Holter monitor shows supraventricular ectopics and PAC. Do I need antiarrhythmic drug?

Question

Hello doctor,

I am a 60-year-old male who just received the results of a 24-hour Holter monitor.

Key findings include:

Sinus rhythm with frequent supraventricular ectopy (2559) which included couplets and one seven beat SVE multiplet.

No complex forms.

No significant pauses or periods of heart block noted.

Constant feeling of missed beats coincides with frequent supraventricular ectopy.

Very infrequent ventricular ectopy that was isolated and univocal.

Cardiologists not concerned with findings and recommended positive affirmation, distraction, and cognitive behavioral strategies. He was very reluctant to recommend anti-arrhythmic treatment seeing this as overkill.

Other matters of interest. Recent stress echo (March) indicated above average fitness for age (14 mets) and reached a maximum heart rate of 160 bpm. Moderate aortic regurgitation (grade 3-4), normal ejection fraction (60), LVEDV (138 mls), no demonstrable ischemia or arrhythmia. The recent PACs are very noticeable and I feel every one of them. I would appreciate a second opinion or advice on whether there is anything else I can do to stop them.

I am currently on Atenolol 100 mg, Crestor 40 mg, Effexor 74 mg, and Valium 5 mg.

Answer 1

Hello,

Welcome to icliniq.com.

Premature atrial contractions or supraventricular ectopics are not harmful per se other than giving you symptoms. So antiarrhythmics are not usually recommended, so I do not disagree with your treating cardiologist. Beta blocker is the safest option available, although not the most effective one and other options are ablation or antiarrhrythmics.

So trying behavioral techniques is a good option. But if it troubles you a lot then you may request low dose antiarrhythmics like Amiodarone for a short period of time, but they may again come back after the drug is stopped. Since there is no atrial fibrillation or SVT (supraventricular tachycardia), antiarrhythmics are absolutely necessary, but the benefit would be in you is just symptomatic, which comes with the risk of side effects.

However, you should have Holter at regular intervals like yearly (with echo for aortic regurgitation), or if you notice sustained ectopics or irregular rhythm implying development of fibrillation. You may discuss changing Atenolol to others like Metoprolol and see if its help. You should try to identify triggers like sleep or gastric disturbances, alcohol or smoking (if any), any particular medications (which you are on), stress, etc. Also, if not had recently, thyroid should be tested.

So in a nutshell, antiarrhythmics may be avoided, but if not tolerable symptomatically then may be tried.

I hope this helps.

Answer 2

Hello,

Welcome back to icliniq.com.

No, they will not kill you. The only risk is of progression of PAC (premature atrial complex) to atrial fibrillation, which would remain. And rarely, PAC may temporarily reduce heart function (ejection fraction). So these are risks, which anyway would be monitored in you with yearly or 2 yearly echos and Holter.

You may have your own ECG (electrocardiography) watch to see the rhythm intermittently. Just monitor for symptoms like sudden palpitations, associated with shortness of breath, dizziness, or chest pain, which may indicate atrial fibrillation, after which you may need blood thinners as well. So nothing to worry about it as of now and it will not kill you.