A few weeks ago I had my annual checkup with my local EP. He’s a terrific doctor and someone I thoroughly enjoy talking to. He’s always so gracious with his time and very easy to talk to. This last appointment was no different.
Before my appointment with him I had an echo done. This wasn’t required as I had one last year but I demanded to have another one. I’m a bit of a hypochondriac and since I’ve been having so many PVCs and PACs this past year I wanted to have one done just to make sure my heart was doing o.k.
I was an absolute nervous wreck the days leading up to my appointment because I was certain the PVCs and PACs I had been battling the past year were causing damage to my heart. Did I mention I was a hypochondriac…lol? Actually, I’m not really that bad except when it comes to my heart. Watching my dad die from heart failure just a little over a year ago really made me a paranoid person when it comes to my heart so I always think and assume the worst. I fully admit I need to work on adjusting my mental attitude with regards to my heart, by the way.
My nerves got so bad that the 24 hours leading up to the appointment I had the worst PVCs and PACs I’ve had to date. My AliveCor monitor was showing 12-15 PVCs and PACs per minute at times. My heart felt like it was going to explode out of my chest – and it was pretty much nonstop. I was having problems sleeping too because my heart was pounding so much. It was awful.
When I lied down to have the echo done my heart was still pounding out of control so I told the technician that she’s probably going to notice my heart jumping all over the place. She just smiled and said that was perfectly fine and she said that they wouldn’t affect anything she was going to do.
The echo didn’t take long to complete, maybe 20 minutes at the most. My appointment with my EP was about an hour after the echo so I had some time to kill. I went out to my car to have a quick snack and to try to relax before my appointment with the doctor. The break helped as my nerves and heart settled down a little but I was still a wreck.
Talking to the Nurses
Before my doctor came into the room, a nurse came in to do all the preliminary things like take my heart rate and my blood pressure. Both were perfectly normal: 70 bpm & 114/68 respectively.
The nurse also did an ECG. Normally they only do a 30-60 minute print out but because I was having so many PVCs and PACs, he did a full 4-minute print out. I joked to him, “You’re going to run out of paper.” The nurse didn’t tell me anything other than he could confirm I was having PVCs and PACs.
After that was all done, the main nurse came in to talk to me for a little bit. She was also very nice and easy to talk to. She looked at the ECG and just said that I was having PVCs and PACs but she wasn’t concerned about anything. While they may feel awful, she said, I wasn’t having so many that she was concerned. That was a relief.
And like she told me last year, she said I could take a low dose of Flecainide (50 mg) “as needed” or even on a daily basis if I desired. She said a low dose of Flecainide is usually very effective at settling down PVCs and PACs. I told her I would certainly consider it so I asked her to prescribe a month’s worth of Flecainide.
My Talk with My EP
After my brief talk with the nurse, my EP came into the room. I felt bad for him because I was the last appointment of the day (5 p.m.). I hate being the last appointment of the day because you never know what kind of mood the doctor is going to be in after talking to patients all day. My doctor was a real pro, however, and he was just as fresh and happy as if I was his first patient of the day! And he didn’t rush me either. He gave me as much time as I needed, which ended up being about 45 minutes.
The first thing he told me was that my echo looked great! He said my heart was perfectly healthy and strong. My ejection fraction was 60-65%, which is about as good as it gets he said. He said anything over 50 is considered normal and anything in the 60-65% range is considered ideal. Instantly I felt a ton of weight lifted from my shoulders!
He then looked at my ECG and repeated what his nurse said. I was having a fair amount of PVCs and PACs but they were benign and I had nothing to worry about. He also reiterated the advice his nurse gave me, which was to take a low dose of Flecainide if my PVCs and PACs are really bad.
I asked him about taking a beta blocker to tame these PVCs and PACs and he didn’t advise that because of the side effects. He joked that if he prescribed a beta blocker, I would probably be very mad at him and curse him out. He said the primary reason being that they can make you very tired. He said it wasn’t worth “knocking me out” just to knock out the PVCs and PACs.
In his experience, he has found low dose Flecainide to be the most effective when dealing with PVCs and PACs. Given my disdain for any of these heart drugs, which my doctor is well aware of, I told him I would think about taking the Flecainide. We both chuckled as we both knew that was code for, “Thanks, but no thanks. I probably won’t take the Flecainide.”
