Ejection Fraction question

[TLII]

This is as much a statement (and hopefully a reassurance for others in similar situations) as a query. I've been having moderate PVCs and PACs (mostly isolated, but with occasional couplets and bigeminy) for about 3 years. When I first noticed them, I freaked out and saw a cardiologist, who prescribed a Holter monitor (which showed the above) and also suggested a stress echo. The results were very reassuring -- estimated ejection fraction rate of 65 -70% and no structural abnormalities, other than a "minor mitral insufficiency (+1)", which the doctor told me was essentially normal for a 47-year-old man.

Fast forward to the following year, when the PVCs and PACs increased enough to convince me (yes, I have anxiety issues) to see an electrophysiologist, who echoed the sentiments of the first cardiologist, but suggested I do an event monitor just to be sure. After two weeks, the results of the event monitor showed a fair number of PACs and PVCs, a few episodes of sinus arrhythmia and a few atrial couplets. Annoying, but not anything too dramatic. At the time, the electrophysiologist, who is a well-known doctor at NYU's heart rhythm center, said I had nothing to worry about, and should only think about medication to lessen these if they became a real bother and/or got significantly worse. He said if I wanted to be "absolutely certain" these were benign I could do a cardiac MRI.

Last year, the ectopic beats came back with a vengeance—100s a day, which was unheard of for me—around the time I had a bad chest cold/virus, and I decided to get the MRI. During the test, I was getting extra beats constantly—due at least in party, I'm sure, to my anxiety. The results showed a normal heart structurally, but my ejection-fraction rate was down to 48%. The electrophysiologist was, again, reassuring, but felt it might be worth doing another event monitor to make sure nothing had changed dramatically with my arrhythmia issues, and also to do another echocardiogram within six months. I did the event monitor not long after, and also had the echocardiogram. The event monitor results were fine, reflecting fewer skipped beats -- I figured this would be the issue as I noticed these really calmed down after my chest cold resolved. The stress echo, taken a month or so later, was, again, completely normal, with an estimated ejection-fraction rate of 65-70%. Both my cardiologist and my electrophysiologist said there was nothing to worry about -- the latter even cancelled our scheduled appointment, as he felt there was no need for me to see him. He said that it was possible that the PVCs during the MRI might have affected the measuring of the ejection-fraction rate, a theory the cardiologist seconded.

Does this sound right? Has anyone else experienced a similar discrepancy? I know MRIs are thought to be more accurate, but it seems significant that both echocardiograms—done by different people at different facilities—would be exactly the same.  

And finally, I just want to thank MedHelp and all of the people who have posted here over the years. It's been hugely reassuring to be able to get other perspectives on this disconcerting ectopic-beat issue, which I realize I am incredibly lucky to know, at least at this point, is essentially benign. Happy new year, everyone.

[TLII]

Thanks for the reassuring words!

[Flycaster305]

I'm not a health professional, but have had PAC/PVC issues since childhood, and although I developed some serious heart issues, they were not related to the PAC/PVCs.  
The most accurate way to determine EF in my opinion is to have a heart cath, but that is pretty invasive.  It sounds to me like you have been given excellent cardiac advice.  Also, I have worked in an environment where I've been able to see hospital patients heart patterns, and almost everyone has PAC/PVCs.
Believe me, if you  have any serious EF problems, you will know it, you will be breathless, experience angina, continuous extreme fatigue, I can tell you from first hand experience, and a goofy heartbeat won't be an issue!
Best wishes for a new year.