Alternate ectopics with paced beat

For the past few days I have been getting long periods of  alternating ectopic and paced beat.  As I have had an AV node ablation I am paced 100%, and my rate is set at 80. But when these ectopics start it means that of the 80 bpm I am only getting 40 effectual ones as the ectopics do not pump blood properly. It is very stressful as I feel quite breathless and cannot do anything. The pacing clinic have looked at a download and said there is nothing they can do and my heart is pacing at 80 even though half of them are useless.  Has anyone else had this happen? 


PVCs (premature ventricular contractions)

by Gemita - 2021-05-06 11:24:13

Theresa, I am really sorry that you are having to tolerate these beats.  They are truly awful, I well know.  I note in the past you have had an AV node ablation, so I presume you still have some arrhythmias dancing around in the atria and although they cannot get through your AV Node to affect your lower chambers, they may still be causing some symptoms.

I would take the problem back to your clinic for further observation. Maybe they need to monitor you and decide whether your PVCs need better control to help with your symptoms.  I would push to be heard.  I see you are in the UK too.  Are you still on any medication, like a beta blocker/calcium channel blocker?  I would perhaps trial a few meds.  Cut out any caffeine, chocolate, alcohol, stress (if you can) for a while, eat small meals and get lots of relaxation and sleep.  

Have you asked about increasing your heart rate again, say to 85 bpm to see if that could help?  It may just outpace the little monsters and calm things down and be all that is needed.  I used to suffer so much with my PVCs until I got my pacemaker set at minimum 70 bpm.  Prior to my pacemaker, I also considered an AV node ablation for atrial tachyarrhythmias (AFib, Flutter and SVT), but decided to try pacemaker first.  It seems to work well for me and help to control most of my ectopic beats, which were leading to my other arrhythmias.  Once I had controlled my ectopic beats, my more serious arrhythmias were better controlled too.  

Also keep blood pressure under good control.  Perhaps get thyroid and electrolytes checked and have a general health check too to make sure nothing is being overlooked.

Good luck Theresa and hope you get these sorted

Alternate ectopics with paced beat

by Theresa52 - 2021-05-06 11:58:39

Thanks for your reply Gemita.   Briefly let me tell you what has happened.  I developed AF, treated with drugs for many years, then got worse and over 3-4 years I had 5 ablations which did not work for me.  I was being hospitalised every few weeks with AF registering at 200+ bpm.  In 2019 I had a Pace and Ablate procedure. 6 months later I went into permanent Atrial flutter, although I did not feel the effects. Had a VT episode shortly after and very nearly passed out.  See my earlier post 'Pandora's Box'.   A year later an ECHO showed EJ had dropped to 41%.  This year in January I was walking up the stairs to the Cardio dept for a pacing check when I nearly passed out with heart rate of 200 in VT.  Another ECHO showed heart out of sync now.  So four weeks ago I had a CRT-D implanted.  I feel totally exhausted and crushed.  Now this new problem with the PVC's.   Sorry to go on, but I feel defeated and now even nervous about leaving the house.  Have left a message with cardio dep.  Thank you for listening if you are still reading this!!

I do understand

by Gemita - 2021-05-06 12:12:39

Yes I am still reading this.  I feel reassured, even if you don't, that four weeks is early days and your heart is still settling down from the CRT-D procedure.  It can take, as you know from your ablation procedures, at least three months or longer of healing before we start to see benefits of treatment.  Ablations clearly didn't help, but CRT therapy should improve any dyssynchrony between your lower chambers and hopefully in time, improve your Ejection Fraction and help overcome your ectopics.  I can understand you are ready to give up, but you mustn't go there because the stress of any negative thinking might make your PVCs worse.  

I would still ask or push for some general blood tests to help rule out a treatable cause for your PVCs.

I have also had to deal with AF with a rapid ventricular response rate over 200 bpm and I well know how it feels.  I also have non sustained VT.

I do wish you well Theresa.  It will get better


by AgentX86 - 2021-05-06 14:33:32

Yes, I had bigeminy, as in two-twins (bi-gemini, the astrological sign) just after my AV ablation.  Awful feeling. Worse than any other arrhythmia I've had, and I've had a lot and very symptomatic (forcing the AV ablation).

My bigeminy stopped when they raised my HR to 80, from 70 (thought they were about to drop it to 60).  At the same time I started taking magnesium suppliments.  They helped a lot and cured my leg cramps, as a bonus.  Magnesium (and the other electrolytes, potassium and sodium) are crucial for muscle operation.

Have your doctors do a good test for electrolytes.  I was indeed short on magnesium but it wouldn't hurt to try it anyway.  It is toxic in huge doses but it's also a laxitive way before that, so it's unlikely that you would get into trouble.  Potassium is a lot more dangerous.  That one you're better off gettiing from food or under medical supervision.  We all get so much sodium that it's rarely a problem.

If you try magnesium, stay away from magnesium oxide (milk of magnesia) for obvious reasons.  The body can't readily absorb it either.  Maybe 10%.  One of the organic forms, like Magnesium Orate, or such is much better. I do 4-500mg a day.  My cardiologist thinks it's a good idea too.