He then demonstrated how PVCs and PACs work using a heart model that was sitting on his desk. He showed me how a normal heart works and then what happens when you have PVCs or PACs. What happens is a single cell in the atria or ventricles triggers a beat when it’s not supposed to. It’s basically a rogue cell that beats out of turn. It’s “defective.”
What I was fascinated about the most was that it was a single cell causing all this trouble. When you have a number of PVCs and PACs, it doesn’t feel like one cell is causing all the trouble. It feels like multiple cells in your heart are revolting!
He said the good news is that in his experience, 50% of the time PVCs and PACs will go away on their own within two years. What usually happens is the defective cell will either die or repair itself. I’m hoping this will be the case for me!
What’s Next
You’re not going to believe this, but within an hour of my appointment – the time it took for me to drive home from my appointment – my heart completely calmed down. The nonstop PVCs and PACs I had been experiencing the 3-4 days prior was history. It was like a switch was turned off and the PVCs and PACs just shut down. This totally confirmed that my PVCs and PACs, especially when they get really bad, are totally stress-induced!
It’s been three weeks since that appointment and other than an occasional PVC or PAC here and there, my heart has been totally calm. It’s possible I’m still having regular PVCs and PACs and I’m just not feeling them. I don’t know because I haven’t been using my Kardia monitor.
I’m fearful if I use the monitor and I discover that I’m still having as many PVCs and PACs as usual it might stress me out and make things worse. As long as I hardly feel them and my heart is mostly calm, I’m good. Sometimes ignorance is bliss:)
I’m just so happy and grateful to God that despite my occasional battles with PVCs and PACs, I’m afib-free and my heart is healthy and strong! Unless something unexpected happens in the next year (i.e. my atrial fibrillation returns), it should be a quiet and peaceful year as far as my heart goes (knock on wood).
Hi Travis ,
I had my 1 st ablation last August 2016 for atrial fib,
However various degrees of fast heart rate later , I have just had my 2 nd ablation 23 rd Feb 2017.
Totally different to last time .
Only 1.5 hour procedure as opposed tom6.5 last time .
He re isolated some breakthroughs with my pulmonary veins and found a random a fib with my neck vein .
I was regular heartbeat after procedure until Monday this week , 4 days after procedure, where I feel dizzy and am having missed and extra beats which are quite alarming as I didn’t have those last time.
Is this normal ?
Very anxious and dissapointed that it hasn’t worked
:(
Melanie, May I ask who did your ablation? Im hearing more and more from the ablated that certain EPs have greater success rates by as much as 25-40%. This can mean everything when we are dealing with percentages of 50-85% success rates. If I do decide to go the ablation route, I will spend the extra dime and pay a visit to Austin TX.
Melanie:
I wouldn’t get too anxious just yet. I know that’s easier said than done but you are only a week or so past your ablation. As you know, the blanking period (i.e. the recovery period) is three months (and sometimes longer for some people).
Give it a little more time before declaring it a disappointment. Hang in there!
Travis
After reading various articles and comments on the internet concerning Afib and PVCs and PACs and magnesium I started eatting food high in magnesium and found that it does help stop the PVCs. My Cardiologist said yes they tell patients to take magnesium supplements (no one told me) but he didn’t tell me what kind to take so I bought Mag oxide which I now read is not well absorbed. Is there a recommended magnesium supplement?
Your website is appreciated.
Cantrell:
The best forms of magnesium include:
magnesium glycinate
magnesium chloride (both liquid and spray)
If you take a magnesium glycinate supplement, you want to be sure it says “Albion” or “TRAACS” on the label. This is a proprietary form of magnesium that is pure and of the highest quality. Also be sure you take a pure form of magnesium glycinate – that is, one that isn’t combined with calcium or other minerals. You want simply magnesium!
For the magnesium chloride liquid supplement I recommend ReMag. Just Google it and you’ll find it. For magnesium chloride spray, I recommend EASE.
I personally only take ReMag and EASE. They absorb well and I can take high doses if necessary without getting loose stools or an upset stomach.
I wish you well!
