Do You Really Need Medication for Early Heartbeats and Arrhythmia?

Do I need to take medication for arrhythmia and premature contractions?

Dear Director Wu,
Regarding the 24-hour Holter monitor from May 2023, which recorded 12,426 premature contractions, I initially took antiarrhythmic medication but found it more uncomfortable than the irregular heartbeat itself.
The doctor switched me to Dronedarone, which has been more tolerable, but I still have some questions:
1.
Can cardiac medications affect the kidneys? My estimated glomerular filtration rate (eGFR) was 110 in April, but it dropped to 88 on June 9.
Could this be caused by the cardiac medication? Which medication, Dronedarone or Sotalol, has a greater impact on kidney function?
2.
Regarding the premature ventricular contractions (PVCs), the stress echocardiogram indicated they are benign.

2.1 Is it necessary to take medication to control them?
2.2 If I can tolerate them, is it possible to stop the medication? (I am concerned about kidney damage or other side effects.) The doctor mentioned that if my heart rate is too low, I can skip the medication for that day, suggesting that it may not be mandatory to take it daily.
However, I have read other articles stating that one should not discontinue cardiac medications on their own.

2.3 If I do not take medication, will the frequency of PVCs increase? (Will the arrhythmia become more severe?)
3.
In daily life, are there any actions (besides medication) that can actively improve PVCs, such as exercise? Can weight loss, diet, or sleep improve PVCs?
4.
My premature contractions have occurred within the past year.
I had a measurement in October 2021 (only 8 times over 24 hours), which allows for comparison.
What could be the cause of this increase? (I suspect it may be related to the extreme sadness from my mother's sudden passing, but I would like to know what other potential causes there might be.)
5.
If medication leads to improvement, will I need to take it for life, or is it possible to discontinue it after improvement?
Thank you in advance for your professional insights.
Sincerely,
Ms.
Wang

Miss Wang, 50~59 year old female. Ask Date: 2023/06/11

Dr. Wu Xueming reply Cardiology

1.
Not related to these two medications.

2.
Taking medication can reduce the frequency of arrhythmias and control symptoms; please discuss any adjustments to medication and whether to continue use with your prescribing physician.

3-5.
Many factors in daily life can contribute to this condition, such as emotions, stress, irregular sleep patterns, or excessive intake of caffeinated beverages.
It is recommended to adjust your lifestyle and engage in regular exercise.

Reply Date: 2023/06/11

More Info

Dear Wang,
Thank you for your detailed inquiry regarding your heart condition and the management of early heartbeats (ventricular premature contractions, or VPCs). I understand your concerns about medication, kidney function, and lifestyle modifications. Let’s address your questions systematically.

1. Impact of Heart Medications on Kidney Function:
Heart medications can potentially affect kidney function, but this largely depends on the specific medication and the individual’s overall health. For instance, beta-blockers like Inderal (propranolol) and antiarrhythmic drugs can have varying effects on renal function. Your eGFR (estimated Glomerular Filtration Rate) dropping from 110 to 88 is concerning, but it’s essential to consider other factors such as hydration status, blood pressure, and any underlying conditions. It’s best to discuss this with your healthcare provider, who can evaluate whether your medications are contributing to this decline.

2. Management of VPCs:
- 2.1: If your echocardiogram indicates that your VPCs are benign, it may not be necessary to take medication if you can tolerate the symptoms. However, if the VPCs are frequent and bothersome, medication may help alleviate symptoms.

- 2.2: If you feel comfortable and your healthcare provider agrees, you may consider tapering off the medication. It’s crucial to do this under medical supervision to monitor for any changes in your heart rhythm.

- 2.3: Stopping medication may lead to an increase in VPCs for some individuals, but this varies from person to person. Regular monitoring is essential to determine the best approach for you.

3. Lifestyle Modifications for VPCs:
Yes, lifestyle changes can positively impact the frequency of VPCs. Here are some recommendations:
- Exercise: Regular aerobic exercise can improve cardiovascular health and may reduce the frequency of arrhythmias.

- Diet: A heart-healthy diet low in sodium and rich in fruits, vegetables, whole grains, and lean proteins can support overall heart health.

- Weight Management: Maintaining a healthy weight can reduce the strain on your heart.

- Sleep: Ensure you get adequate sleep, as sleep deprivation can exacerbate arrhythmias.

- Stress Management: Techniques such as yoga, meditation, or deep-breathing exercises can help manage stress, which is a known trigger for arrhythmias.

4. Possible Causes of Increased VPCs:
The sudden increase in VPCs could be related to various factors, including stress, anxiety, or significant life changes, such as the loss of a loved one. Emotional stress can lead to physiological changes in the body, including increased heart rate and arrhythmias. It’s important to address any emotional or psychological stressors, possibly with the help of a mental health professional.

5. Long-term Medication Use:
Whether you need to take medication for life depends on your specific situation. Some individuals may find that their arrhythmias improve over time and can discontinue medication, while others may need to continue for long-term management. Regular follow-ups with your healthcare provider will help determine the best course of action.

In conclusion, while medications can be beneficial in managing VPCs, lifestyle modifications play a crucial role in overall heart health. It’s essential to maintain open communication with your healthcare provider about your concerns, medication side effects, and any changes in your symptoms. Together, you can develop a comprehensive management plan that addresses both your physical and emotional health.

Best wishes for your health and well-being.

Sincerely,
Doctor Q&A Teams

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