JennKay

Thanks for the response, RecipeForDisaster! Sorry to hear you have to deal with these too. They drive me crazy! I don't know for sure what triggered my initial episodes of bigeminy and trigeminy, but looking back I think it may have been a combination of job related stress, summer heat, and me not knowing about my vagal overactivity. I wasn't on beta blockers when they occurred initially. However, when I was taking 12.5mg of metoprolol, my heart would beat hard (like a pounding I could feel in my chest at a low heart rate for me, in the 50 bpm range), I would get chest pain, it would be difficult for me to breathe, and my hands and feet would tingle. It was super scary. Then, I started getting 3am adrenaline surges where my heart would jump to 130 bpm while I was lying flat in bed and my whole body would start shaking. I've read other posts here where people have very similar adrenaline surges, which is how I figured out what they were. The adrenaline surges prompted the 3-week event monitor b/c the cardiologist wanted to see what type of tachycardia I was in at 3am - it ended up being sinus tachycardia. Most of my symptoms have slowly gone away after stopping the beta blockers. Although, I still wake-up a night (which I have read here is not uncommon for people with dysautonomia) and the PVCs and PACs still occur. I've asked a few different doctors about the night waking, b/c I have seen so many at this point, and some have said I am sensitive to the natural circadian release of adrenaline in the early morning hours, others have suggested a sleep aid, one even suggested behavior therapy. I'm thinking the night waking is related to my vagal nerve issues, just don't know how to address it besides trying not to get overestimulated before bed.

Thanks, Sushi! Did the Strattera help with the ectopic beats, or was it mainly improving the symptoms associated with your elevated vagal tone? I have also wondered if something like this would be helpful for my symptoms. And yes, I agree about the ablation and antiarrhythmic being big hammers for ectopic beats. The first cardiologist I saw when all of this started said the same thing and that no treatment is necessary but I decided to try metoprolol anyway. I wish I would have passed on that b/c it definitely caused more issues. I now suspect the issues I had on beta blockers were due to my elevated vagal tone - the beta blockers essentially left my vagal activity fully unopposed! Bad idea... Do you think you developed afib b/c of your elevated vagal tone?

Thanks for the response! Your experience sounds like mine. My ectopics get worse after a meal, before having to go number two, around hormone changes in my cycle (ovulation in particular), basically anything that requires or increases vagal activity seems to set them off. In fact, when this all started, the bigeminy and trigeminy would only happen at rest. I didn't understand this, but I now suspect it was triggered at this time because this is when my vagal activity increases (to decrease my heart rate when sitting down). Even now, when I feel a few ectopics in a row, if I get up and walk for a bit, this will break the cycle. I felt the NSVT on my long-term monitor. I reported it as "fluttering/skipped beats," but honestly I didn't remember one trigger from another trigger during the 3 week monitor. I do feel the bigeminy and trigeminy, it has the pattern you describe, a normal beat, a normal beat, early beat, longer pause than normal, then the cycle repeats. I tend to notice the early beat more than the first beat after the early beat where it should be stronger than normal. I sense to be sensitive to the disruption in the regular heart beat pattern. This paper seems to confirm that vagal activity can generate PVCs and that ablation can often address this issue - https://www.frontiersin.org/articles/10.3389/fphys.2021.653225/full#S1 It is nice to know that this exists and appears to be effective!

Hi all! This is my first post, although I have been reading through many of your discussions since my ordeal started this past June. In short, out of what seems like no where, I started having episodes of bigeminy and trigeminy with sporadic adrenaline surges. I've had an echo, EKG, Holter, and long term event monitor. Almost everything has come back normal, except the ectopic beats and a short run of NSVT which multiple cardiologists have said is fine since my heart is structurally normal. My ectopic burden on the Holter (done in June) was 3% at its highest. However, my ectopic burden on the event monitor (done in August) was <0.01%. I have tried metoprolol and antenolol, both of which I did not tolerate. In fact, I suspect they were causing most of my POTS-like symptoms (adrenaline surges, hypotension, tingling hands, brain fog, dizziness) since most of these symptoms improve or fully resolve when I stop taking the beta blockers. Anyway, I finally found an integrative cardiologist who works with dysautonomia patients and he performed an ANS test, the report is called TM-FLOW. Again, almost everything was normal, except it says I have vasovagal syndrome. I've never fainted before, but I have struggled throughout my life with hypotension and am easily nauseated, which I now suspect is the result of my elevated parasympathetic vagal activity. So, my question to you all is, does anyone here have ectopic beats that they believe are mediated by vagal nerve activity and how do you deal with these? If so, what do you do to treat this? Am asking because the ectopics drive me absolutely crazy and I never want to try another beta blocker...ever!