Travis
Hi Travis,
Thanks for the information on Magnesium. I was just advised by one of the cardiologists who did my cardioversion last week to take this supplement. I bought Jamieson Night Magnesium, not knowing at all what to look for. Not even sure i should be taking this kind as it helps you sleep. I only took it once as the box says if taking blood thinners or have high blood pressure consult your health care provider. Given that the cardioversion worked only for two days and i am once again back in AFIB any and all help needed.
Thanks again for your blogs. This site is really helping me by providing excellent information and i love reading everyones experiences. It really help to know i am not alone with this dreaded condition.
Regards,
Kathy
Kathy:
I would not recommend that specific brand of magnesium as it’s primarily magnesium oxide, which is an inferior type of magnesium. The problem with magnesium oxide is that it isn’t absorbed very well. You want to look for a magnesium chelate such as magnesium glycinate or even magnesium citrate.
I actually use magnesium chloride liquid. The oral magnesium supplement I use exclusively is called ReMag. I also use a magnesium spray called, Ease, from time-to-time as well.
If you go the magnesium glycinate route, make sure it has Albion/TRAACS magnesium.
You should also know that the magnesium product you’re taking now has melatonin in it. You may or may not want that as an added ingredient. A dedicated magnesium supplement would be best. If melatonin is needed you could take that as a separate supplement.
Travis
Thanks Travis.
Hi Travis,
Thank you so much for your blog, it is very helpful and reassuring.
My story, in brief, is that I have had PACs and short atrial runs of up to 30 seconds or so (documented as SVT) for the last 7 years. However, this year the PACs turned into an episode of paroxysmal afib (confirmed in hospital) which self-terminated after about 3 hours.
As I suffer daily with multiple blips, bumps and runs, this episode scared me into realizing my fear of afib in the long run.
I sought the help of a well respected EP and he agreed that my holter monitor results were “all over the place” and that he would do an ablation study and afib ablation if he could capture it. I had my ablation on 9th September this year and, although I thought SVT would be the culprit, he could not induce it but afib was induced elsewhere! He feels my problems are due to atrial tachycardia.
I am still having PACs and runs (maybe SVT). I take Diltiazem and Xarelto, which I hate! I see the nurse at the afib clinic in 2 weeks but don’t see my EP until end of March.
Your last blog about panicking before your appointment and during the echo sounds just like me! During my last echo my heart was beating 120 bpm and is normally 60-70! I wondered if, with all your experience of bumps, bangs and blips you had any ideas as to what I might be in for!
Hey Jane. Since you’ve only had one afib episode, it’s very likely your echo will turn out normal – or close to normal. If you’re having thousands of PVCs or PACs per day (we’re talking 20,000+) or suffer from persistent afib, then there is a good chance they’ll discover a slight enlargement of the left atrium. This doesn’t sound like you, however, so I wouldn’t go into it expecting anything bad:)
After you have it completed, it would be great if you could give us an update!
I wish you well.
Travis
Hi Travis, thanks for your reply. I had an echo roughly one year ago and all was normal even though my PACs had been at their worst during the months leading up to it and you’re right, I have less than 20,000/day.
I will update in March when I have seen my EP and, in the meantime, will try not to get discouraged!
I’m pleased to hear that your heart is behaving itself lately!
Jane
Thanks Jane! If your last echo from just a year ago was normal, you should be very confident that all will be normal this time around as well. I look forward to your update.
Have a Merry Christmas and a Happy New Year!
Travis
Hi Travis,
I said I would update you after my 6 month post ablation visit to my EP so here goes! He is very confident and satisfied with the procedure and suggested I discontinue the Diltiazem (which helped my pacs considerably). I discontinued it for about 4 days and instead of the random daily, bearable pacs, short runs, etc., I got an episode of pacs every other beat, every 3 beats, every 8 beats – you understand! So I took Diltiazem again for a few days. I missed one dose (on purpose) and here they come again.
My next appointment is in October and I don’t want to go whining back to him before that as I know there are way worst cases than me! However, I feel all of these blips so in the meantime, I wondered with all your experience and research of pacs, pvcs etc., if you think my procedure most likely has failed?
