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41, Athletic, Sinus Pause
41 year-old athletic, fit male. I would say top 5% fit. I've had a first degree AV block since at least age 37, but developed it between age 30 (normal ECG) and then. Went to a cardiologist on the advice of my primary care, no symptoms of any kind, she just said I should go. Wore a Holter monitor, and have bradycardia (39 - 49 BPM) during the night with at least three pauses of 3-5 seconds.
Now I have a cardionet thing, and last night it recorded more bradycardia, but no pauses. The doctor called after they transmitted the data, to ask if I was okay.
I have a sleep study coming up to screen for OSA.
The electrophysiologist wants to do an EP study and thinks I might need a pacemaker. My radiologist buddy told me cardios love to do their little procedures, and to give it some hard thought.
Again, no symptons - wondering if anyone else has sinus pauses of this duration at night not due to SSS or something else?
Now I have a cardionet thing, and last night it recorded more bradycardia, but no pauses. The doctor called after they transmitted the data, to ask if I was okay.
I have a sleep study coming up to screen for OSA.
The electrophysiologist wants to do an EP study and thinks I might need a pacemaker. My radiologist buddy told me cardios love to do their little procedures, and to give it some hard thought.
Again, no symptons - wondering if anyone else has sinus pauses of this duration at night not due to SSS or something else?
Well, at night my heart rate is down to 37, and that's perfectly normal for me. I wouldn't even know it if I hadn't studied my Holter report. The note from my cardiologist was:
"Sinus rhythm. Normal findings except rare PACs. No significant tachycardia, bradycardia or pauses".
By the way I think the criteria for further examination is pauses longer than 2,7 sec at daytime and 3 sec at night (during sinus rhythm, in A-fib somewhat longer pauses are normal).
An EP study to reveal SSS is focused on the sinus node. They use atrial pacing (no risk of developing ventricular arrhythmias) to create an artificial atrial tachycardia and suddenly stops it, to measure how long it takes for the sinus node to start up. I think a pause longer than 1,5 seconds is abnormal (test positive for SSS) but I'm not completely sure about this.
A pacemaker inserted for SSS will almost never be noticed. The sinus node will still be in charge of the heart activity, but the pacemaker creates a floor in the heart rate, usually 50, so when your heart rate goes below that, the pacemaker takes over. If you have events of rapid heart rate too, that's usually treated with beta blockers when you have the pacemaker installed.
"Sinus rhythm. Normal findings except rare PACs. No significant tachycardia, bradycardia or pauses".
By the way I think the criteria for further examination is pauses longer than 2,7 sec at daytime and 3 sec at night (during sinus rhythm, in A-fib somewhat longer pauses are normal).
An EP study to reveal SSS is focused on the sinus node. They use atrial pacing (no risk of developing ventricular arrhythmias) to create an artificial atrial tachycardia and suddenly stops it, to measure how long it takes for the sinus node to start up. I think a pause longer than 1,5 seconds is abnormal (test positive for SSS) but I'm not completely sure about this.
A pacemaker inserted for SSS will almost never be noticed. The sinus node will still be in charge of the heart activity, but the pacemaker creates a floor in the heart rate, usually 50, so when your heart rate goes below that, the pacemaker takes over. If you have events of rapid heart rate too, that's usually treated with beta blockers when you have the pacemaker installed.
I absolutely agree. I guess what I was trying to point out was the fact that a pacer isn't the end of intense physical activities. I was reading a thread on the Cycling News Forum (hint, hint) of an elite cyclist who has had 3 unsuccessful ablations, and who might have to consider a pacer. There was an informative response from a maker of pacemakers who was trying to assure him that the equipment today is not like they put in years ago, and that he would probably be able to continue his training and competing; that's how good these things are today. It also mentioned that 5-10% of trained athletes will develop a cardiac irregularity. Sort of gives creedence to my fun theory that you're given a certain number of heartbeats. Don't use them all up at once!
One thing I think few consider on here...with treating pvcs...
beta blockers can cause acquired heart block.
I already acquired 1st degree years ago from a medication, stopped the meds, but too late..damage done...so when my EP suggested beta blockers for my crazy amounts of pvcs...I said no way...
below is a quote from cardio smart
"Exposure to toxic substances and taking certain medicines, including digitalis and beta blockers, also may cause heart block. Doctors closely watch people who are taking these medicines for signs of problems."
beta blockers can cause acquired heart block.
I already acquired 1st degree years ago from a medication, stopped the meds, but too late..damage done...so when my EP suggested beta blockers for my crazy amounts of pvcs...I said no way...
below is a quote from cardio smart
"Exposure to toxic substances and taking certain medicines, including digitalis and beta blockers, also may cause heart block. Doctors closely watch people who are taking these medicines for signs of problems."
You are right, a PM might be suggested for someone getting pauses that long but I don't think it's a clear cut decision point. It requires analysis of other factors.
Other things to consider are
A Sinus Pause is *usually* followed by a Junctional Escape Beat. What does that look like?
Was it just athletic vagal tone that slowed the SA cycle or was it blocked?
I'm wondering if they want to do the EP study to evaluate for SA block. From what I've read in the past, it's hard to understand SA block from surface ECG.
