FAQs Coping with A-Fib: PVCs & PACs

Revised January 2019

“I have a lot of extra beats, skipped beats, and palpitations (PVCs and/or PACs) which are very disturbing and frightful. They seem to proceed an A-Fib attack. What can or should I do about them?”

Most A-Fib doctors aren’t overly concerned about extra beats (Premature Ventricular Contractions—PVCs) or Premature Atrial Contractions—PACs), because they are considered  benign. Everybody gets them, not just people with A-Fib.

PVCs and PACs occur when electrically-active tissue in the heart decides to fire off (depolarize) before it has received the signal from the normal pacemaker of the heart, the sinus node.

PACs come from one of the atria (upper chambers of the heart). PACs generate an early beat (ventricular depolarization). They can cause palpitations and an irregular pulse, but in general they are benign.They are generally more common than PVCs. PACs become more prevalent as we age. PACs (and PVCs) increase with age—from about one per hour in those 50 to 55 years old to 2.6 per hour among those 70 and older.

But PACs Often Precede or Forewarn of an A-Fib Attack

However, studies indicate that PACs often precede or forewarn of an A-Fib attack. A-Fibbers seem to have more problems with extra beats than normal people. In an important study, doctors from China showed how frequent PACs (more than 100 beats/day) actually predict who will develop A-Fib. These patients also have a higher risk of cardiovascular complications, stroke and death. Frequent PACs may occur because of a diseased atrium (atrial cardiomyopathy).

Also, after a successful A-Fib PVA(I) ablation, people seem to have more extra beats which tend to diminish over time as the heart heals and gets used to beating properly.

Sometimes PVCs Aren’t Always Benign

In patients with other heart problems like Coronary Artery Disease (CAD), frequent PVCs often aren’t “benign.” They can increase chances of a fatal heart attack or sudden death. PVCs have been implicated in the development of cardiomyopathy and LV (Left Ventricular) dysfunction. But catheter ablation or antiarrhythmic pharmacological agents appear to reverse this cardiomyopathy and LV dysfunction. RF ablation for frequent PVCs in patients without structural heart disease has been shown to completely reverse cardiomyopathy in numerous studies.

Catheter Ablation Can Be Performed to Free You of PACs/PVCs

If these extra beats cause you problems, beta blockers and antiarrhythmic meds may help. But sites in the heart that produce PACs/PVCs can also be mapped and ablated.

A catheter ablation, in addition to removing A-Fib producing spots in the heart, can also map and ablate areas producing PACs/PVCs. For some, frequent PACs/PVCs can be as damaging and troublesome as A-Fib. Ablations are done not just to fix A-Fib, but can also be for the sole purpose of freeing someone from frequent PACs/PVCs. They are an option patients with frequent PACs/PVCs should be aware of.

Try the Valsalva Maneuver

On the anecdotal side, some people recommend the ‘Valsalva maneuver’ (one type of Vagal maneuver) to stop PVCs/PACs—closing one’s mouth and pinching one’s nose shut while forcing exhalation, or sticking one’s head in a sink of really cold water (constricting blood vessels). For details about the Valsalva Maneuver see: FAQs Natural Therapies: The Vagal Maneuver.

For more about PVCs and PACs see: Premature Atrial Contractions (PACs) Predict A-Fib.

For ‘natural’ remedies see: FAQ Minerals Deficiencies: PVCs & PACs.

(Thanks to John Thornton for calling our attention to this research on PVCs.)

Back to FAQs: Coping with Your A-Fib
Last updated: Thursday, August 20, 2020

• Pearson, Anthony. Premature Atrial Contractions: Benign or Malignant? Medscape Today, January 6, 2020. https://www.medpagetoday.com/blogs/[/spoiler]

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