Kenkeith, I need your help.

[PikaPika88]

Hi Kenkeith,

I think we met somewhere before.  I posted this in the other: rhythm forum but no one replied.

Is that normal that a person can without any Ventricular and Atrial Ectopy?  I never see one mentioned that 0 activity at all!  That day with the holter, I was dizzy whole day but no black out.

I got my Holter Report in the mail.  I have a look and think (no dr explain it), there are somethings was hidden.....  Must be the strong coffee worked!  No PAC, PVC nor Pause.

HEART RATE
Minimum HR-4 Intervals : 63 bpm at 02:07
Maximum HR-4 Intervals : 128 bpm at 18:56
Average HR-24 Hours : 80 bpm
Minimum HR-Hourly : 66 bpm at 4:00
Maximum HR-Hourly : 105 bpm at 11:00
Analyzed Beats : 113663
Analyzed Minutes : 1438

ST SEGMENT ANALYSIS
Total ST Minutes CH1 : 0
Total ST Minutes CH2 : 0
Total ST Minutes CH3 : 0
Max Delta ST Depression : N/A
Max Delta ST Elevation : +2.4 at 3:22 @ CH2
Max ST Episode : N/A
Max HR In ST Episode : 0

VENTRICULAR ECTOPY
VE Total : 0
V-Pair Total : 0
V-Run Total : 0  
Longest V-Run : N/A
Maximum HR V-Run : N/A
Minimum HR V-Run : N/A
VE's per 1000/per Hour : 0/0
Ventricular R on T : 0

SUPRAVENTRICULAR ECTOPY
SVE Total : 0  
SV-Run Total : 0
Longest SV-Run : N/A
Maximum HR SV-Run : N/A
SVE's per 1000/per hour : 0/0
Total Aberrant Beats/Runs : 0/0
Atrial Fib/Flutter : 0.0%

HEART RATE VARIABILITY
SDNN-24 Hour : 136
SDANN Index : 114
SDNN Index : 74
rMSSD : 63
pNN50 : 42
Spectral Power-24 Hour : 4877.9
Min Spectral Power Hour : 881.8
Max Spectral Power Hour : 11012.0

BRADYCARDIA
Pauses in Excess of 2.0 sec : 0
Max Pause : N/A

QT
Max QT : 649 ms (Ch.1)
Max QTc : 665 ms
Time of Max QT : at 23:24. HR 74 bpm.
Ventricular Escape : N/A

Do you know what is HEART RATE VARIABILITY?  
What is the normal QT/QTc range?  
The QT/QTc is increased each year?  Do you know what is that respresenting for?  
I had 3 or 4 thyroid tests.  All come back within normal.
Why there was a Max Delta ST Elevation : +2.4 at 3:22 @ CH2 but the counting of Max ST Episode : N/A ?  Are they different things?

Thanks.

[kenkeith]

Hi Pika, I believe we met in Australia? (wink)

Heart rate varibility: With a holter heart rate is measured with different power frequencies.  Spectral power: total power, very low frequency, low frequency and high frequency.  I don't know the significance.

Normal QT/QTc range.  Out of range if greater 440ms.  QTc is QT with heart rate factored out of the measurement.  Long QT syndrome can be inherited as a congenital mutation of ION channels or it can be acquired as a result of drugs that block cardiac channels. Also, there can be an electrolytic imbalance.

ION channels involve membrane cell physiology.  Atoms, part of the cell chemistry that carry cardiac impulse/action potential are disordered and present a block and cause rhythm events.

In context to a holter exam I'm unable to get information on ST.  With an EKG there are different leads, etc. and there is more information available.

Apparently, you have the  holter report.  There should be a written narative with doctor's conclusion!  Other findings and exams influence.  Reading between the lines there appears to be an arrhythmia problem or WPW.?!

[PikaPika88]

The aim for the holter is to find out that morning "express train" and a few episoles of blackout.  As far as my GP said, "the holter is normal".  Now the gastro dr turns...  She is going to find out weather is my tummy caused trouble or not, on the 30th.  I suppose it'll turn out all normal again.  The Holter Report conclusion as follow:

-Dual chamber pacemaker with atrial pacing and ventricular pacing and isolated pacemaker fusion beats.

-Average heart rate was 80. Minimum heart rate was 63 at 02:07. Maxium heart rate was 128 at 18:56.

-No ventricular ectopic beats.

-No supraventricular ectopic beats.

-No pauses greater than 2.0 seconds.

-One patient triggered event, coinciding with ventricular paced rhythm, rate 72-89 bpm.

That's all!

I think my cardio reakon that my heart is obesity too.  He set that morning "express train" once I woke up... He wants my heart also do a lot of exercise.  To get rid of the obesity?  I don't know why he wants to pace instead of sensing?   He said he is setting to pace the Atrial only.  Why the holter report said was pacing both?

Holter and Stress Test reports didn't say I got wpw.  Holter said "normal".  Stress Test said: BBB, St Elevation V1,  ?Burgada variant.  2 cardios said: wpw!  Confuse?

Thanks a lot for replying.

[kenkeith]

You can probably rule out WPW.  Possibly BBB and ST elevation develops with exertion?!.

Do you have a family history of heart disease?  Brugada variant can be the outcome of RV pathology (there is no evidence of that?!), by drugs i.e. anti arrhythmic, etc.,  electrolyte abnormalities, and it can easily be a normal variant,

A dual chamber ICD has a higher capability of detecting atrial arrhythmias in patients with Brugada syndrome or a carefully programmed ICD.  It would be difficult to overlook or miss by a test if your unit is of said technology.

[PikaPika88]

Thanks for that.

I have pacemaker not ICD.  Old cardio said, wpw was fixed but I still have wpw pattern.  After few months, he said I got AT/AF and ventricle had a quick responsed.  The young cardio said, not fixed yet.  After a year, he explained to the young cardio.  Although my av node had ablated.  I got a very active conducting accessory pathway.  It direct conducted from Atrial to Ventricle.  The pacemaker is just sitting there for an insurance.  (Now it's guiding my heart to do PUSH UP, every morning!)  

The old cardio wanted me to take Flecainide with Verapamil but I dropped off the Verapamil first.  Later admitted to hospital because my heart was naughty.  Flecainide not worked.  At first the ER doc though my pacemaker faulty.  The technician said was working fine.  Only picked up 2 beats late.... Now I don't have to take any heart med at all!  When I was 15 years old, was diagnosed with RBBB and PAT.  Now with a long term pacing right ventricle (25 years), I developed LBBB and a lazy heart, lazy tummy, lazy pancreas, lazy liver...... and a lazy eyes is coming.  

I still feel quite a bit of express train in my chest... but it is not palpitation.  Not a pac nor pvc!  Must be heartburn.