If you don't like suppliments, dark chocolate is a good source of it.  About 3/4 of a pound of chocolate a day will give you all you need.  It does have other side effects, though.  ;-)

I just wanted to say no apologies needed!

by asully - 2021-05-06 14:57:24

You apologize at the end of your post for "going on", but I think we all do this at times when we are worried and facing complex medical issues.  I find the worry is the worst when they send you home without a direct answer and your left wondering how "safe" you truly are.  Plus the physical exhaustion of dealing with new symptoms can be a real drain on mental capacity and incredibly stressful.  I wanted to say that I can relate to your concerns and frustrations!  But I am grateful that you share them because it lets me know I am not alone in my expierience.  I am sorry I don't have information to help with your current medical problems although I think Gemitas suggestion of trying to overdrive the ectopics is a good one,  and hopefully you fell safer now with the ICD in place in case of VTach!  I am currently considering ICD implant but haven't had more than a few short runs of non-sustained VT so I haven't quite reached my personal tipping point, I am sure the first time I have a sustained episode I will be demanding that ICD goes in immediately!  I hope you feel better, and safer soon!

Edited to add: although I did not have and AV node ablation I essentially got an unintended one during my tricuspid replacement.  I have been having lots of ectopics as of late, I can feel them and then when I use my 6L Kardia clearly see them.  I am 100percent paced as well and know that any disruption in my rhythm makes me symptomatic because of the disruption to pumping action.  If these ectopics are causing you symptoms I would keep pestering them to look for a solutions.  My other half always says "The squeaky wheel gets the grease!"  and I have found this very true in terms of dealing with the medical field.


A brief history

by AgentX86 - 2021-05-06 20:54:57

Just to fill that part in...  I started, or  was detected, with very proximal AF in 2007, which went dormant after a DCCV until 2014.  I was having a lot of trouble functioning, SOB, the whole thing.  After due dilligence by my cardiologist, I also had four blocked arteries, two 100% and one 90%, with no possibilty of stenting for any so I had a CABG.  While they did that, they clipped my LAA to reduce the probability of stroke, and did a full maze procedure.  The maze took care of the AF but left me with permanent flutter (240-300bpm).  Fortunately my AV node was slow so my HR was only 80-100bpm but it was very irregular, sorta like AF but a pattern.

I fought the AFL with drugs, then three failed ablations and more drugs.  The last, sotalol, damaged my SI node so I needed a PM.  I had the AV ablation at the same time.  Then the bigeminy PVCs.  Fortunately, they're gone now.  That was awful.  I understand and, yes, others have been down this road.  I feel for you.

I'm still in AF but as you mention, I can't feel it so it's as good as it'll get.  But because I'm in constant flutter I still have to take anticoagulants for the rest of my life, even though my LAA has been clipped.

PVC's and more

by Theresa52 - 2021-05-07 06:22:22

Thank you all so much for taking the time to reply.  Although I would not wish arrhythmia problems on anyone, I am so pleased to have your company on the way!  You all so clearly understand how it is, and that helps so much and I don't have to explain it.   As Asully said it is so stressful not to feel 'safe' and to wonder if you need to call the amubulance again!!  The arrhythmia nurses are helpful and when they don't ring me back the same day I am comforted!  I love 'the squeaky wheel gets the grease'!

Thank you again Gemita for your reassuring words. I must remember it is still early days.

Agent - you mention Magnesium and I have started taking it more regularly now.  I take Magnesium Citrate, and find I can just tolerate 200mg per day.  I'm glad you warned against Potassium supplements bercause I was going to get some.  I will do it with food, especially as I like bananas, apricots and spinach.  My heart rate is already 80, down to 70 at night.  I don't really want to go much higher.  I had to have my rate response switched off as despite much twiddling of settings with it, every time I bent down my hr shot up to 140-50.  They told me it was ultra sensitive and switched it off.  

Thank you all - we are warriors!



by AgentX86 - 2021-05-07 13:07:23

I did a quick search and found this very infomative link to the different forms of magnesium. <> 

I've been taking either the glycinate of orotate forms.  I found the glycinate works better for me.  The warning at the end is important.  Get it from a reputable source with the proper testing.  Regulations are nonexistent for these suppliments so keep that in mind. This goes for all suppliments, not just magnesium.


by Theresa52 - 2021-05-08 06:56:17

Thank you - that is a clear description of the different types.  I might like to try the glycinate or orotate - can I ask where you get them from?

Theresa52 - Magnesium in all its forms

by Gemita - 2021-05-08 08:33:40

Hello Theresa,

I was told Magnesium Taurate was good for cardiovascular health but I attach above a link in case it helps.  I would though tell your doctors that you want to take extra magnesium (supplement) in case of any interactions and to make sure that you will stay safe and not get into trouble with electrolyte imbalances.

I have tried BioCare Magnesium Taurate (very expensive and didn't do very much for me), but now I am on BioCare Vitamin C powder (low acidity) which is Vitamin C (as Magnesium Ascorbate).  This keeps me "regular" as a life long constipation sufferer and gives me my magnesium as well (which I have always been deficient in).  

Another tip, a cupful of Epsom Salts in the bath (or just try foot baths) is a great way to get extra magnesium into our body.  You can soak your feet each night as you relax - might be cheaper and avoid any bowel disturbances.  A lot of people tell me it works for them.  I am trying it on hubby who loves the attention.  I don't have time for relaxing

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