I think you'd want to consider 2 things to eval for a PM in this situation.
Etiology of the pause: is it sinus node dysfunction (block)? Athletic Vagal Tone? AV bock?
Symptoms: If it's asymptomatic, structurally normal heart, vagal tone etiology I would have a rough time letting them stick a PM in my body.
Then again I may have no idea what I'm talking about, please see this through with your doctor. I'm just trying to make the point that there's analysis you can do to help make a more informed decision.
Other things to consider are
A Sinus Pause is *usually* followed by a Junctional Escape Beat. What does that look like?
Was it just athletic vagal tone that slowed the SA cycle or was it blocked?
I'm wondering if they want to do the EP study to evaluate for SA block. From what I've read in the past, it's hard to understand SA block from surface ECG.
I think you'd want to consider 2 things to eval for a PM in this situation.
Etiology of the pause: is it sinus node dysfunction (block)? Athletic Vagal Tone? AV bock?
Symptoms: If it's asymptomatic, structurally normal heart, vagal tone etiology I would have a rough time letting them stick a PM in my body.
Then again I may have no idea what I'm talking about, please see this through with your doctor. I'm just trying to make the point that there's analysis you can do to help make a more informed decision.
Hi guys. I found a good site with clear information. Keep reading...the next chapter so to speak is about heart pause.....
"But generally a 3 second or more pause is almost always pathological "
I want to post the link.....but we usually cant..I will message you the link
"But generally a 3 second or more pause is almost always pathological "
I want to post the link.....but we usually cant..I will message you the link
Hang on a second. Athletic bradycardia is perfectly normal. Pauses of "3-5 seconds" I would think is another.
This guy is hitting low numbers that I hit in my sleep too, but no one ever hinted about needing a pacemaker. From what he's telling us I disagree about needing a PM or an EP study. There is risk to implanting the leads and there's risk to having the leads there for the rest of his life. I wouldn't recommend ANY risk to someone who doesn't need it.
From what he's told us
Asymptomatic sleep bradycardia in a fit athlete would not indicate a need for a PM. His heart is responding correctly to physical stress.
First degree HB would not indicate a need either.
Neither of these would indicate a need for an EP study!!
Perhaps there's more to this though. I used cardionet as-well, none of my events ever triggered a call from the doc and I was throwing 5,000 PVCs a day. During the evening my HR would go down to high 40s while I was awake but it was asymptomatic and didn't trigger a call back. I remember one occasion when it was 48ish, and my kid fell out of bed. I jumped out of my recliner and was upstairs in an instance, and no problems.
Noaz, perhaps this ins't anything to do with the brady. Perhaps they are seeing higher degrees of heart block than 1st. If there was a HB situation, what occurred after it? was there any sort of escape rhythm?
nor would any of these indicate a need for an EP study. Doing an EP study assumes that an ablation is probably required. Who ablates muscle for HB or athletic bradycardia??!!
I just don't get why they are pushing for these based only on nocturnal brady and 1st degree HB in an athlete. There must be more to the story.
From what he's told us
Asymptomatic sleep bradycardia in a fit athlete would not indicate a need for a PM. His heart is responding correctly to physical stress.
First degree HB would not indicate a need either.
Neither of these would indicate a need for an EP study!!
Perhaps there's more to this though. I used cardionet as-well, none of my events ever triggered a call from the doc and I was throwing 5,000 PVCs a day. During the evening my HR would go down to high 40s while I was awake but it was asymptomatic and didn't trigger a call back. I remember one occasion when it was 48ish, and my kid fell out of bed. I jumped out of my recliner and was upstairs in an instance, and no problems.
Noaz, perhaps this ins't anything to do with the brady. Perhaps they are seeing higher degrees of heart block than 1st. If there was a HB situation, what occurred after it? was there any sort of escape rhythm?
nor would any of these indicate a need for an EP study. Doing an EP study assumes that an ablation is probably required. Who ablates muscle for HB or athletic bradycardia??!!
I just don't get why they are pushing for these based only on nocturnal brady and 1st degree HB in an athlete. There must be more to the story.
The modern pacemaker is very advanced, and should have minimal impact. It can be programmed to track different parts of your heart at any given moment, has an accelerometer to adjust pacing, and many other technological features. It can be adjusted and tweaked to accommodate your lifestyle. There are online examples of elite athletes who are fitted with pacers. I don't believe I'm permitted to cite links, but a cycling forum has a very interesting article concerning a competitive cyclist and his particular arrhythmia who is being advised to consider a pacer. Don't discount the option of a pacer. It could ultimately save your life.
If it's asymptomatic, what lead to the studies?
Personally I wouldn't treat asymptomatic brady.
Personally I wouldn't treat asymptomatic brady.
I don't have this problem but read a bit about it while researching my tachycardia. If I were you I would definitely research the condition before putting in a pacemaker. If you are only at level one WebMd indicates that a pacemaker is not needed. It would however, be important for you to go to your yearly checkup to ensure you do not develop a heart rhythm problem like afib. Being that you are healthy, in shape and not having much symptoms research how having a pacemaker would affect your life. Good luck.
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