Arrhythmias: Insights on Heart Rhythm Disorders and Treatment Options

Cardiac arrhythmia?

Hello Dr.
He, over the past year and a half, I have undergone four 24-hour Holter ECGs at my own expense.
Initially, I didn't feel any missed beats, as my heart rate was relatively fast with only about 50 VPCs, which I didn't notice.
However, during the second test, it increased to 190, the third to over 300 VPCs plus 50 APCs, and the fourth to 800 VPCs plus 100 APCs.
I would like to ask, Dr.
He, will this arrhythmia gradually increase? I have consulted with doctors, but they have no answers regarding the cause.
My echocardiogram shows normal structure, so can it only be classified as autonomic nervous system dysfunction? During my last visit to Renai Hospital, the doctor mentioned that many people experience thousands of VPCs, and that taking medication to control it to a few hundred can make one feel much better.
He suggested that I might have other arrhythmias that haven't been detected, which could be causing my discomfort, and recommended that I undergo a Holter monitor for 7 to 14 days at my own expense.
Do you think this is necessary, Dr.
He? The doctor prescribed Mexiletine HCl (Meletin 100mg/cap), but I am hesitant to take it due to the side effects I read about.
Will it make a difference if I don't take the medication? The doctor also mentioned the possibility of catheter ablation, although the effect may not be significant, it could provide some relief compared to my current condition.
Can I consult about catheter ablation after the pandemic is over, Dr.
He? I am truly grateful for your prayers for your patients, and your responses are not like the canned messages from other doctors.
May God bless us all with good health! Peace.

Niming, 20~29 year old female. Ask Date: 2021/06/04

Dr. He Dongjin reply Cardiology

Hello, actually, a VPC and APC below 1000 are still considered normal heart structures, which is good.
It really seems to be caused by autonomic nervous system dysregulation, so the frequency can vary.
Not taking medication shouldn't be an issue.
As for electrical ablation, I don't think it's necessary; it seems like using a sledgehammer to crack a nut.
Exercise, prayer, and faith should be sufficient.
God will bless you, so don't worry.
I will pray for your peace and well-being.
Changhua Hospital cares about you.

Reply Date: 2021/06/04

More Info

Understanding arrhythmias can be a complex and often anxiety-inducing journey, especially when experiencing symptoms like palpitations, skipped beats, or increased heart rates. Based on your detailed history and the results of your multiple Holter monitors, it appears that you have been experiencing a significant amount of ventricular premature contractions (VPCs) and atrial premature contractions (APCs).
Firstly, it’s important to understand that arrhythmias can be categorized into various types, and their severity can vary widely. The presence of VPCs and APCs is not uncommon, and many individuals may experience them without any underlying heart disease. In your case, the increase in the number of VPCs over time—from 50 to over 800—could indicate a heightened sensitivity of your heart's electrical system, possibly influenced by factors such as stress, anxiety, or autonomic nervous system imbalances.
The autonomic nervous system, which regulates involuntary bodily functions, can indeed play a significant role in heart rhythm disorders. Stress and anxiety can lead to increased sympathetic nervous system activity, which may exacerbate arrhythmias. This could explain why you feel more discomfort during periods of heightened anxiety or stress.
Regarding your question about whether the frequency of your arrhythmias will continue to increase, it is difficult to predict. Some individuals may experience fluctuations in their arrhythmias due to various factors, including lifestyle changes, stress levels, and overall health. It is also possible for arrhythmias to stabilize or even decrease with appropriate management, including lifestyle modifications and medication.

You mentioned that your echocardiogram results were normal, which is reassuring. Structural heart disease is a significant concern when evaluating arrhythmias, and the absence of such issues is a positive sign. However, if your symptoms persist or worsen, further investigation may be warranted. Your doctor’s suggestion to consider a longer-term Holter monitor (7-14 days) could provide more comprehensive data on your heart's rhythm and help identify any patterns or triggers associated with your symptoms.

As for the medication you were prescribed, Mexiletine is an antiarrhythmic drug that can help stabilize heart rhythms. While it does have potential side effects, many patients tolerate it well. It’s essential to weigh the benefits against the risks and discuss any concerns with your healthcare provider. If you are hesitant about starting this medication, express your concerns to your doctor, who may be able to provide alternative options or additional reassurance.

Regarding the possibility of catheter ablation (often referred to as "electric burning"), this procedure can be effective for certain types of arrhythmias, particularly if they are symptomatic and not well-controlled with medication. Your doctor can provide more information on whether this option is suitable for you based on your specific arrhythmia type and overall health.

In summary, while your situation may seem daunting, it’s crucial to maintain open communication with your healthcare provider. They can help you navigate your treatment options, whether that involves medication, lifestyle changes, or further diagnostic testing. Remember, many individuals with similar arrhythmias lead healthy, active lives with appropriate management. Continue to focus on stress reduction techniques, regular exercise, and a balanced diet, as these can significantly impact your overall well-being and heart health.

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