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I went a little long on this one but I had a lot of ground to cover!
In this Q&A episode a reader asks if I still battle PACs and PVCs after my ablation. She also asks how bad they are and if my supplements are helping. I answer all of her questions and I do a deep dive into what PACs and PVCs are, what causes them, how to tame them, and when to be concerned about them.
Here is a transcript of the audio/video:
Jules writes, “About six months after my second ablation, I experienced PACs and PVCs. I read on your blog that you’re still having issues with PACs and PVCs as well. Are they still giving you issues? Are they uncomfortable or just nerve-racking? And are the supplements you are taking, are they helping control these PACs and PVCs?”
Well, Jules, the quick answer to your questions are, yes, I’m still having occasional PACs and PVCs. So, yes, they are still giving me issues. Are they uncomfortable or nerve-racking? Definitely uncomfortable, not so much nerve-racking. And the supplements, I’m not sure if they’re helping or not. But we’re gonna unpack these answers in greater detail here in just a moment. Before I do that, let me first define what PACs and PVCs are because every time this topic comes up, when I’ve written about it in my blog in the past, I always get a flood of emails from people saying, “Well, what’s a PAC and what’s a PVC?”
I’m not gonna get real technical, so just bear with me, but I do need to take a step back and just explain what these are. PACs are premature atrial contractions, or sometimes referred to as premature atrial complexes or atrial complex. They’re also known as atrial premature complexes, or APC, and sometimes you’ll even have them referred to as atrial premature beats, or APBs. But in most cases, most doctors, you’re gonna hear PACs, premature atrial contractions. And what these are, these are premature or early beats that originate from the atria. So your heart is comprised of four chambers. You got the two upper chambers, which are the atria, and then the two lower chambers, which are the ventricles. An early or premature heartbeat that originates from the atria, those are your PACs. All right. So the PVCs, those are called premature ventricular contractions or premature ventricular complexes. And again, these are premature or early heartbeats that originate from the ventricles. All right?
So, what happens is these premature or early beats disrupt your heart’s normal rhythm, which is called… This whole cycle is called the cardiac cycle, and it originates from the SA node. And if you have… The SA node is the heart’s natural pacemaker, and it’s the SA node that starts this cycle, which is your heartbeat. And if you have a normal resting heart rate of 60 to 100 heartbeats a minute, you’re gonna have 60 to 100 cardiac cycles. The SA node is the pacemaker, so only the SA node should be dictating when a heartbeat occurs. Unfortunately though, the cells in the heart have the capability of firing signals that can also cause your heart to beat. And so if a cell in the atria or the cell in the ventricle fires when it’s really not supposed to, it disrupts the cycle and causes this premature beat. So you literally get a beat that comes early. It budges in front of the SA node signal, if you will.
So, what happens then is you have these palpitations. Another word for PACs and PVCs is palpitations or ectopic heartbeats or ectopy. These are all the same things, and basically gives you a sensation that your heart is pausing, skipping a beat, or intense heart pounding. Sometimes it can feel almost like you are at a loss of breath, like you’re trying to catch your breath, but on a very small scale. It’s not like you’re… It’s not intense like that, but you can feel this weird, “Oh, I’m catching my breath here.” All these sensations are palpitations, or ectopy, or PVCs and PACs, and they can be super annoying at times.
I’ve only had to deal with PVCs once prior to my ablation. I can’t remember how far before my ablation, but I remember the night specifically because I had to go to the urgent care because my heart… It was intense palpitations. And I knew it wasn’t AFib because I know when I’m in AFib, because when I’m in AFib I’m out for the count. And so it wasn’t AFib. So I went to urgent care, they hooked me up to the ECG, and they’re like, “Oh, yeah, you’re just having PVCs. You’ll be fine.” So I’m like, “Okay.” I’d never heard of them before. They just told me they’re benign, not to worry. Fortunately for me, they went away and I never thought about it again.
Well, I didn’t have to deal with them again, with these palpitations, until four months after my ablation. And what triggered them was the intense stress I was going through that particular night. I was in the hospital literally watching my father die from heart failure, which was traumatic enough because I was very close to my dad, but it’s traumatic enough to watch someone that you love literally die before your eyes. But in his case, he was dying of heart failure. Of course, I have AFib and I had just come off my ablation, so it was like, “Oh, my gosh, my dad’s dying of heart failure.” And it completely set me off, and I had intense palpitations, intense PVCs and PACs that night in the hospital. And that again, four months after my ablation, and I’ve been battling PACs and PVCs now ever since, on and off.
