atrial tachycardia follow-up question

[annie1724]

Hello Doctor,
Thank you for answering my question yesterday regarding atrial tachycardia.  I have a follow-up question, (and have included a portion of my previous question and your answer to refresh your memory since I know you read a lot of these!)

Previous question:
........I had the ablation 8 weeks ago, and my AVNRT was successfully ablated.  However, in the weeks since the procedure I have had very brief runs (2-17 beats) of tachycardia once or twice a week.  I also experience occassional skipped beats and also extremely brief feelings (2-3 seconds) of a fluttering in my heart.  My EP had me wear a 48 hour monitor, which showed PACs (1/10 of 1% of total beats) and also two "3 beat runs of atrial tachycardia"........ 1. How likely is it that the atrial tachycardia is still a result of my heart being irritated from the ablation?

Your answer:
"1.  That would be unusual 8 weeks out of from the procedure, but certainly possible.  First of all, I don't think there is any evidence so far that you have atrial tachycardia, instead, just some PAC's.  It's highly likely that they have always been there and that's why you were found to have AVNRT.  PAC's usually start AVNRT. "


My follow-up question:
You said you didn't think there was any evidence so far that I have atrial tachycardia.  My EP said that the monitor showed a "three beat run of atrial tachycardia."  Is that the same as a run of PAC's?  And then could the 5 or 10 beats in a row that I feel also be a run of PAC's ? That would be great news if I'm understanding you correctly!

Thank you so much for taking the time to follow-up on my question!

Especially relieved to hear that atach doesn't automatically lead to a-fib!

[Cleveland Clinic]

Short burst of PAC's, 5-10 beats, is definitely very possible in your case.  The fact that you had 3 pac's in a row (again, not, by definition sustained atrial tachycardia) on the monitor makes it likely.  So, I wouldn't worry too much about this.  If this really bothers you a lot, you could consider medical therapy.  But only if this is really frequent and causes you significant symptoms.  In cases where medications aren't helpful we take those patients to the EP lab and perform an ablation procedure.      

[is_something_wrong]

While you are waiting for the doctor to answer, I'll just give a quick comment here (I hope you remember me from the heart rhythm forum).

Atrial tachycardia (atrial ectopic tachycardia) is a run of PACs. One could, of course, say that all supraventricular tachycardias are runs of PACs, but the mechanism is somewhat different for junctional / atrioventricular rhythms AVNRT (from the AV Node, and created by a so-called re-entry mechanism).

From the "textbook" a single PAC is a PAC, a double PAC is a PAC couplet and three or more PACs are "atrial tachycardia". This rule is more known regarding PVCs, where three PVCs is (using the similar logic) considered V-tach, and people getting an occational PVC triplet tend to read a ton of cardiology and believe they're dying because V-tach is life threatening.

There is a difference between sustained ventricular tachycardia and a PVC triplet. But short runs of PVCs have a name, NSVT. I guess there are no similar name to short runs of PACs (what would that be, NSSVT?), to differ from "sustained atrial tachycardia" I think the word is just "some PACs" or "a run of PACs" or "a line of PACs".

Best wishes! The doctor will answer you soon! :)