Sick Sinus Syndrome, PAC and PSVT with Sinus Arrest

[JRoss]

Hello,

I am a 29 yr. old male, fit with a healthy diet, who was diagnosed with Sick Sinus Syndrome 3 months ago.  Specifically, I have frequent PAC and non-sustained runs of SVT (6-10 rapid beats that feel like flutters).  This is followed by sinus arrest or a pause that gives the sensation that my heart is stopping or skipping a beat.  During my initial 24hr. Holter, I had many pauses in the 2 second range during the day while at night, I had many over 3 seconds with the longest being 3.8 seconds.  This happens frequently throughout the day and seems to have gotten progressively worse over the last 3 months.  

My cardiologist put me on 50 mg of Metoprolol to slow down my heart rate (reduce the SVT) in the hopes of reducing the sinus pauses.  Since starting these beta blockers a month ago, I have felt somewhat sluggish but this may be psychological.  My most recent Holter show that my pauses have shrunk to no more than 1 second.  

While this seems like an improvement, I have serious concerns about being on beta blockers for the rest of my life (I'm 29).  In your opinion, do I seem like a candidate for ablation to control the PAC/SVT in hopes of eliminating the sinus pauses?  Would a rate-responsive, dual chamber pacemaker be a more natural approach?

Also, is the concern that my sinus pauses would lengthen and that my heart would eventually stop?  I have never experienced any discomfort or dizziness/faintness from my disorder, so, I'm wondering what the risks may be of doing nothing at all???

Your thoughts are most appreciated, (apologies for the length)

[Michael J. McWilliams, M.D.]

In your opinion, do I seem like a candidate for ablation to control the PAC/SVT in hopes of eliminating the sinus pauses?  Would a rate-responsive, dual chamber pacemaker be a more natural approach?

If the PAC/SVT is coming from one location, yes it can be ablated.  If it comes from many locations, it cannot be ablated.  Your doctor can probably get a pretty good idea from looking at the p wave morphology on the EKG.

You do not want a pacemaker at your age.  you would probably 5-10 generator change outs through out your life and the cumulative risk of these change outs is that an infection is likely.  Pacemakers must be extracted if infected and this can be risk.  It is best to stick with medications.  If you have no symptoms, you do not need a pacemaker.

Also, is the concern that my sinus pauses would lengthen and that my heart would eventually stop?  

It won't stop.  There are several back up systems and all of them should be functional in someone your age.

I have never experienced any discomfort or dizziness/faintness from my disorder, so, I'm wondering what the risks may be of doing nothing at all???

If you have no symptoms and don't want to take medications, there is no harm in this.  You may pass out at some point in your life from this, but that could serve as your warning that something needs to be done.

I hope this helps -- good luck.

[PikaPika88]

Dual chamber pacemaker would not work for "Pause".  It may be able to work on SSS.  I'm not a doctor but I've gone through all these.  I'm still having the difficulties to get myself feel better.

[JRoss]

Thank you, ForumMD-MJM

I am now seriously considering stopping the beta blockers and just monitoring.  While I have never passed out, I do have the sensation (flutter and skipped beats) very frequently, every day.  Is there a concern that my heart is working too hard and will eventually "wear down" other parts?

Given that I have sinus arrest/pauses of close to 4 seconds at night, is there a risk in this?  Quality of sleep??

Since a pacemaker doesn't seem like a good idea at my age, I would really like to avoid beta blockers.

Many thanks,

JRoss

[jpcox]

I read in your post that you were diagnosed with sick sinus and I was wondering if you had any symptoms with this and how your were diagnosed.  I was recently told by my cardio that a sinus pause and a compensatory pause were the same thing.  When you have this pause what are your symptoms? Do people without sick sinus still have these pauses? The reason I am asking is a couple of weeks ago, I believe I experienced some sort of very noticeable pause.  This was not caught on a monitor, so it has left me wondering..... thank you.

[JRoss]

Hi jpcox,

The only symptoms I have with my pauses is that I notice the sensation of my heart pausing resulting in the feeling that it has missed a beat.  My pauses, pre-beta blocker meds, were recorded at up to 2 seconds during the day and almost at 4 seconds during the night.  Other than the sensation and fact that I can tell when I'm having these pauses, I have not had any other symptoms such as light headedness or fainting, pain, discomfort or anything else really.  Now that I'm taking beta blockers to slow down the pre-pause SVT (6-10 rapid beats), my pauses have been recorded at no more than 1 second.  

I can't say whether people without sick sinus have pauses or not, but my understanding is that it is relatively common to have the occasional pause.  I have these episodes or short run SVT and accompanying pauses every day and often for many parts of the day.  I've been told that sick sinus syndrome is a degenerative so I'm not too optimistic of it getting better.  

Hope this helps,