PAC's and HR

[gasattack3]

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O.k. so one of my senior cardiac attendings told me that you can "get rid of" PAC's with sometimes simply increasing the pt's HR. This person said she did this with another "provider" and illustrated how 0.2mg Robinul increased HR and eliminated PAC's...... It was in a cardiac case, post-bypass but I don't know other details.

Didn't know what to say really. I respect this attending very much and just wanted to get thoughts on this matter... I felt dumb then and maybe even dumber now for posting this but it bothered me a bit that I'd never heard of such a thing and so I'm posting it...... (no I did not just smoke a joint or do any other illicit drug)

 

[deleted9493]

Well, yeah, if you increase the sinus rate enough you'll theoretically make the aberrant focus unable to depolarize (refractory period).

 

[Idiopathic]

a few thoughts

PACs are benign, and can be caused by increased stress response, catecholamines, electrolyte abnormalities, etc...all things that can be fixed, not covered up

PACs predict conversion to a-fib, which is not benign, and speeding up someone artificially to cover up PACs may facilitate conversion to a-fib, especially in this high risk population

think of how fast the atrium can beat, up to 400 times per minute. if it really wants to find an aberrant pathway, it will, unless you are thinking of speeding up to 160-180 or so.

PACs can be concerning in someone with known AVNRT/PSVT/WPW and I think antiarrythmic therapy is usually guided at protecting the atrium from these impulses, but i dont usually try and get rid of them in the OR otherwise

just my opinion, though. id love to hear others.

 

[Idiopathic]

O.k. so one of my senior cardiac attendings told me that you can "get rid of" PAC's with sometimes simply increasing the pt's HR. This person said she did this with another "provider" and illustrated how 0.2mg Robinul increased HR and eliminated PAC's...... It was in a cardiac case, post-bypass but I don't know other details.

Didn't know what to say really. I respect this attending very much and just wanted to get thoughts on this matter... I felt dumb then and maybe even dumber now for posting this but it bothered me a bit that I'd never heard of such a thing and so I'm posting it...... (no I did not just smoke a joint or do any other illicit drug)

for about 30 minutes...or just long enough to drop off in the ICU 😉