status.

There is increasing evidence that magnesium plays a crucial role in preventing and terminating cardiac arrhythmias. A group of cardiologists and pharmacologists at the Hartford Hospital reasoned that a pre-procedure infusion of magnesium might help prevent the acute development of atrial fibrillation following a radiofrequency ablation for this disorder. As a first step in proving or disproving this hypothesis, they decided to do a trial in which half the participants would have saline solution (0.9% sodium chloride) with 4 grams of magnesium sulfate (800 mg elemental magnesium) infused over a 15-minute period just prior to accessing the left atrium in a standard PVI procedure, while the other half would just have a saline solution infusion.

The trial involved 22 patients with paroxysmal or persistent afib. Samples of venous blood (for determination of extracellular Mg concentration) and buccal scrapings (scrapings from inside the cheek) were collected before the start of the procedure, 15 minutes after the completion of the infusion, at the end of the ablation procedure, and at 6 hours after the infusion. The blood samples (serum) were analyzed for extracellular magnesium concentration and the buccal scrapings were analyzed (using the EXAtest) for intracellular magnesium concentration as well as for concentrations of calcium, potassium, sodium, chloride, and phosphate. At least one study has shown that there is an excellent correlation between the magnesium (intracellular) content of buccal scrapings and that of myocytes (heart cells). The major findings are as follows:

• None of the study participants were deficient in Mg at baseline when considering blood serum values only. The average serum Mg concentration was 2.08 mg/dL versus the normal lower limit of 1.6 mg/dL.

• The majority (89%) of participants were magnesium-deficient at baseline when considering intracellular (EXAtest) values only. The average intracellular Mg concentration was 32.2 mEq/IU versus a normal lower limit of 33.9 mEq/IU. NOTE: The unit is defined as x-ray intensity (peak divided by background) divided by unit cell volume.

• There was no correlation whatsoever between serum magnesium and intracellular magnesium concentrations.

• Serum levels of Mg rose rapidly in the magnesium infusion group 15 minutes post-infusion and, although declining over the 6-hour observation period, remained considerably higher than the level in the placebo group (saline infusion only).

• Intracellular level of Mg increased rapidly in the magnesium infusion group 15 minutes post infusion and continued to rise throughout the 6-hour observation period. Somewhat surprisingly, the intracellular Mg level also increased somewhat (over baseline) in the placebo group over the 6-hour period. The Hartford researchers speculate that the ablation procedure itself, most likely the anaesthesia, facilitates the transfer of magnesium from serum to intracellular space.

• The intracellular calcium concentration increased significantly in the Mg infusion group post infusion, but gradually reverted to baseline over the 6-hour period.

• The intracellular potassium concentration increased by about 50% from baseline to the end of the PVI procedure and then began to drop off at the 6-hour mark.

The authors of the report conclude that future studies are needed to evaluate the electrophysiologic benefits of magnesium repletion and the effects of routine procedures and anaesthesia on intracellular electrolytes.
Shah, SA, et al. The impact of magnesium sulfate on serum magnesium concentrations and intracellular electrolyte concentrations among patients undergoing radio frequency catheter ablation. Connecticut Medicine, Vol. 72, May 2008, pp. 261-65

Editor’s comment: A 2006 LAF Survey (LAFS-11) found that, among a small sample of 7 afibbers who had EXAtest results, all 7 were either below or very close to the lower normal limit. The Hartford report provides important additional evidence to support the conclusion that afibbers are likely low in intracellular magnesium even though their blood serum levels may be normal. It is also of interest that replenishing magnesium via an infusion not only increases intracellular Mg concentration, but also increases intracellular potassium levels. This is all good support for our long-held conviction that lone afibbers with normal kidney function are likely to benefit from supplementing with magnesium, potassium, and taurine (facilitates the uptake of Mg and K)."

Hans

Hi Gregg,

Thanks for the compliment.

For all who use supplements, I suggest trying Hans's Vitamin store here through iHerb [www.afibbers.org] He gets a small commission on sales and it helps support the cost of running very helpful site.

George

Thanks George and i am more than glad to support Hans in any way possible, the least we can do as a small measure to support what is the best website for this disease process!

My contribution...

Frequent PAC/PVC bouts, show up randomly and disappear randomly. What works for me most of the time.

In between
1. Get the proper amount of rest.
2. Eat a balanced and healthy diet.
3. Control stress? Who can do that? Moderate physical and mental exercise are both good.
4. Hyrdrate. I drink a lot of all natural fruit juice, LSV8, and water.
5. Fruits. I eat bananas, apples, clementine, etc. This works for me.
6. I also take one atenelol 50mg/day, 1 OTC prilosec. (Have had three afib episodes in last 5 years and moderate Hypertension).

When they come on
1. Immediate fruit intake, usually a banana.
2. Mg supplement
3. Lots of fluids
4. Moderate exercise
5. No kidding here...1-2 glasses of wine, white or red depending on my meal Not sure if the alcohol or the fact that I am mentally relaxing, but this SOMETIMES works.
6. I had dental surgery followed by a sports injury this spring and was prescribed Vicodin for pain...never needed them but in the midst of bigeminy/trigeminy and could not sleep with a big day at work coming up...I took one (think it was 325mg). Put me out in 30 minutes and the ectopics went bye-bye. Unfortunately, this is an extremely addictive drug so not a long term solution, but in this experiment of one, it did work.

I am M, 43, fit and in otherwise good health.

And this board is fantastic!