Please help me understand my holter results

[Aroojali18]

Hi all, im suffering from dilated cardiomyopathy from last 6 years, recently were having lot of pvc's so my cardiologist hooked to me holter for 48 hrs, my report says i have notmal sinus rythum. And 358 couplets and 22 triplets were recorded. Total number of beats were 231438 and ventricular beats were 6%, does anyone has an idea if the report looks ok? I do not have icd installed

[MichelleP_3811]

In general a pause that short isn't a huge concern but considering your circumstances it could give an indication if there is a block somewhere.  Seeing it on an ekg would be helpful but I believe pauses only become concerning when they reach around 3 seconds I believe but I am not totally sure especially in instances when cardiomyopathy is involved.  I would ask your doctor about it.  .  In any event, listen to what the doctors tell you to do to try and give your heart the best chances as possible.  Best of luck to you.

[Aroojali18]

I still have dilated cardiomyopathy with an EF 41% showed in last MUGA scan that was done in July this year, what do you this 1.3 seconds pause in my holter indicate anything?

[MichelleP_3811]

I see you were diagnosed with dialated cardiomyopathy?  Do you still have it?  I would assume you had an echo back then to diagnose it.  If you haven't had one recently then push to get a new one to see where your cardiomyopathy is at.  Maybe even see if you can get a cardiac mri.  This will give you a better idea if your pvc activity is of danger to you and if intervention is warranted.  

[MichelleP_3811]

I am assuming the 151148 is your total beat count for the day?  6% of that is around 10,000 beats as pvcs.  It's quite a few though most doctors don't try to ablate unless it reaches close to 20,000 but I can imagine it is making you feel poorly.  The main issue I see is that you have them firing off in 4 different places.  It would be hard to ablate them all but there may be one spot that is the worst and taking care of that spot may give you a lot of relief and calm the other spots down.  But just for your peace of mind, in an otherwise healthy heart, your runs are short.  It is mostly when a person gets caught in vt that there is great danger so try not to stress too much.  Try to calm any fears about all of this as it will make things worse and then just follow your doctors orders.  Do the stress test and ask for an echo if you haven't had one of those yet.  Avoid caffeine and manage stomach issues just to see if it helps calm them a bit too.  Keep us posted on your further tests.

[Aroojali18]

I Visited arrhythmia clinic n they repeated my holter now report says sinus rtythm with average heart rate 93 bmp( range 59-167 bmp)
Rare PACs. No atrial fibrillation or atrial flutter.
Frequent PVC's couplets and bigeminal cycles, several episodes of NSVT ( longest run was 6 beats at 103 bpm, fastest run was at 241 bmp for beats)
PVC Burden is 6% (15148) at least 4 different morphologics
Longest pause 1.48 seconds, no high grade AV Block.

Summery: sinus rhythm with frequent PVC's

For me it looks bad that previous report. I had no pause in last report n my fastest beat was 168 now it's 241, couplets are now 1156, bigeminal cycles are 865. I'm also having difficulty in sleep doctor. doesn't know the cause of me having too many pvc and he thinks stress test can give him better idea.

[MichelleP_3811]

Ok best of luck.  Keep us posted on how you are doing and what the doctor says.

[Aroojali18]

Yes i did feel my heart at the time too. I just received call from my cardiologist, they are sending me to the cardiac arrhythmia clinic he told me my average heart rate is 72 but my heart took some serious beats and my heart rate went up to 176. He also said they can't consider an icd at this point since my last muga showed my EF is at 41% and to get an ICD device my EF should be under 35%.

[MichelleP_3811]

Did you notice the run?  7 beats isn't a lot and your heart corrected itself on its own so there may not be a need at this time for the icd but again you should take the advice of the cardiologist who has your whole heart history in perspective.  

[Aroojali18]

My report say there were no supra-ventricular tachycardia. There were 2 short run of ventricular tachycardia the longest being 7 beats in duration at the heart rate of 168 BPM.  

[itdood]

I thought the decision to get an ICD was based on electrical patterns, not LVEF?

I know people who have them but their LVEF is in great shape.  It was based on symptomatic vtach, or so I thought.

[MichelleP_3811]

Well at this point I think you need to wait to see what the cardiologist says. This is something that should be discussed with a cardiologist not a regular doctor because they will be able to look at your whole situation and determine your risk factors.  Though I can't tell you what to do I would suggest listening to the advice of the cardiologist.  Did it indicate how long the 2 runs were?  the fact they were short could work in your favor but do speak with a cardiologist because you do have other factors involved.  As for and AED you would need to be absolutely certain that you had someone in your life who knew how to use it properly.  I would assume they would have to be cpr trained on top of it.  Again ask your cardiologist what your risk factors are and find out if the people living with you are willing to do the proper training.  Best of luck.  Keep us posted what the doctor says.  

[Aroojali18]

Thank you,  it also said 2 short non sustained ventricular tachycardia. For my understanding its not dangerous right? And yes you are rught there were 13959 ventricular premature beats in 2 days. I have talked to one of my family doctor he thinks n believe i should get an ice installed anyway but since im currently living in canada my doctor would decide if i really need one, they considered icd device two months ago when my echo showed my ef is on 34% so they sent me for muga scan to find out the accurate number of my ef n on muga it showed my ef is 41%. If i do not get an icd at this point should I consider getting an AED?

[MichelleP_3811]

You should talk to your doctor based on your situation considering you have heart disease but it doesn't sound like your pvcs are getting caught in a dangerous pattern.  At the most you have had 3 in a row and though in an unhealthy heart they can pose a threat if you haven't had a vt that does not stop then you may not need an icd at this point.  Your total number of pvc beats equaled to be 6% of the amount of beats you had in 2 days so 6% of 231438 or 13,886 total or approximately 7,000 pvcs a day.  That is considered under the threshold for the danger zone of having 20,000 or more a day but again, since you have cardiomyopathy please discuss what this means for your situation.