Do i really need a pacemaker with 26/min zz HR

Hi Doctor,

My bro aged 21 recently jus joined army force as regular, physical fit in average, not really stressful workout in camp as he's a military police. During 1 week ago, he went for full medical check up in camp & founded out by MO his HR is only 36/min. Immediately warded to hospital. 24hour EKG, worst result during resting was 26/min. Cardiologist specialist (I don't think really trustworthy as he contradicted his words - He thinks my bro dont need a pacemaker since he's young. But last opinion was to take electro test & pace maker surgery together) said the top & middle part of the heart is zz when he zz / rested. The next day after the electro test, he confirmed & determine he needed a pacemaker immediately as the highesr HR was 36/min. The doc & nurse was stressing him, saying the lab & DOC is waiting to operate the pacemaker. I halt the surgery as pacemaker is forever & it might affect his career/life. Next day aft discharge, the HR when Zz was 45-50/min. My decision is to monitor him all the time & get 2nd opinion meanwhile while hoping HR will recover to normal rate 60-100. Am I doing the wrong thing in risking his life? Does he really need a pacemaker? I'm worried every night he might nvr wake up. I zz with him & did random check to monitor..Please help! THKS


This discussion is related to Do I really need a pacemaker?.

[kay2486]

that is a very low hr, most people who have a pacemaker lead normal lifes, hes not too young for a pacemaker he will need one so nothing too serious happens

[caregiver222]

A heartrate of 26 beats indicates a ventricular rhythym with a damaged or inoperative atrial pacemaker.

He should have had a pacemaker installed.

If the heart rate eventually improves, the pacemaker can be removed.

[mum2four]

Are you the Dr even if his HR drops to 26 or lower only once a month he stills needs a pacemaker. You can recover from death and you cant repair brain damage or organ damage from lack of oxygen to them. It just takes one really bad HR day to cause irrpairable damage or death.

So yes I do think not having the pacemaker is risking his life and while you want to help him maintain his job and life he has a better chance with the pacemaker than with out. Monitering him 24 hours wont stop the low HR from causing harm only the pacemaker can do that.

[is_something_wrong]

The reason for a low heartrate must be found I think.

Myself, I have heart rates down in the 30s at sleep, and a heart rate down to 30 is considered normal during sleep. The relevant question is if this low heart rate is sinus bradycardia, or caused by blocks/ventricular escape rhythm. If it is, it's not benign.

Another very relevant question is if the heart is able to maintain a sufficient cardiac output with a heart rate that low. If your brother have an efficient heart, able to pump large volumes of blood on each beat, I doubt a pacemaker is needed. It's also important that heart rate increases as is should upon exertion.

It's a bit hard to say for us non-doctors, especially when we don't know the test results. I would say his cardiologist probably know this better than us, but it's a bit concerning that his heart rate drops down to the 20s.

I'm really not sure..

Good luck!

[is_something_wrong]

Sorry, didn't read your post good enough.

If top and middle heart is sleeping, it indicates a ventricular escape rhythm (sinus node and AV node inactive). A pacemaker is correct (as the cardiologist finally decided) i think.

Good luck!

[Missy_couture]

Dear everyone & is_something_wrong,

Thank you everyone for being so kind, helpful and providing useful informations & opinion! We're going for 2nd opinion from National Heart Center tomorrow which hopefully we'll get to the bottom of the causes of Sinus Nod.

Given a best career in life is no use without a good heart to enjoy the fruits

Thanks everyone for the blessing, I'm actually struggling from stress of making wrong decision & lack of sleep. After the comments received, I shouldn't be playing doctor anymore, it's a precious life here.

[mum2four]

It easy to get scared and want to run.

Life is precious so try to focus on the positives things and that in oppinion is that the Dr's have found something that needs attention and investigating. Information is power for sure and dont be affraid to get more information but in the end I doubt a Dr would put a person threw heart surgery when thay dont need it.

[Missy_couture]

Hi dear,

You're absolutely right. I chose to run & got so worried sick.

We went for 2nd opinion to a director cardiologist.

After reading my bro ECG reports for 5 days hospitalized, he said still didn't indicate he needs a pacemaker immediately. He'll get a holter monitor for 24 hours for more report next week.

His slow HR during zz time might already being like that since he was born but happened to get discovered. Recent nights, his resting HR mean is 40.

Snr Cardiologist & director of edu & training, he said putting on pacemaker is fast & painless but he's very young to need one, especially, the reports didn't sign 100% signs that he needs it/yet. With pacemaker, it might bring in other problem if he don't really need it. e.g. battery lead leakage, infection, allergy etc.

He had high fever of 39.2 degree few days after discovered of slow HR during army medical check up & send him to hospital last week. Which i read, the slow heart rate might due to the fever recovering period.

Thank god, we did not make any rush decision of the half hour (he pressured my bro & my family of the urgency of operation - saying he's in the lab with equipments ready for PM ops) from the 1st cardiologist. he informed my bro at 2:40pm for ops at 3pm.

Anyway, its still early to comment before the holter monitoring report.
This time round, i'll trust the decision to this snr cardiologist if he can find any reason to put pacemaker or the lying cause of his sinus bradycardia.

Thanks for everything you said..

[mum2four]

Thats all you can do it wait for all the test result and make choices based on more than one oppinion if you need to. Take it easy try not worry, many people have pacemakers ect with no problems.