Frequent Heart Palpitations: Causes, Management, and Treatment Options

Frequency of premature heart contractions?

Hello, Doctor.
I would like to ask, for example, if there are about 4-5 premature beats this month and sometimes about 7-10 premature beats in a month, does this count as worsening or becoming more frequent? What is the definition of frequent premature beats? Currently, I am taking Concor 1.25 mg and Sotalol 150 mg in the morning and evening, but is there really no way to prevent them from occurring with medication? Or is it considered effective control if they only occur a few times a month?
Additionally, I would like to ask if antidepressants are considered medications that stabilize the autonomic nervous system.
I have noticed that I have had about 6-7 premature beats this month, and I wonder if this is related to the fact that I forgot to take my antidepressant for over a week this month (I need to take it once a day).
Can antidepressants and medications for anxiety control premature beats, or is it that we can only hope to reduce their occurrence rather than eliminate them entirely?
I understand that you mentioned that with this level of occurrence, there is no need for catheter ablation, but I am still looking for ways to eradicate the problem.
I have consulted more than five specialists in arrhythmia, and they all say that maintaining the current medication is sufficient, and that surgery may not prevent recurrence and would still require medication.
So should I go for ablation or not? Is there a chance it could be eradicated, or could there be new sites of ectopic foci after the procedure?
I read online that such premature beats often have no identifiable triggers; some people feel them while others do not.
I remember one doctor said that it is not caused by mitral valve prolapse but rather is due to my constitution.
How can I improve this? I exercise daily, go to bed early, wake up early, and eat a light diet, yet I still experience 4-5 premature beats each month.
Whenever I ask my doctor during follow-ups, I only receive the advice to continue taking medication, and I am gradually coming to accept that I will have premature beats.
However, sometimes they feel strong and sometimes weak, and it is really difficult not to let it interfere with my thoughts.
Thank you, Doctor.

Mr. Wang, 20~29 year old female. Ask Date: 2022/11/19

Dr. He Dongjin reply Cardiology

Hello, this amount is really not much for a month.
It is related to changes in both internal and external environments, including the recent seasonal transitions, stress, and the stability of the autonomic nervous system.
Based on my 30 years of experience with 24-hour Holter monitoring, almost no one is free from premature beats.
Besides learning to coexist with them, there seems to be no other method.
Pray more, and I will also pray for your peace.
Changhua Hospital cares about you.

Reply Date: 2022/11/19

More Info

Frequent heart palpitations, particularly premature beats (often referred to as premature atrial contractions or premature ventricular contractions), can be concerning for many individuals. Understanding the causes, management strategies, and treatment options is essential for those experiencing these symptoms.

Definition and Frequency of Premature Beats:
Premature beats are early heartbeats that disrupt the regular rhythm of the heart. They can occur in isolation or in patterns and are often benign. The frequency of these beats can vary significantly among individuals. In your case, experiencing 4-5 premature beats in a month, and sometimes up to 7-10, may not necessarily indicate a worsening condition. However, the perception of frequency can be subjective. Generally, frequent premature beats are often defined as more than 10-15 occurrences per day, but this can vary based on individual circumstances and underlying health conditions.

Management and Treatment Options:
Currently, you are taking medications such as Concor (Bisoprolol) and Sotalol, which are beta-blockers and antiarrhythmic agents, respectively. These medications can help manage heart rhythm and reduce the frequency of palpitations. However, they may not completely eliminate the occurrence of premature beats. It is essential to have realistic expectations regarding medication; while they can significantly reduce the frequency and severity of palpitations, they may not eliminate them entirely.

If you find that your palpitations are still bothersome despite medication, it is crucial to discuss this with your healthcare provider. They may consider adjusting your medication or exploring other options, such as lifestyle modifications or further diagnostic testing.

Impact of Mental Health on Heart Rhythm:
You mentioned experiencing increased palpitations during a period of missed antidepressant medication. There is a well-established connection between mental health conditions, such as depression and anxiety, and heart rhythm disturbances. Stress and anxiety can exacerbate palpitations, and managing these conditions may help reduce the frequency of your symptoms. Antidepressants and anti-anxiety medications can stabilize the autonomic nervous system, which may indirectly help in reducing the occurrence of premature beats.

Electrophysiology Study and Catheter Ablation:
Regarding your concerns about catheter ablation, it is a procedure that can potentially cure certain types of arrhythmias, including some forms of premature beats. However, the decision to proceed with this intervention should be based on a thorough evaluation by a cardiologist specializing in electrophysiology. If your palpitations are infrequent and not associated with significant symptoms or underlying heart disease, many doctors may recommend continuing with medication rather than pursuing invasive procedures.

Lifestyle Modifications:
You mentioned that you are already engaging in healthy lifestyle practices, such as regular exercise, maintaining a balanced diet, and ensuring adequate sleep. These habits are beneficial for overall cardiovascular health and can help mitigate stress and anxiety, which may contribute to palpitations. Additionally, consider monitoring your caffeine and alcohol intake, as both can trigger or exacerbate premature beats in some individuals.

Conclusion:
In summary, while experiencing 4-10 premature beats a month may not indicate a severe worsening of your condition, it is essential to maintain open communication with your healthcare provider. They can help you assess whether your current management plan is adequate or if further intervention is warranted. Remember that while complete elimination of palpitations may not be possible, effective management can significantly improve your quality of life. If you continue to have concerns or if your symptoms change, do not hesitate to seek further evaluation.

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