[harley_fan]

This may be a dumb questions but.. I had a patient that was in A. Fib and would have a couple beats that some nurses called PACs. I'm wondering if someone is in A. Fib could they have PACs or would this just be A.Fib with RVR for a few beats. Any clarification at all would be helpful. Thanks!!

[steelcityrn]

Yes, you can have afib with runs of pac's.

[VicChic]

Yes, that's correct. In fact, sometimes frequent PAC's are an indication of an underlying or impending atrial arrhythmia like A-Fib coming on.

[VicChic]

And no this was NOT a dumb question at all. On the contrary, it actually shows good critical thinking skills. Way to go!

[Tweety]

Originally Posted by steelcityrn

Yes, you can have afib with runs of pac's.

I'm confused. If the hallmark of a-fib is irregularity how to you do if the PAC is premature?

[VicChic]

I'm not exactly sure about your question Tweety, but I think you're asking about how can you tell what beat is the premature atrial contraction if the PAC makes the rhythm irregular and the A-fib itself also makes it irregular? To answer that question, remember that although both PAC's and A-fib both make a rhythm irregular, between PAC's and A-fib, only the PAC's will have an actual p wave indicating the atrial contraction. True Afib will NEVER have a true, distinctive p wave b/c the atria is FIBRILLATING, not contracting. So in Atrial Fibrillation with frequent/occasional Premature Atrial Contractions, look for distinct p waves to tell which are true PAC's.
I hope this helps to clear things up. If it doesn't, I'm sorry, but someone else might get it for ya' next time.

[telehead]

True Afib will NEVER have a true, distinctive p wave b/c the atria is FIBRILLATING, not contracting. So in Atrial Fibrillation with frequent/occasional Premature Atrial Contractions, look for distinct p waves to tell which are true PAC's.

I won't presume to speak for Tweety, but I think this is where the confusion comes from. My interpretation is as follows: As you state, with true afib, you have no distinctive p waves- the distinct electrical representation of a single focus discharge. But unless the hr is 60 or below and you're running on a junctional or ventricular pacer, the discharges in the atria are present- they just occur as multi-focal discharges. As such, this ectopy can occur anywhere (and everywhere ) in the atria. With no regularity, it can't truly be a pac. In my mind, the only way I could note pac's on strip containing afib is if the heart is extremely irritable and you have brief flops from fib to sinus and back again. In that case, I could see a regular pattern, if even only for 6-10 beats and witness a pac within that stretch.

That's my thinking... where are my holes?

[Tweety]

I'm having trouble visualizing a heart in fibrillation, suddenly producing a single PAC and staying in fibrillation. It's easier for me to understand if they go back into a sinus rhythm, then throw PACs, then back into fib and back and forth. This I have seen.

I don't know much and I just worked a 12 hour shift, but I can't see fib with PACs in my little tired brain.

[LCRN]

To my understanding if someone is in true atrial fibrillation they cannot have a PAC because as said previous in the post there are no distinct P waves and the atria are "fibrillating". The only thing I can think of--> if the patient broke into a sinus rhythym and was trying to go into afib--> possibly that's what nurse's were visualizing on the monitor.

Frequent PAC's can be an indication that the patient is trying to go into a-fib however if the patient is in a fib you will not have PAC's.

LCRN

[Spidey's mom]

See!? This is why is hate hate hate heart rhythm stuff!

I swear, every time I ask a question at work about a rhythm strip, I get a different interpretation. It is so frustrating.

And when you ask how you measure, oh boy .. watch out.

steph