And it’s crazy because sometimes I can go weeks without them. Sometimes I’ll go weeks with them. Sometimes they’re more intense than they are in other cases, but I’ve been battling them on and off. And I just wrote a blogpost about a month ago declaring I finally figured out how to get rid of these things, which we’ll talk about in a second, and I thought I was done. And literally a week after I posted that, they came back, and I still continue to battle them on and off. Now, fortunately, the battles are fewer and they’re not as intense. So, let’s just talk about what causes these things. Again, stress, anxiety, worry, fear. Diet is a big one, specifically caffeine, alcohol, excessive carbs, or if you pig out. If you sit down and have a huge meal and you’re really bloated, those can trigger or that can definitely trigger palpitations.
A lack of sleep is a huge one. Especially for me, if I have a couple of nights where I don’t sleep very well, and I’m not a very good sleeper to begin with, I’ve been battling insomnia for years, so if I have a string of nights where I don’t sleep very well, that’ll trigger ’em. Other health conditions, such as high blood pressure, obesity, sleep apnea, all these things can trigger these PVCs and PACs. For me, again, I can pinpoint my specific trigger was the death of my father, watching him die. That’s what initially started them. But what I’m still perplexed about is, here it is two and a half years later and I’m still battling these things, and I may have to battle these for the rest of my life, who knows.
The other question I also get, when I talk about these PACs and PVCs, is people say, “Well, do you think the ablation caused them? Or do you think the ablation made things worse?” And I don’t believe that. I’m not a believer that ablations cause palpitations or trigger them or anything like that, because, like I said, if that was the case I would have had, I would think anyway, the PACs and PVCs would have come about much sooner after my ablation. Certainly not four months after, ’cause I, for the first four months my heart was totally calm. I didn’t have any issues, so I don’t think that is the case. I have, however, reached out to a cardiologist that I do talk to occasionally, and I just asked him if he sees any kind of history of people that have more intense PVCs and PACs after their ablations, and I haven’t heard back from him. But if I do, I’ll definitely pass that along, but I don’t… I’m just not a firm believer that ablations cause palpitations, PVCs and PACs. I just don’t think that’s the case.
I will say this though, once you go through an ablation, and even if you don’t go through an ablation, the one thing us AFib-ers have in common is we are very obsessed with our heart. We feel and notice every abnormal heartbeat that we have, and so I think it just makes us… ‘Cause people, even healthy people, have PACs and PVCs. Almost everybody has PACs and PVCS, but they don’t notice them. But AFib-ers, we’re so obsessed with our heart, we feel everything. So we’re just more in tune to our hearts and so I think, especially after an ablation, you’re more sensitive because, once you have an ablation you’re like, “Okay, did it work?” And your sitting there and you’re like, “Okay. Yup, I don’t feel anything. I don’t feel any AFib.” But subconsciously you’re so tuned in your heart all the time, especially after an ablation ’cause you’re like… You’re just trying to make sure that it worked, and so then when you have a PVC or a PAC, you feel it. And so if you have a lot of them, you feel them. And so I just think that plays a role.
It’s also possible that there’s certainly a lot of inflammation in the heart after an ablation. Now that inflammation typically goes away after the three-month blanking period, but it’s possible there’s some inflammation still going on well beyond the three months. And maybe the inflammation causes these cells to fire prematurely, so maybe there’s some of that. But again, I’m two and a half years out of my ablation now and I’m still battling these things. So the inflammation in my heart has been gone for a long time, and yet I’m still having these things. And so, again, if it was just the ablation, I would have thought… I would have felt them sooner and they would have been gone a long time ago.
