It is not clear why you have popping sensation when you breathe in. If the pain or popping sensation increases with taking deep breaths, not associated with sweating, dizziness and not related with exertion, it is unlikely that it is related to heart. It could be either be musculo-skeletal pain (related to muscles and bones in the chest region) or a condition known as costo-chondritis. Treatment will involve taking anti-inflammatory medications like ibuprofen as and when needed. If the pain continues to recur, I would recommend you to follow up with your primary care doctor.
If you have had no episodes of Afib and A fib is under control, your doctor could consider stopping rythmol and re- assess if you have AFib recurrence and there is any change in PVCs frequency. Rythmol by itself cause PVCs in 1-2 % of patients taking it. Since you have undergone 4 ablations it is more likely that you may be one of those patients who may have extensive substrate changes with scar and require anti-arrhythmic medication for control of atrial fibrillation. If the PVCs are significantly impairing your lifestyle and your current antiarrhythmic drug is not doing the job, your doctor could consider changing to another anti-arrhythmic medication and reassess if there is a decrease in frequency of PVCs
In the recently published study , Dr.Narayan and his group compared FIRM+ conventional approach to conventional approach alone and showed that FIRM techinque was able to terminate or slow down atrial fibrillation in 86 % patients before conventional approach. The early data is very thought provoking and warrants furhter studies. This study was a non-randomized study and did have limitations. This techique requires further validation in larger populations before the findings can be extrapolated. Also further randomized controlled studies are needed to demonstrate the overall safety and efficacy of this techique in all population groups. Like any other idea it needs work to tease out the details. If you are not willing to participate in the early phases of the research you may definitely want wait until we get further data.
It is important to make sure what you describe as PVCs are not actually runs of atrial fibrillation. When you are angry or stressed , there is increased activity of sympathetic nervous system and this can precipitate arrhythmias like atrial fibrillation or PVCs. ECG at time of episodes or looping monitor will enable to us identify whether the episodes are actually atrial fibrillation or just PVCs. The next step would depend on what the ECG or looping monitor would show. If it is atrial fibrillation during the episodes, the symptoms are significantly imparing your lifestyle and flecainide is not working, then catheter ablation would be a good option to pursue.
Odd beats could just be premature atrial or ventricular beats or short runs of atrial fibrillation. The best way to rule out atrial fibrillation is to have a looping monitor placed and analyse your ECG during these episodes. The next step would depend on what the monitor would show. If the monitor does show premature atrial or ventricular contractions and your lifestyle is not significantly impaired due to these rare premature beats, then there is no indication for any immediate intervention. If monitor shows atrial fibrillation or heavy load of premature atrial or ventricular beats, then you could pursue rhythm control either with medication or catheter ablation.
AF ablation may cause changes in autonomic nervous system like slightly higher resting sinus rate, a decrease in heart rate variability. But these symtpoms often resolve within a few months after ablation, but sometimes may be present at even one year after ablation. Similarly there may be damage to esophagus or nerves close to esophagus during the procedure which results in symptoms like nausea, vomiting and bloating but the symptoms resolve in few weeks. One of presentations of atrial fibrillation can be excessive sweating.In your case, excessive sweating may be due to runs of atrial fibrillation during exercise. We recommend you to follow up with cardiologist and consider transteplephonic monitoring during these episodes of excessive sweating to rule out AF recurrence. Make sure you are not going into AF during your cycling trips.
As described in the question above, AF ablation can cause alterations in autonomic nervous system . Patient may develop symptoms like nausea after ablation which resolve over few weeks. One of presentations of atrial fibrillation is excessive sweating.In your case, excessive sweating may be due to runs of atrial fibrillation during exercise. We recommend you to follow up with cardiologist and consider transteplephonic monitoring during these episodes of excessive sweating to rule out AF recurrence. if you are in normal sinus rhythm on a monitor I don't have a clear answer toyour excessive perspiration.
Your symptoms seem to be more likely caused by acid reflux from your stomach than from a heart attack, but only a thorough evaluation can conclude that with certainty.
Some tests (EKG) may show signs of an old heart attack. These signs are not always conclusive, and need to be confirmed with other tests. Your doctor seems to be doing the right thing by ordering more definitive tests to clarify whether your husband has had a heart attack or not.
Dr. Andrea Natale
Dr. Andrea Natale is a board certified electrophysiology expert and practices at executive medical director of the Texas Cardiac Arrhythmia Institute at St. David's Medical Center in Austin, Texas. Dr. Natale also is the Senior Medical Director at Pacific Atrial Fib and Arrhythmia Center in San Francisco. He visits MetroHealth in Cleveland, and Akron General, Ohio. He has pioneered a new circumferential ultrasound vein-ablation system to correct atrial fibrillation and performed the procedure on the world's first five patients. For further details Please visit :Link
Dr. Dhanunjaya Lakkireddy
Dr. Dhanunjaya Lakkireddy, MD, F.A.C.C, FHRS. is a board certified electrophysiology expert and practices at Mid-America Cardiology and The University of Kansas Hospital Clinics in Kansas City, KS, USA. He has several distinctions in clinical and research career to his credit and serves as an associate editor for Journal of Atrial Fibrillation.For further details Please visit :Link
Dr. Dhanunjay Lakkireddy, MD, F.A.C.C, FHRS, The Kansas City Heart Rhythm Institute (KCHRI), KS, USA.
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