17 year old with bradycardia

[Darlene__0__0]

  My 17 year old son has been diagnosed with sinus bradycardia.  He has had symptoms since 4-30-98.  Symptoms include:  fatigue, lightheadedness, concentration problems, dizziness-hard to focus, objects jerk.  He is very athletic.  The pediatrician, neurologist, and ear, nose, throat specialist have tried to find his problem since May.  Many tests have been done.  All tests show he is in excellent condition.  We were referred to a cardiologist who has done EKG, 24 hr. monitor, and eccocardiogram.  We do not have the monitor results yet, and a stress test will be done in 2 days.  However, the cardiologist believes this is sinus bradycardia and a pacemaker will most likely be needed.  He said this is rare in a 17 year old and that there are really no medications to treat it.  
  Questions:
  1.  Are there alternatives other than a pacemaker?
  2.  Will he be able to play basketball with a pacemaker?  This is his Senior year and the season begins in November.  
  3.  How does this effect a teenagers lifestyle?
  4.  What is the life expectancy of a 17 year old who requires a pacemaker?
  5.  He seems to feel some better with each passing week.  Is this something that could possibly improve with time, without a pacemaker?
  6.  His heart rate is 48.  Would this pacemaker be used continually since his heartrate seems to be low all the time?
  7.  If so, would this mean battery replacement more ofter than 5-7 years?
  8.  Does this condition bring on other heart problems?
  
  2.  

[CCF Cardio MD - MTR]

_
Dear Darlene, thank you for your question.  I'll respond to each of your listed
questions individually.
1) It's premature to comment on alternatives to a pacemaker until the results
of the stress test and portable heart monitor are back.  These tests will determine
what his "true" rhythm is and that will be need to be known before deciding that
he does need a pacemaker.  With slow, bradycardic rhythms, there are no alternatives
to pacemakers for long-term treatment.
2) It's hard to say whether he will be able to play basketball with a pacemaker.
Certainly, that would not be allowed for a month or two after a pacemaker is
inserted to allow the lead to "fix" in place.  Unlike atheletes with fast heart
rhythm abnormalities, your son would not be at risk for sudden death with
exercise (even with a pacemaker), but there may be issues related to protecting
the device that would limit participation in athletics.  Your cardiologist would
have to answer this question.
3) If your son gets a pacemaker, he shouldn't have restrictions in his lifestyle.
He could still do almost all the activities that other teenagers do but he would
have to be more careful about avoiding activities where he could be hit in the
chest.  A direct blow to the chest could dislodge the pacemaker lead or damage
the battery.
4) Again, it doesn't seem that your son's rhythm disturbance is life-threatening;
it just causes symptoms that are affecting his life.  Thus, if your son needs
a pacemaker, his life expectancy should not be affected.  Again, you should ask
his cardiologist about this question.
5) I can't answer this question without knowing the results of his pending tests.
However, I'm sure his cardiologist would be absolutely sure that he needs a
pacemaker before he would advise him to go ahead with the procedure.
6) I'm sure that his heart rate is not always 48 because everyone's heart rate
continuously fluctuates.  Most pacemakers are programmed to pace below a certain
lower rate limit which is usually 50 beats per min. but that varies with each
person who needs a pacemaker.  The cardiologist who implants the pacemaker determines
what the lower rate limit should be.
7) Pacemaker batteries usually need replacement every 5-7 years as you stated.
If the pacemaker is continously pacing, the battery may not last that long.
So, it depends on how frequently the pacemaker is needed and the battery life
cannot be accurately predicted once the pacemaker's implanted.  
8) I doubt your son would have other heart problems in the future, but without
knowing the results of all his tests, I can't answer this question thoroughly.
I hope I've answered all your questions.  If not, please write back.  
Information provided in the heart forum is for general purposes only.   Specific
diagnoses and therapies can only be provided by your physician.