And I just wanna talk about the supplements quick. The supplements, there’s four electrolytes that can cause these palpitations: Magnesium, potassium, sodium, and calcium. Those are the four big electrolytes. If those are out of whack in any way, shape or form, they can cause your heart to be jumpy. Palpitations, PVCs, PACs. So, if you drink a lot of milk, take a lot of calcium supplements, eat a potassium-rich diet, or take potassium supplements, if you take magnesium supplements, if you take any of these in excess, it could certainly upset the balance of these electrolytes which can then cause palpitations. And just a note on that, for the longest time, I was taking 800 to 1,000 milligrams of magnesium a day. And my heart, I had palpitations 24/7 and I could not figure it out. So I just assumed, I just need to take more. So I went from 800 milligrams of magnesium to 900. Of course, that made things worse, but worse in the sense that they never went away. I thought, “I’m just not taking enough.” So I went up to 1,000 milligrams a day. Real stupid and, in hindsight, it is kinda obvious that, “Well, why didn’t you just go the other way, try to cut back on the magnesium?” I’m pretty stubborn that way.
Anyway, so I eventually started doing that. In fact, I made a drastic step. I cut my magnesium in half. I went to 400 milligrams a day. And the day I did that, my palpitations disappeared. And ever since then, now I’ve been taking 300 to 400, no more than 400 milligrams, of magnesium a day. And ever since I’ve been doing that, it’s been six months ago now, I have had fewer battles with palpitations, PACs and PVCs. Again, I still have them, but I don’t have as many or as often, and they’re not nearly as intense. So if you’re taking supplements, magnesium, potassium, calcium, or if you have a high-sodium diet, try cutting back on those things and it might help settle those palpitations. But the reverse is also true. If you’re not getting enough magnesium or enough potassium, taking supplements of those might help. So that’s just my take on supplements.
Now, the other thing I wanna talk about, before I end here, is that, again, most people have… Almost everyone has PACs and PVCs. And even if you have a lot of these, doctors aren’t gonna get concerned unless you have around 20% to 25% of your heartbeats are PVCs or PACs. So let’s break this down. If you have 60 beats a minute, your resting heart rate is 60 beats a minute, you’re gonna have 86,400 heartbeats in a day. 20% to 25% of that then is 17,280 to 21,600. So that means you would have to have 17,280 PVCs or PACs a day or more before a doctor is really gonna start getting concerned. And most of us, and most of you listening to this or watching this video, don’t have that many.
But even in those extreme cases, if you are someone that has 17,000 plus PVCs or PACs a day, doctors still aren’t necessarily gonna get concerned if your heart is structurally sound, and that is determined by having an echocardiogram or an echo. And I personally, myself, I have an echo done every year just as a preventative measure. It gives me peace of mind, and because I do battle palpitations and I know I’m not having nearly 17,000 a day, but I have an echo done every year just to make sure that these palpitations aren’t causing any damage to my heart. Because for some people, very few people, excessive palpitations like that can cause heart failure over many years. If you’re having 17,000 PACs or PVCs a day for many years, it can obviously wear on your heart. So, I have an echo done in every year. So far, hey, my heart has been solid as a rock, structurally sound, so my doctors have zero concerns about my palpitation.
So if you’re having a lot of palpitations, you might wanna ask your doctor to have an echo done, and even a Holter monitor for 24 hours just to have a baseline, so you know how many PACs and PVCs you are having. And then with that information, with the Holter monitor information and the echo, it’ll give you more peace of mind. And when you have that peace of mind, you might not have as many palpitations ’cause your anxiety and worry is gonna settle down a lot more if you know, “Hey, I’m only having 5,000 a day and my heart is structurally sound. They’re annoying, but I don’t care.”
And if you do have excessive palpitations, 20% or more, and the doctors are concerned… Well, again, if your heart is structurally sound, they’re probably not gonna do anything. But if it’s a quality of life issue, doctors then will reluctantly… ‘Cause believe it or not they actually don’t like to prescribe drugs for PVCs and PACs, they will prescribe usually a beta blocker or a low-dose flecainide, which is an anti-arrhythmic drug, a low dose of that on a daily basis to help settle those down. And in extreme cases, they’ll also recommend an ablation. You can actually have a PVC/PAC ablation to knock those out. Again, those are extreme cases, probably doesn’t apply to 95% of the people listening to this.
So, there you have it, Jules, my very long-winded answers to your questions. But I just wanted to dive into this a little bit more because I do… I get asked… I get a lot of questions on PACs and PVCs ’cause I talk about them a lot, because fortunately I haven’t had AFib, but my new battle has been these stubborn PACs and PVCs.
