Bradycardia and heart pause while sleeping

I am a 55 y/o white male. I have a history of MVP with severe regurgitation.Recently I had two 24 hr holter monitors about a month apart. While I was sleeping, one revealed a 2.5 sec. pause and a heart rate down to 33 b/m. The other revealed a 3 sec pause and a HR of 37. What do these findings mean? Do I need a pacemaker? I am probably going to have to have mitral valve repair soon. Should the pacemaker implantation or repair be done first? Can I have the mitral repair first without the pacemaker or would this cause the above findings to get worse? My cardiologist says you do not worry about a pause until it gets to 5 secs. Do you agree? I do not like the fact that my heart is stopping. What are the chances that the pauses amd bradycardia will get worse without treatment? Could the MVP and pauses be related in any way? Anything else I should be aware of? Thank you.

[Michael J. McWilliams, M.D.]

Pauses during sleep are usually nothing to worry about.  If your pauses were both during sleep and did not causes symptoms, there is no indication for a pacemaker.

If you can wait until after surgery, that is probably best.  Sometimes manipulation of the heart during surgery can dislodge leads.

In general, cardiologists like doing procedures.  If your cardiologist thinks the pacemaker can wait, it probably can.  I would need to see the strips to comment on if I agree.

They could get longer with no treatment.  Your cardiologist will recommend a pacemaker when/if they are concerned.

MVP usually does not causes pauses or brady arrhythmias.   Sometimes the surgery to repair the mitral valve can damage the conduction system and causes pauses, but you will not know until after the surgery.  It does not sound like you need to worry about this.

I hope this helps.