I’m a woman (52) who’s had heart palpitations for 20 years. Now they happen more often. I get 10 – 50/day where I feel my heart skip around. I’ve been to cardiologists and they find nothing wrong and say it’s just PVCs and PACs. Should I worry?
Dr. Hongo’s expertise covers the full range of current technology and skill in cardiac arrhythmias management, including specialized pacemakers for resynchronizing the weakened heart, implantable defibrillators, and catheter ablation for heart rhythm problems. He is also principal investigator for several trials in electrophysiology, and lectures widely on all aspects of arrhythmias. He is a member and fellow of the American College of Cardiology, Heart Rhythm Society, and the Alpha Omega Alpha Honor Medical Society. Dr. Richard Hongo received his M.D. in 1995 from Loma Linda University School of Medicine. Dr. Hongo is board certified in Cardiology and Cardiac Electrophysiology.
In general, premature atrial complexes (PACs) and premature ventricular complexes(PVCs) are not harmful. This holds especially true if there is nothing else wrong with the heart. When someone presents with bothersome PACs and PVCs, an echocardiogram or ultrasound of the heart is frequently done to make sure an underlying heart condition isn’t present. (Read more about the thumps, flutters and skipped beats that come with heart palpitations.)
The rare time that PACs cause a problem is when they are so frequent in number that they risk triggering other rhythm problems. One such rhythm problem is atrial fibrillation (AF). AF is usually recognized by a change in the pattern of palpitations from skips and bumps to a persistent fluttering that lasts for minutes to sometimes days. If such a change in the palpitations occurs, the rhythm should be evaluated again right away. AF can lead to stroke if it is left untreated for over 24-48 hours.
In the case of PVCs, the rare time that they cause a problem is when they are so frequent in number that they start to weaken the heart muscle. It is currently felt that if the overall burden of PVCs is over 10-20 percent of all your heart beats, then the risk of muscle damage starts to rise. 24-hour Holter ECG monitors can be worn to figure out what the PVC burden is, and sometimes this test is repeated periodically to monitor the burden of PVCs over time. Catheter ablation of the spot in the heart where the PVC is coming from has been shown to prevent and even reverse muscle damage from excessive PVCs.
Finally, even though PACs and PVCs are most often safe, they can be quite disruptive. The palpitations can sometimes become so bothersome that they prevent proper sleeping. Some people will start avoiding physical activities - like exercising - because it can worsen the palpitations. Concern for these abnormal beats can lead to anxiety and mood problems. When palpitations interfere with life, even if they are not technically dangerous, they are a problem that needs treatment. There are medications such and beta-blockers or calcium-channel blockers that can be effective. It is not unusual to trial a number of different medications, at differing doses, before you get suppression of the palpitations. Catheter ablation of the premature focus in the heart can also be an effective and safe way to eliminate palpitations from PACs and PVCs.
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