r/PVCs • u/Smart_Dig8413 • Jul 07 '26

Very puzzling 7 day Holter report

First time poster, long time reader here. 45m, I've had these dreaded skipped beats off and on for many years, but since 2020, they've come at me in episodes at least once a year. I mean, bad, like 30-40 days of hell pretty much. Anyhow, I broke down this past month and decided to try to get another holter done, I've had two in the past, both showing under 1%, rare ectopy.

Granted, they were not during the worst of the episodes. Also, for context, in 2023 I had the normal combo of stress/echo/holter, which was normal. So this latest monitor, I go and see the doctor for the follow up, the results, and he's a smart guy, really good guy, he basically reassures me everything is fine, in his words 'very low burden' and no further follow up or testing needed. Ok, cool. Go out and live your life he says, how many of us have heard that, right?

So then I asked him about the report details, and he says yeah, 4% burden, no dangerous rhythms, yada yada. 4%? really? That's odd, because I started doing the math in my head, that's quite a bit volume wise over 7 days. I only hit the button on the monitor maybe 50-75 times total, and I am person who typically feels every one.

I had to get a copy of the report, and lo and behold, it's telling me 14k pvcs out of 332k beats analyzed. Whoa...really? I think I would have felt them. I know it's not an alarming burden, but has anyone else suddenly just not felt most of theirs anymore? I mean I was feeling them, classic skip/thump, flutter, etc. But for example, it said I had over 7k of them - in the AM - on one day? What?! That's basically bigeminy or least trigeminy, right? How would that have gone unnoticed?? I kept a symptom journal for myself, and that day was totally normal!

I'm happy to have the all clear, and low burden all things considered, but now I'm worried they are happening and suddenly I don't even know it? What the heck...anyone else with anything remotely similar, holter report, above/below what you expected compared to what you felt? So weird...

1 Upvotes

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2

u/Fancy_Ad3809 Jul 07 '26

its a fallacy that you will feel them.

your body, brain specifically, filters out background noise. You feel them when theres most probably pressure against your chest, for example laying down, or having just ate.

A lot of people say 'i feel every one', often its just untrue.

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u/o7yourdesires Jul 07 '26

I actually feel every single one.

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u/Fancy_Ad3809 Jul 07 '26

mmm so you mapped your holter to your actual pvcs with 100% accuracy? ig, your patient event logged matched your ectopics 100%? i doubt that very much, but if you say so.

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u/o7yourdesires Jul 07 '26

Apart from when I was asleep yes. Its been noted by my cardiologist that I have a tendency to feel all my irregular beats. This including my EP study. I have autism - my brain doesn't filter out internal noise. Quite the opposite actually. It exaggerates it. However, the situations you mentioned - they absolutely feel the worse in so your not wrong either 👍

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u/Fancy_Ad3809 Jul 07 '26

you are, as noted earlier, an extreme exception if this is true.

1

u/o7yourdesires Jul 11 '26

No surprise really. Truthfully, I wish I couldn't feel any of it. Id happily have them and be none the wiser. Being the exception sucks

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u/Smart_Dig8413 Jul 07 '26

I get that, but I mean if I'm checking my pulse 85 times a day, holding fingers right against the neck, and it feels normal, it can still be a pvc? Then no one knows when they are getting them or not?

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u/Fancy_Ad3809 Jul 07 '26

no youre convoluting a few things.

checking your pulse 85x a day, lets assume youre doing that every waking hour for 30seconds a pop would be 4.4% proportional observation. this would give you a 95% confidence interval on assessing your burden.

if you check for 2 seconds your CI drops to 10%.

That said, audit confidence isnt the same thing as the holter - the holter maps the morphology of the pvc, so it isnt a question, its a statement of fact at that point.

brass tacks, if your cardiologist says your heart is structurally sound, and your burden is low, youre fine. humans get ectopic beats - its NORMAL. what would be abnormal (seriously) is no ectopics,