Bradycardia LQTS

I am a fairly healthy 40 year old woman and I have Long QT Syndrome type 2 and have had 4 recent faints shortly after waking up. A holter monitor picked up bradycardia at a rate of 32 with 4 second pauses. I did feel very dizzy at the time of this and noted it on my sheet and it did coincide with the pauses. Is this enough to have caused my previous fainting or do you think my fainting could be from an arrythmia? My resting pulse is in the 40-50 range. I have an appointment this week to discuss a pacemaker. I am on a low dose of Bisoprolol (2.5 mg) and my EP wanted to up the dose to 5 mg but is sure the bradycardia will worsen. He also mentioned a defribillator along with the pacemaker. Do you think that he is worried that the fainting was actually caused by torsades and not bradycardia? He said that there was no sign of torsades on the holter but that I do have PVCs during bradycardia which he thinks is a problem. What is the difference of PVCs during bradycardia or during a normal heart rate?
Thanks

[Michael J. McWilliams, M.D.]

That is a very difficult decision to make and in the same situation I would be having the same thoughts.  PVCs during bradycardia are more likely to trigger torsades.  It is impossible to know for sure unless you capture it on a holter monitor.  This is a very rare but real problems and the decision is always difficult. Your doctor and yourself need to sit down and discuss the risks, benefits and alternatives to a defibrillator.  They will tell you that they aren't sure that you need one but proving that it was torsades can be difficult and waiting too long may be dangerous.  I am sorry to hear that you are in this position.

I hope this helps.