If you have a question for me that you’d like me to answer, you can send it to me via my contact page and as I always say, everyone that contacts me will get a direct personal reply from me, whether I showcase your question on this Q&A session or not. But I just encourage people to reach out to me if they do have any questions. And also stop by my website to leave comments on this session and previous sessions. So there you have it. Thanks for listening, and have a great day!
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Another major cause of PVCs almost nobody talks about: OBESITY.
If you have a-fib, get your visceral fat measured – even if you’re skinny fat.
There are scales that can measure visceral fat.
Visceral fat causes inflammation and stresses the heart and other organs, so of course caffeine and stress will compound heart issues when you’re abdominally obese.
It’s no wonder why pills, ablations, and supplements don’t really work, because it’s not addressing the real issue – and not addressing the REAL issue that requires the MOST work.
And what a shock, as obesity continues to rise, heart issues are on the increase.
Do cardio at the gym for a solid month and you’ll be 99.9% heart flutter free. Then you’ll just have to maintain your health once a week at the gym.
Granted, this is from my personal experience, and your time at the gym will vary depending on how much weight you have to lose.
There’s a reason why we’re required to have 2 1/2 hours of moderate exercise a week. Almost nobody is at the gym.
Your heart is a muscle just like your biceps. Use it, or lose it.
I’m glad I stumbled onto your site. I have been having PAC’s recently 3 months post ablation. Mind you, this is my 6th ablation!
Thanks for the great insight.
Whoops, sorry Travis, for calling you Jeff. ;-)
Struggling with pvcs . Its destroying my life. Each one feels like I’m dying.
Check this out:
A quick and easy fix for any ventricular rhythm problem. Too good to be true? Maybe. It’s early days, but this is being met with enthusiastic optimism. If it does become clinical practice, though, that probably won’t be for several years.
Very interesting indeed. But like you said, this type of noninvasive ablation is likely years away. Still, though, it’s promising.
For those of you that don’t have access to Medscape (it’s free to get a Medscape account), the article talks about doing ablations via x-rays.
I had a posteroseptal ablation on September 14, 2016. I have pacs when I’m tired and lacking sleep. The pacs are not severe. They are only mild. What should I do or how do I cure these? I won’t go back to medications.
PACs can be tricky to “cure.” They usually go away on their own over time. You can try taking magnesium supplements to help settle the PACs in the meantime.
Many thanks for sharing your experiences and for your positive outlook on health and life. I have been having daily PACs and PVCs for the past 4 months. They annoy me sometimes but to be fair they are tolerable and I understand that many people have them much worse. My concern is that they might lead to Ventricular Tachycardia and I think I may have briefly experienced this recently. Do you or anyone else know if an ablation would cure both PACs and PVCs? I can ‘t find any information on this question. I understand that PVCs can be ablated only if they originate from the same site. PACs and PVCs obviously originate from opposite locations so would an ablation cure both? Thanks for any info or insight you can offer.
Ablations can be hit or miss when it comes to PACs and PVCs. The issue is, a doctor can nuke the sources of the PACs and PVCs but then other sources can pop up later. Every cell in your heart has the ability to trigger a beat. That’s what causes PACs and PVCs. These rogue cells just decide to trigger a beat. The “go before” they are supposed to! The AV Node is the “brain” of the heart and it governs when these cells are supposed to trigger a beat. When things are working properly, they all fire at the same time. That’s how you get NSR. When cells go rogue, however, they start firing out of turn and so you get premature beats. A good EP will spot these rogue cells and nuke them during an ablation, but other cells could go rogue the day after your ablation! It’s sort of a game of whac a mole.
I have suffered from PACs and PVCs on and off since my ablation but they always resolve on their own (eventually). Most PACs and PVCs resolve on their own as a heart cell only has a life-span of about two years.
Hope that helps.
Thanks for responding. I noticed that experts don’t seem to talk much about PAC/PVC recurrences after ‘successful’ ablation. I would really like to know if this is actively being researched. Also, if recurrence is a problem why are experts increasingly preferring ablation over drugs? I found your remarks about heart cell lifetimes interesting because some people say they have had them for decades. I have never read any experience of PAC/PVC disappearing on their own. It seems once you have them they will never go or reduce without intervention. Can I ask where you got that information? Thanks.
