Atrial Fibrillation: Symptoms, Severity, and Next Steps

Arrhythmia

Hello Dr.
He: I apologize for the lengthy content, but I would like to ask for your clarification.
Thank you.
The doctor informed me that I have arrhythmia, but I am not quite clear on whether my condition is serious.
What type of condition is it? How should I proceed from here? Is surgery necessary? I would appreciate your help.
Thank you.
Symptoms: My heart noticeably skips a beat or pauses before a noticeable beat (without accompanying symptoms).
Duration: This has been occurring almost daily since April 23 of this year (in the morning, afternoon, and evening).

Background: A month ago, I visited a cardiology clinic for an examination, where I underwent blood tests, X-rays, and an echocardiogram.
The doctor informed me that the results were normal.
However, a 24-hour Holter monitor revealed arrhythmia with an unknown cause.
The doctor provided the Holter and echocardiogram reports and recommended further evaluation at a larger hospital.
The reports are as follows:
Holter Report:
- PREDOMINANT RHYTHM: Sinus
- INTERVALS: PR: 0.12 sec, QRS: 0.08 sec, QT: 0.34 sec (At Ventricular Rate = 80/min)
- HEART RATE:
- DAY: Mean 91, Minimum 65, Maximum 154
- NIGHT: Mean 68, Minimum 49, Maximum 130
1.
Sinus rhythm with rate 49-154/min and mean 80/min.
2.
There were intermittent sinus arrhythmias.
3.
No APCs (Atrial Premature Contractions).
4.
Moderate to frequent VPCs (Ventricular Premature Contractions) (total 269) with bigeminy, trigeminy, and quadrigeminy.
5.
No pauses.
6.
There were intermittent T wave inversions.
7.
Palpitations in the patient diary were associated with intermittent sinus tachycardias and VPCs.
Echocardiogram Report:
- Measurements: AO: 25mm, LVIDd: 44mm, LA: 21mm, LVIDs: 30mm, IVS: 9mm, EF: 60%, LVPW: 9mm, LV mass: 118gm
- Normal chamber size
- Preserved LV systolic function
- Trivial mitral regurgitation
- No E/A reversal
- Mild tricuspid regurgitation
___________________
- TSH: 2.27
- FT4: 1.50
Tina

Tina, 30~39 year old female. Ask Date: 2012/06/24

Dr. He Dongjin reply Cardiology

Dear Tina, you have mild arrhythmia primarily caused by premature ventricular contractions, with a total of 269 occurrences within 24 hours.
In fact, having up to 1000 occurrences in a day can be considered normal.
This is a benign arrhythmia, and there is no need for medication as it poses no life-threatening risks.
However, you may experience symptoms that can be uncomfortable.
Medication would only help alleviate these symptoms.
No surgery is required; observation is sufficient.
Overall, there are no significant issues.
It may be considered that your palpitations, chest tightness, and shortness of breath are due to autonomic nervous system dysregulation.
Changhua Hospital is concerned about your well-being.

Reply Date: 2012/06/24

More Info

Atrial fibrillation (AF) is a common type of arrhythmia characterized by an irregular and often rapid heart rate. It can lead to various symptoms and potential complications, including an increased risk of stroke and heart failure. Based on the information you provided, it appears that you are experiencing palpitations and have been diagnosed with some form of arrhythmia, which may include AF or other types of irregular heartbeats.

Symptoms and Severity
The symptoms you describe, such as a noticeable heartbeat or a pause followed by a strong beat, are typical of palpitations, which can occur in various arrhythmias, including AF. The fact that these episodes happen almost daily and at different times of the day suggests that they may be more than just occasional benign palpitations.
Your Holter monitor report indicates that you have a sinus rhythm with episodes of frequent ventricular premature contractions (VPCs), which can contribute to the sensation of palpitations. The presence of VPCs, especially in patterns like bigeminy (every other beat is a VPC) or trigeminy (every third beat is a VPC), can sometimes cause discomfort and anxiety, but they are not always indicative of a serious underlying condition.

Next Steps
Given that your initial tests, including blood work, chest X-ray, and echocardiogram, came back normal, it is essential to follow up with a cardiologist for further evaluation. Here are some recommended next steps:
1. Further Evaluation: Since the Holter monitor has shown arrhythmias, a cardiologist may recommend additional tests, such as an exercise stress test or an electrophysiological study, to better understand the nature of your arrhythmia.

2. Management Options: Depending on the findings, management may include lifestyle modifications, medication to control heart rate or rhythm, and in some cases, procedures like catheter ablation if the arrhythmia is persistent and symptomatic.

3. Monitoring: Regular follow-up appointments will be crucial to monitor your condition and adjust treatment as necessary. Keeping a diary of your symptoms can help your healthcare provider understand the frequency and triggers of your palpitations.

4. Education: Understanding your condition is vital. Ask your doctor about AF, its implications, and how it can be managed. This knowledge can help alleviate anxiety and empower you to make informed decisions about your health.

Surgical Considerations
Surgery is not typically the first line of treatment for atrial fibrillation unless other treatments have failed or if there are significant complications. Procedures like catheter ablation can be performed to target the areas of the heart that are causing the arrhythmia. However, this is usually considered after a thorough evaluation and discussion of the risks and benefits.

Conclusion
In summary, while your symptoms and Holter monitor findings indicate some form of arrhythmia, the severity and appropriate management can only be determined through further evaluation by a cardiologist. It is essential to communicate openly with your healthcare provider about your symptoms and concerns, as they can guide you through the next steps in your care. Remember, many people with AF lead normal, active lives with appropriate management.

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