Heart Rhythm Abnormalities: Insights on Ectopic Beats and Ablation

Follow-up Inquiry #178599 Consultation

Dear Dr.
He,
Thank you very much for your personal response and guidance in the inquiry consultation #178599.
I have greatly benefited from it.
I would like to ask Dr.
He the following questions:
1.
Regarding the issue of having one (or multiple) ectopic foci in the heart:
(1) You mentioned that the presence of ectopic foci can lead to abnormal electrical discharges in certain areas of the heart, resulting in abnormal premature beats (such as frequent episodes that cannot be controlled by medication).
Could you clarify whether these ectopic foci are fixed in position or if they can be mobile? Or do both types exist?
(2) Following up on that, concerning benign versus abnormal premature beats, is it correct to say that the "cause" is the same for both, namely that the presence of ectopic foci leads to abnormal electrical discharges in certain areas of the heart? The difference lies in that occasional premature beats that are controllable and do not affect daily life (or life-threatening) are considered benign, while frequent episodes that cannot be controlled by medication and impact daily life (or are life-threatening) are classified as abnormal.
Is this understanding correct? Or is it that benign premature beats are not caused by ectopic foci leading to abnormal discharges, but rather by other factors?
(3) I have found information stating that a normal heartbeat is initiated by the sinoatrial node (the normal pacemaker), but that both the atria and ventricles also have the ability to initiate contractions.
In normal circumstances, the sinoatrial node triggers the heartbeat, while the atria and ventricles remain inactive.
Is it correct to say that premature beats occur when the atria and ventricles are abnormally activated when they should not be, leading to premature contractions?
2.
Regarding catheter ablation for premature beats, based on my understanding of your response, it seems that the procedure is recommended only when the premature beats are excessively frequent (more than 1% of daily heartbeats, approximately over 1000 times a day) and cannot be effectively controlled by medication, significantly impacting quality of life or posing a risk to life.
However, it appears that catheter ablation can only target existing ectopic foci for ablation, and there remains a possibility of recurrence at the same site (though the probability is low) or the emergence of new ectopic foci in other areas of the heart that could again lead to premature beats.
Therefore, it seems that complete cure of premature beats is not possible.

Thank you, Dr.
He.

Axiang, 30~39 year old female. Ask Date: 2022/02/14

Dr. He Dongjin reply Cardiology

You may have multiple ectopic foci that can be either fixed or wandering.
Indeed, the atria and ventricles may exhibit abnormal activity when they should not, leading to premature beats.
It is true that complete cure is unlikely because there is a possibility of recurrence at the same site or the emergence of new ectopic foci in other areas of the heart, which can again trigger premature beats.
You are absolutely correct.
Changhua Hospital cares about you.

Reply Date: 2022/02/14

More Info

Understanding heart rhythm abnormalities, particularly ectopic beats, is crucial for managing cardiovascular health. Ectopic beats, which include premature atrial contractions (PACs) and premature ventricular contractions (PVCs), arise from abnormal electrical activity in the heart. Here, I will address your questions regarding the nature of these ectopic beats, their causes, and the implications for treatment, including ablation procedures.

1. Nature of Ectopic Beats:
- Fixed vs. Non-Fixed Ectopic Foci: Ectopic foci can indeed be either fixed or mobile. A fixed ectopic focus is a specific area in the heart that consistently generates abnormal electrical impulses, leading to ectopic beats. Conversely, a non-fixed focus may vary in location, potentially moving within the heart tissue. Both types can contribute to arrhythmias, and their identification often requires advanced diagnostic techniques such as electrophysiological studies.

- Benign vs. Pathological Ectopic Beats: The distinction between benign and pathological ectopic beats is primarily based on their frequency and impact on the patient's quality of life. Benign ectopic beats are typically sporadic, do not lead to significant symptoms, and can often be managed with lifestyle modifications. In contrast, pathological ectopic beats are frequent, may be symptomatic, and can lead to more serious arrhythmias if left untreated. Your understanding that both types arise from ectopic foci is correct, but benign ectopic beats may also be influenced by factors such as stress, caffeine intake, or electrolyte imbalances.

2. Mechanism of Ectopic Beats:
- The normal heart rhythm is initiated by the sinoatrial (SA) node, which serves as the primary pacemaker. However, under certain conditions, other areas of the heart, such as the atria or ventricles, can initiate impulses, leading to ectopic beats. This phenomenon can occur when the heart is under stress, during exercise, or due to structural heart changes. Your assertion that ectopic beats represent abnormal activation of the atria or ventricles is accurate.

3. Ablation Procedures:
- Ablation is typically recommended for patients experiencing frequent ectopic beats (often defined as more than 1% of total heartbeats per day) that significantly impact their quality of life or pose a risk of more severe arrhythmias. The procedure involves identifying and destroying the ectopic foci responsible for the abnormal rhythms. While ablation can effectively reduce the frequency of ectopic beats, it is important to understand that it may not completely eliminate the risk of future ectopic activity. New ectopic foci can develop, and some patients may experience recurrence of symptoms. However, the success rate for ablation is generally high, and many patients report significant improvements in their symptoms and quality of life post-procedure.

In summary, understanding the nature and implications of ectopic beats is essential for effective management. While benign ectopic beats may not require aggressive treatment, those that are frequent and symptomatic warrant further evaluation and possibly intervention. If you are experiencing significant symptoms or have concerns about your heart rhythm, it is advisable to consult with a cardiologist or electrophysiologist who can provide personalized recommendations based on your specific condition. Regular follow-ups and monitoring can help ensure that any changes in your heart rhythm are appropriately managed.

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