My main concern is that when I went to the hospital with my first and only afib episode so far, the doctor confirming afib said that pacs eventually lead to afib. Is this true?
I am also going to send off for some ReMag even though my magnesium showed normal on a regular blood test. I understand that this test is a waste of time.
Thanks so much for your help!
Jane
Hi Travis and glad things went well for you. Thought I would update with my latest. I did really well for the first 12 weeks after the ablation. A few blips every now and then. Had a stress test and Echo at week 10 and all looked great.
The only thing I still have is intense chest pressure right in the middle of the chest and sometimes into the stomache and now it isn’t constant. I have an Endoscopy tomorrow 11/21 to make sure the esophagus and stomach are okay. After that not sure if all is fine.
Week 12 happened and this past Thursday night I had 2 hours of afib and then Friday night 4 hours, Saturday 2 hours. I took a protocol of Hawthorn Berry and afib tonic which really calmed things done quickly. Dr. had cut in half my Toprol and Tikosyn and after 2 days of the half Tikosysn is when all the afib started again. Will see now what the next steps will be.
I love my EP and he has the credentials listed in the Beat Your A Fib book so prefer to stay with him. Out of all of this I have had Vertigo so do therapy once a week plus exercises for that and lo and behold after an audiology test now have tinnitus in the left ear!! Seems like these 8 months have been traumatic yet at the same time now I know what to watch for and what really I need to go to the ER etc about.
Getting past the trauma and being on high alert all the time has been difficult yet I keep working on staying positive and stopped limiting what I do like the travel in order to see any family members. I hear you when you talk about monitors – when I have been on them and all the tests always are just wonderful!! Now if I could have something immediately when the chest burn and fullness occurs or anything else that might be interesting.
I trust that God is taking care of me and the angels watch over me and I am learning to trust more when my gut tells me something too. Talk to you soon and thanks again for all the support you provide. Have a wonderful Thanksgiving too. Carol
Thanks so much for this post. I had an ablation one week ago and was looking for support and other people’s experience. Now I have a better understanding of the ups and downs post procedure.
Hey Jackie! Congrats on your ablation. If you have any questions as you go through the next 3-month blanking period, let me know! I wish you well.
Travis
One week post ablation. Had a few instances of accelerated HD over 100. For the most part I am between 72-82. Before I used to be mostly 55-65. I still feel as if I am groggy. Dr. Office says it is not unusual. My procedure was done at Inova Hospital Heart Center, in Fairfax VA. My EP was highly recommended Arrhythmia Specialist. I am still on Eliquis and Beta blocker I was on before the procedure. I feel so tired I am beginning to wonder if I made the right decision and if my vitality will come back. I guess it will be a while before I can resume my exercise routines. Your blog is a blessing. Thanks for sharing
Hi Travis. Post 4 months after my ablation went to see my EP following 3 weeks on the portable HR monitor. He said there were no indications of afib during that period and I continue to feel great with minor occasional palpitations. Watching my diet, avoiding potential triggers, etc.
He wants me to have another round of HR monitoring in 4 months. Is that the norm? Thanks for all the great info you put out there.
Jacqueline:
Congrats on your successful ablation. That’s awesome! Every EP will have their own post-procedure follow up process. My EP had me do a heart monitor only once after my ablation (can’t recall when that was – I think it was around the 3-month mark). Like you, nothing was detected so he didn’t feel any other monitoring was required unless I reported any issues.
Having you do another round of heart monitoring seems very reasonable. I’d be reassured, actually. You’ll have confirmation then that everything is A-o.k.!
Travis
Carol:
Great to hear from you, Carol! I hope the endoscopy went well today. Sorry to hear about your recent episodes. If you continue to get episodes you may need to consider a 2nd “touch up” ablation. As I’m sure you know, most of us afibbers need 2 and sometimes 3 ablations to put the beast to bed completely. If you go for a 2nd procedure, please let me know. It’s imperative you are working with the most experienced EP – and by experienced I mean they have a long track record doing complex ablations.
I’m interested in what you’re doing for your afib protocol/tonic with Hawthorn Berry. How much are you taking and what kind are you taking when you have an episode? And are you taking anything else with the Hawthorn Berry?
I wish you well and have a Happy Thanksgiving!!
Travis
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