3 Brief Blocks in 6 days: Pacemaker?

Pauses

by AgentX86 - 2018-07-18 14:15:04

I was told thatpauses exceeding 3-seconds meant that a pacemaker was in your future. Others have said six. IMO, you're there, particularly with a complete heart block.  The good news is that you have escape beats to fall back on.

Really?

by b luepost - 2018-07-18 15:02:29

The pacemaker duty cycle is going to be  3/1000 of 1 percent.

Thinking I should just get an RR iphone app to wake me up if RR > 5 secs.  Will have to move into the guest bedroom.  

Guess I'm in the disbelief stage.

Disbelief

by AgentX86 - 2018-07-18 15:46:43

As a friend says,  "growing old isn't for sissies", to which I add "but it beats the only alternative".

Seriously,  a pacemaker isn't the end of the world. It's really the beginning. For 99%, it's a piece of cake - much less pain than a tooth filling and most feel better immediately after.

symptoms

by Tracey_E - 2018-07-18 16:04:34

Those episodes are pretty darned short. Are you symptomatic? If not, I'd wait. Heart block typically gets worse over time so there may be a pacer in your future, but I wouldn't be in any rush to do it. Are you seeing a cardiologist or electrophysiologist? If a cardiologist, I'd get a second opinion with an ep before making any decisions. 

If your ventricles were still beating, then it's not a pause. When they talk about pauses, they usually mean sinus pauses where there is no atrial beat. 6 seconds is the cutoff to recommend pacing. In your case, the atria is still beating, the ventricles are beating just not in sync with the atria. Typically the block lasts long enough that our heart rate drops. If the pause is only 3 seconds and the ventricles are still beating, there's no way your pulse can be dropping much. 

Don't go doing the math and figuring percentages. If your heart completely stops for 6 seconds, you can pass out. If it stops for longer than that, it may not start up again. Mathmatically that's a very insignificant amount of pacing because it's only kicking in a few beats out of thousands, but practically it's the difference between staying upright and passing out. Quality, not quantity. 

No Symptoms

by b luepost - 2018-07-18 16:27:10

No symptoms.  Only happens during sleep.  Here is the summary:

"Intermittent second-degree heart block and 3 episodes of complete heart block with
pauses up to 5.4 seconds were also noted."

The comment about escape beats was made by the EP I saw.  The summary above is from somebody else, possibly the referring cardiologist.  The Ziopatch readout was similar.

I am going to get a second opinion.  A little concerned that I got sucked into the EP funnel a too quickly.  "To a hammer everything looks like a nail."

Thanks for your comments and yes all it takes is one really bad beat.  

Just wondered if there were any similar folks on this forum.

Hey

by bluevelvetcake - 2018-07-18 17:13:09

I went to the ER for symptoms and left with a monitor for 48hours. I had a similar diagnosis and ended up with a PM a few days later. I then went to an EP and he made me feel like they might have overreacted but after he saw my PM firing off after his own testing he said indeed it was necessary. So I went the reverse route and the "hammer" didn't initially think of me as a nail. 

But here is something one of the 4 cardiologists in a week told me. If my heart is doing this now it will just get worse. It is A LOT better to have this surgery the younger you can get it. It jsut gets harder and harder to recover the older you are. Not that a PM is a bad recovery but things are harder as you get older. You are 70 and in good physical health it sounds like. You will bounce back quickly now but what about in 5 years or ten years. It sounds like a PM is in your future no matter what. So the question is, do you want to get it now or later? 

Asymptomatic Heart Block While Sleeping

by Heart-Rhythm-Center.com - 2018-07-18 17:16:50

Dear B luepost:

Certainly 3rd degree heart block is concerning BUT... If the heart block is not causing you symptoms and comes from a reversible cause such as perhaps sleep apnea then generally a pacemaker is not indicated. Both central and obstructive sleep apnea can cause high vagal tone and lead to periods of bradycardia (slow heart rates) and even heart block while sleeping. Treatment involved weight loss (if overweight) and a sleep study to diagnose the disorder. If you have sleep apnea then CPAP therapy is usually helpful. Discuss the situation with the doctor that ordered the holter monitor and explain your concern.

Hope this helps.

It only takes one

by Gotrhythm - 2018-07-19 14:40:11

Nobody should get a pacemaker that doesn't need one. But I have to wonder what led up to you getting the Holter monitortest that brought up the problem? I wonder what the doctor saw or you reported that made the test seem neccessary. Do you really have no symptoms?

You can't really do the percentage thing, to figure out "how bad"  your problem is. Trust me, I know, I tried it too. LOL. It doesn't matter how short the pause is compared to the number of hours in which there was no pause. The only time a 5.4 second pause is likely to cause trouble is the time it happens.

I had learned that my symptoms would go away after a few seconds and had just "ridden them out" for so many years that I denied I had any symptoms except extreme tiredness. Well yeah, I had them, but I didn't think I was lying. I didn't think they "counted." LOL. I was 68 and evviably healthy--young for my age by any measure.

It can be ridiculously hard to get meaningful to you information from a cardiologist. Still, it's your heart and your life. If you can't get satisfactory dialogue with this EP find another one.

Other Symptoms

by b luepost - 2018-07-19 15:15:33

By "no symptoms" I meant I can't feel the heart blocks.

Had a Holter to look at symptoms I *can* feel, mainly PVC's and SVT's.  During the 6 days I identified about 15 events for highlighting, and none of them correlated with the heart block.  Have been tracking these symptoms for 20 years.

Wife is currently building an iphone app (she works in the mobile health space) that will alarm if the RR interval is > n seconds.  Kind of a high tech redneck alternative to a PM. 

She keeps saying she always wanted to be an executrix but I don't find it funny.

It's your life

by AgentX86 - 2018-07-19 22:19:49

No one can tell you what to do but I listen to the experts I pay to help me.  It only takes one pause to kill you and if you're wife's app finds that one, exactly how does it help?  Sorry, but you're being irrational.

Seriously

by b luepost - 2018-07-21 13:55:36

The iphone app is just for fun while the real work of getting 2nd opinions and making a decision got done last week.  Going back to the EP on Tuesday for a final consult before getting the PM.