Appointment with cardiologist tomorrow...

Hi guys, i had a 7 days Holter monitor and asked for results to be send in today, so that i come prepared with a list of questions. In No Way Am I asking to interpret conclusions, instead, if you are me and trying to get ready for the appointment, What Would You Ask cardiologist. Here are the conclusions:

"Patient was monitored for 7 Days. Patient was in Sinus Rhythm 86.88% of the time, with presense of 1st and 2nd Degree AV Block with 2:1 and 3:1 AV conduction. Intermittent Atrial Flutter noted with very low burden 0.17%. Longest pause with duration of 2.4 s (day 6 at 23:05). Ventricular ectopy with burden 0.04%.

Diagnostic findings: Normal sinus rhythm with very long 1st degree AV block, PR interval almost 400 ms. Intermittent bundle branch block, these could be confused with slow VT, but they are clearly conducted 1:1. Average heart rate 80 bpm, min 40 bpm, max 99 bpm. Nocturnal episodes of second degree AV block, sometimes with persistent 2:1 conduction for a few seconds. The longest pause was 2.4 secs.

Final conclusion: Paroxysmal atrial fibrillation and Flutter with very little burden. Transient Wenckebach, in keeping with normal high vagal tone overnight. No significant bradycardia"

Thank you so much,






by Lavender - 2023-10-10 22:46:44

I would ask the cardiologist to explain the test results and advise if a pacemaker is going to be helpful. Your pauses aren't too long, but sometimes this stuff is progressive. 

Ask him about the slowing of conduction between the atria and ventricles. With no significant bradycardia, I wonder if they will just medicate or watch. 

Good luck

by Gemita - 2023-10-11 06:27:56

Dima, thank you for your post.  I am sorry I am late in my response.  Since your main question has always been whether you require an ablation or a pacemaker, or both, my first thoughts are:

When you see your cardiologist:-

(1) report any difficult symptoms that you may be getting.  Based on your symptoms, he will be in a much better position to recommend a treatment plan following your holter results.

(2) The decision on whether you need a pacemaker or an ablation should be a joint one, although clearly if you trust your doctor you would do well to listen to what the doctor has to say before making any decision.

Looking at the Holter results, I cannot see anything truly worrying and the overall conclusion seems to be a reassuring one.  However as Lavender has already suggested, when electrical disturbances start they usually progress, so it is important that you receive timely treatment before you run into difficulty.  Data and percentages do not always tell the full story and you need to correlate any symptoms you may be getting with your holter findings to arrive at a decision about your future care. 

I found your holter results for the 7-day period of monitoring to be very detailed and certainly helpful.  You were clearly out of rhythm for 13% of the monitoring period, but with no evidence of any significant pauses (over 3 seconds).  

(3) Clearly you need to discuss:  the presence of 1st and 2nd Degree AV Block and how these might progress?  The PR interval at almost 400 ms (normal would be up to 200 ms) is too high and you need to know why?  You could also ask about your bundle branch blocks, whether right or left bundle branches are affected or both?  There is a lot going on and although not significant, these disturbances need to be watched, to keep you safe.

(4) The final conclusion of your holter results suggest that you have Paroxysmal Atrial Fibrillation/Flutter + ventricular ectopics with a very low episode burden which is really good news although clearly your monitor was only for 7 days and you might be getting more episodes over a longer period of time.  Holter results conclude you have no significant bradycardia.  Electrical disturbances are clearly present and I would want to know how best to manage these?  Longer periods of monitoring will continue to be necessary to keep you safe and to pick up any early changes. 

Good luck when you see your Cardiologist

7 Day Holter

by Penguin - 2023-10-11 06:39:20

A 7 day holter is a good test and has obviously yielded some results. Were you symptomatic during this time? Generally, when you go in for the chat afterwards, the EP / Consultant will let you know whether your symptoms correlated with what was recorded.  If the findings are borderline, symptoms may be the most important thing that the consultant considers.

I agree with Lavender that a good question to ask would be about the risk of progression. Wenkebach block (Mobitz I) is usually considered to be less likely to progress than Mobitz II.   Was this only found at night? 

Is it likely that AF / A.Flutter may progress & what is his opinion re: medication vs a pacemaker vs an ablation to treat this. 

You could ask about the last sentence and whether the high vagal tone at night influenced the findings and whether they were normal or not ?

I agree with Gemita's comment above re: your PR interval.  There are reasons for a long PR interval and it may be helpful to drill down into these and ask why it is so long - for example is it the size of your heart? are you missing beats and if so how often? is there any medication effect?   What does having a long PR interval imply in terms of your cardiac health? 



Thank you All...

by dimabai - 2023-10-11 17:28:06

Thank you All, you are an amazing group of people and support that most of us need. Your suggestions helped me immensely. My main sympotom is extreme tiredness, exhaustion. Yes, was symptomatic during Holter. Here is the very gyst of what cardiologist said:

"From Holter results perspective - not seeing any signs that can cause symptoms. I was in NSR 99.8% of the time. Pauses, skipped beats, long PR Interval (no concern), BBB, Wenkerbach (no concern) - not progressing to higher AV block (total for above symptoms 13%), night time bradycardia (18%) - quite normal, cannot contribute to my symptoms. Average heart rate during 7 days Holter 66bpm. I was in Afib only 0.17%. Not recommending PM or Ablation at this point"

On one hand, the results are good, but i was secretly hoping of finding a reason for my symptoms. Cardiologist suggested looking into either organic causes or depression (yes, i had it for a long time, but never have felt that exhausted). No follow-up at this point. Will also see EP soon and have a Sleep Study. Will keep you updated. Again, thank you All!

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