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What Is The Treatment For Symptomatic Premature Atrial Contractions?

Posted on Thu, 19 Dec 2013

Question: Ive had 6 bouts of a fib in 8 yrs On atenolol cant tolerate antiarrythmics. Migraines and mild increase in heart rate which is my trigger. Question is pacs of which are 99% of the time silent would become symptomatic when HR over 100. I had the flu for 2 days and now im symptomatic with pacs but no afib yet with hr in the 80's.im worried this is secondary to remodelling what are ur thoughts thx

Answered by Dr. Anantharamakrishnan (2 hours later)

Brief Answer: Need just to watch Detailed Answer: Hi friend, Welcome to Health Care Magic What is ‘symptomatic’? Simply being aware of it may not be significant…. The feeling depends on individual sensitivity – some do not feel them at all / some may feel every beat. Symptoms like blurred vision, dizziness, loss of consciousness, shortness of breath, chest pain dictate the need for urgent work up Medicines like Phenylephrine used for ‘flu’; Salbutamol used for wheezing and so on – could exacerbate Titrating the dose of atenolol (maximum dose is 100 mg) can help...but Watch – the resting heart rate may become slower and/or the pressure may become lower... Discuss with your doctor. If there are no clues and if the problem is still bothering to the extent of interfering with life style, your doctor may recommend Electro Physiological Studies (EPS) > it resembles angio – a catheter is put inside the heart / electrical activity recorded / stimulation and suppression tests are carried out / suitable medicine tested and so on. Though the test is the gold standard, it is INVASIVE and is not generally done unless there are compelling indications. This super-speciality expert is called ELECTRO-PHYSIOLOGIST. There are other advanced treatment modalities - like ablation (thermal or radio-frequency), which could be done during EPS. The treating doctor may suggest them depending on need, based on his assessment of the situation. Good luck Take care Wishing all well God bless

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (51 minutes later)

Thank you im concerned about feeling the apcs. Im also concerned that initially i went into afib when my heart rate was about 110 but for the last 2 days as soon as it hits about 70 i feel the apcs and it almost felt like i was going into afib. Could this be remodelling or an effect of the flecainide which i did stop today from terrible headache or increased catecholamine outburst. Thx much for addressing this im wuite worried.

Answered by Dr. Anantharamakrishnan (2 hours later)

Brief Answer: Get it documented, if troublesome Detailed Answer: Hi, The basic substrate – an abnormal focus or circuit – exists / and could be influenced by several factors. Flecainide is the most likely candidate. Catechols could do, but generally, the basic rate too is likely to go up. Remodelling is not likely to occur – unless specific intervention like surgery, atrial enlargement and so on occur. Feeling of symptom does not correctly correlate and documentation (Holter or Event monitor) is necessary, if a change is suspected. Watchful expectancy until the infection wanes, is all that may be required, for the present. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (4 hours later)

Thank you for all your help I've scheduled an appointment with an ep md next week at Stanford thx again you were most helpful. One last question noted that if I bend over I will feel an apc. Also had echo done yesterday left atrium was 4.2 I'm 6'2" tall and weigh 235 lbs. And have mild MR. Are these significant findings. Thx

Answered by Dr. Anantharamakrishnan (9 hours later)

Brief Answer: Weight reduction and cardiac follow up Detailed Answer: Hi Your BMI falls under ‘Obese' (more than ‘overweight’ / BMI = 30.2 / Need life style changes like diet and exercise, cessation of tobacco and alcohol…and so on… / a good dietician will be of great help Some movements can bring out missed beats – due to shift in intravascular volumes and compensatory adjustments… Left atrium dimension is just above limits / shows ‘mild’ abnormality / no cause for concern; needs follow up So is mild MR / not clinically significant / need to follow Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (2 hours later)

Thank you Dr I have an appt with an ep cardiologist next week I just am worried because every extra beat I feel reminds me of my afib episodes thx for being understanding

Answered by Dr. Anantharamakrishnan (33 minutes later)

Brief Answer: Ignore the fear / treat an episode if it occurs Detailed Answer: Hi Fear of disease is worse than disease itself… A-fib may not occur / if it occurs, it is treatable... Relax. You are young – still on the right side of sixty! You sound intelligent You stand an excellent chance of returning to normalcy. Be positive – why fear the heart beats faster, forcible or more? The problem is only if it could not beat! You are tolerating the rate well - means that you do not have any significant basic disease… Be in touch with your doctor - it is a question of time and you will be well. Medicine is well advanced nowadays – management is possible for almost all situations... Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar