I just do not understand Sic Sinus Syndrome

Good Morning,
I have been scheduled for a PM.I am 48 years old. I have had slow heart rate for years. 45-50 bpm.My brother also has slow heart rate, but not symptoms. In the last two years, I have become symptomatic. Why have I not been symptomatic until now-what causes the change? Why do the symptoms get worse and the heart rate get slower when I am on a regular running program. When I quit running, my heart rate gets faster. My Dr. recommends a dual lead, even though I show no A-V block. Is this normal. My heart has a normal rate response, my only problem is when I sit idle for a few minutes. A shot of caffiene will usually help relieve symptoms for a while. IT seems like I am a marginal candidate for a PM. Are there other options? As long as I am very physically active throughout the day, my symptoms are rare.Is there any cases of symptoms going away? My local hospital has a long waiting time for a PM. What is normal wait time at the Cleveland Heart Clinic?

[Michael J. McWilliams, M.D.]

Why have I not been symptomatic until now-what causes the change?

It is hard to say.  The important thing is correlating symptoms with a heart rhythm on monitor.  If you only have symptoms when your heart is beating at its slowest, than yes a pacemaker might help.

Why do the symptoms get worse and the heart rate get slower when I am on a regular running program.

Runners usually have slow heart rates and it usually does not cause symptoms.  I would have to see your EKG strips to know why it is causing your symptoms.

My Dr. recommends a dual lead, even though I show no A-V block. Is this normal.

In theory you could get away with an atrial lead only if you have no AV block.  In general there is about a 1% chance per year of progressing to need a second lead.  If you really only want lead, you can make a good argument for it.  If you do get two leads, it is important that only your atrial lead pace unless you absolutely need ventricular pacing.  Each pacemaker company has their own algorithm to prevent unnecessary pacing.

Are there other options?

If you are truly having symptomatic bradycardia, probably not.  It is hard to suggest other options if I haven't seen the EKGs and talked to you about your symptoms.


My local hospital has a long waiting time for a PM. What is normal wait time at the Cleveland Heart Clinic?

It depends on the urgency.  Yours sounds elective so it is reasonable to wait a few weeks.  If it is an emergency you can get it the next day.

I hope this helps. Good luck.

[PikaPika88]

Dr asked me to do more exercise (at least a 45 minuates walk) and only count the sweaty one.  Is that the way to get rid of the Atrial Tachy?  Dr MJM said on the above thread: "Runners usually have slow heart rates".  Anyone knows about that?  But it seems the more I walk, the palps will take longer time to convert back to normal.  Sometime it takes a week to get my beats settle down.  I also got SSS and a 2 leads pacemaker.  Everytime when I walk (within 5 minutes), my chest looks like a garbage truck trumbling around, making noises, vibration, SOB and anxiety........  I never experienced a slow heart rate when or after a 5 minutes walk.  Am I doing my exercise in the wrong way?

[chaskog]

A related discussion, APS and heart conditions was started.