My source on the lifespan of a heart cell came from my EP. It was also him who told me that for “many people,” PACs and PVCs disappear on their own over time because the rogue cell dies (or simply stops malfunctioning).
I have experienced episodes of PACs and PVCs a handful of times over the years. Sometimes they are so severe I feel like I’m in afib but I’m not. These intense episodes will last a week or more. Then as sudden as they come on, they disappear. I’ve NEVER done anything to stop them – i.e. ablation, medication, etc.
This leads me to believe that either the rogue cells have died or have stopped malfunctioning. It’s above my pay grade to understand why…lol. I’m just thankful they have always resolved on their own.
Given the complexity of PACs and PVCs and the challenges of “treating” them, I would never consider an ablation myself to treat them unless they were causing damage to my heart. That isn’t usually a concern until you get to about 20% of your heartbeats being PACs and PVCs for a long period of time. The damage is confirmed through an ECHO. If I had an echo and the doctor told me these PACs and PVCs are now a genuine cause for concern, then and only then would I have an ablation.
Did you ever get your pvcs in control
PACs and PVCs. I had plenty after my third ablation.
Quick review: My paroxysmal AF was fixed with the first ablation 5+ years ago. Almost a year later, flutter was fixed. Then a year and a half later saw complex atrial tachycardia fixed. ZIO patch (two week monitor, better than Holter) found plenty of PACs, PVCs following that third ablation. I lived with them for a couple of years. They got better/ I got used to them and functioned normally.
Recently, apparently hidden among those ectopics were very short pops of tachycardia. I couldn’t distinguish the difference; never knew they were happening. The tachy continued and worsened last week. 120 bpm up to 230, one to one conduction, atria and ventricles. It rocked the gurney in ER. Standing up = passing out.
Diltiazem drip kept the conduction to the ventricles down to 120. Addition of dofetilide (Tikosyn®) converted me to normal sinus after a day. Dofetilide required three days of titration and constant monitoring in the hospital. Dangerous stuff. Not as toxic as amiodarone, but both are possible triggers for deadlier rhythms should electrolytes go off or kidney function alter. I’m told dofetilide will probably be good for not much more than three years.
What next? If amiodarone fails then the ONLY remaining option to avoid the dreaded tachycardia is to ablate (Destroy!) the AV node and install a pacemaker making me utterly dependent on a little metal ticker with battery to sustain life. (My electrophysiologist is up on the His bundle pacing. Look it up. fascinating.)
Dark, right? Sorry. But I thought you should know.
PVCs, when they’re very frequent can lead to cardiomyopathy. PACs can mask short bursts of tachy. We who were subject to Afib in the first place have atria that aren’t robust as would be best. Scarring them with ablations can render them mechanically less functional. Things often trend downhill with time however conscientious we are about lifetyle and nutrition. Nothing (yet!) is a perfect solution.
Get a Delorean, go back, and make sure you get good genes.
Geez, thanks for the uplifting story. As my dad used to say to me, “you’re full of good news, aren’t you?”
I appreciate you sharing your story as there are definitely good lessons to be learned from it. However, I want to caution anyone reading your comments that in most cases PACs and PVCs don’t lead to the dark tunnel you’ve been down. Cases like your’s are the exception and not the rule!
Furthermore, I wouldn’t give up hope. You still have options. The first obvious option is to seek out the most experienced EP you can find for a second opinion. If I were in your shoes, I wouldn’t hesitate to have a 2nd, 3rd, or even 4th ablation if that’s what it took to get rid of my PVCs and PACs. But if you find the right EP, one more ablation may be all it takes.
I would also add that going the nuclear option (AV node ablation) isn’t the end of the world. Yes, it would really suck but at least you’d still be alive and likely feeling much better without being on all the toxic drugs. Again, the AV node ablation is ALWAYS the last resort option. I would only consider it myself if my 2nd, 3rd, 4th ablation didn’t work by an experienced EP but it’s still an option.
Life isn’t fair and we have to deal with the cards we’re dealt. I wouldn’t fold and walk away from the table, however. I’d stay in the game and wouldn’t give up hope. The winning hand could be just one card away!!
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