Sinus Pause how dangerous?

[JohnniSmith]

A quick recap of my overall health.  When I was 19 I was diagnosed with Paroxysmal Supraventricular Tachycardia and PVC's.  The irregular heart beats have always been deemed benign.  I did go to a cardiologist but stopped going years ago.  I had numerous test done.  After the intial testing was done I was getting an EKG and a check up every year, the same at my primary care Doctor.  Saw no reason to see the cardiologist anymore.  My primary care Doctor agreed.  I have been on a beta blocker since the age of 19.  

Fast forward to the present.  I'm 35 years old and a fit, athletic guy.  I do have high cholesterol and was on a statin for a few years (before they changed the standards).  I am now off the statin.  My cholesterol jumped 20 points in 6 months fyi.

I weight train/exercise five days a week.  I've tried a variety of workout routines over the years including two years of P90X (which is a high intensity interval workouts six days a week.)

Normally I have PSVT  every now and then even with the beta blocker.  Starting this past January I began having PSVT episodes (10-15 irregular heart beats a day).  That's not a lot but for me it is.  This lasted until mid February when I went to see the Doctor for a regular check up.  The irregular PSVT beats have gone back to their (for me normal) pattern, which is every now and then.  

My Doctor wanted to put on a ZIO patch for two weeks.  I had the ZIO patch on for two weeks and got the results back a few days ago.

Out of the two week period only one thing concerned my Doctor, a 3 second pause in my heart beat.  This only happened once.  I'm assuming it's a Sinus Pause.  I've already made an appointment to see the cardiologist which is in about two weeks.  I will admit to being rather annoyed.

I've been trying to find out as much as I can about Sinus Pause.  I found a youtube video where the paramedic tells the viewer a Sinus Pause is a potentially life threatening arryhthmia.

My pause was exactly 3 seconds, not sure if this happened while I was asleep or not.  I've never had any lightheaded feeling during any of my arryhthmias so this new finding has me scratching my head.

[MichelleP_3811]

That is great news.  A pause that long during sleep is not unheard of.  the svt as well does not seem to be getting super high.  Could be a run of pacs as opposed to what I had which was called avnrt.  My rate would get well into the 200s.  it was pretty manic and very hard to breath even if it lasted only a few seconds but most arrhythmias start and stop in what feels like one beat so something is going on but it sounds like they are short enough and not going super fast that there isn't a big concern.  I suggest watching stress and what you eat as well caffeine.  Those are the big arrhythmia triggers.  And yes, the internet is not the place to be diagnosed.  Seeing a doctor is always warranted if there are bothering symptoms around.  Glad to hear you are doing well.

[JohnniSmith]

Okay I've had my appointment with the cardiologist.  He brought up my results on his computer.  Two weeks worth of recordings with the Zio Patch monitor.  The 3 second pause occurred at 4:57 a.m.  It only happened once during the two week recording.  He stated that it's NORMAL yes NORMAL for everyone's heart to pause during sleep cycles, even for 3 seconds.  What I have read about 3 seconds pauses on the internet was false.  I had read that ANY pause that long is a problem.  Even a youtube video claimed it's a life threatening arrhythmia....BS!

He told me it's nothing to worry about.  He then told me he looked through my other arrhythmias 39 episodes during the two week period.  Again nothing to worry about at all.  Some PSVT's but no big deal, he even stated that with PSVT you'll get times where you'll hardly have any symptoms.  This may last for weeks, months or years, then you might get a "flare up" that will last for days, or weeks, but again nothing to worry about.

He looked through my history and told me my betablocker 80 mg twice a day, is a low dose.  He did not want to do any tests (no stress test, echo, etc).  They did give me an EKG when I arrived.

So I'm fine, no big deal, just more of an annoyance with the PSVT's every now and then.  He said how about a visit one year from now?  I said that was fine.

My advice for those seeking information...see your Doctor.  Don't rely on information from the internet alone!

Thanks all!

[JohnniSmith]

When I posted the longest it's lasted is 35 seconds.  That has only happened once in my life, that occurred years ago.  My "skips" normally last for a few seconds.

[JohnniSmith]

My primary Doctor has told me it's PSVT.  I've had a few holtor monitors in the past.  This recent ZIO patch showed the following.

The printout says 4 SVT runs occurred.  The run with the fastest interval lasting 4 beats with a max heart rate of 148 bpm.  The longest lasting 5 beats with a rate of 127 bpm.  One pause occurred lasting 3 seconds.
  
Possible Atrial Rhythm was present.

Findings:  Supraventricular Tachycardia, Sinus Rhythm, Ventricular Ectopic beats, Supraventricular Ectopic beats.

Atrial Fibrillation:  None found
AV Block: (2nd Mobitz II, 3rd )  Whatever that means

As for what I feel.  It's like a light switch one moment normal heart rate, the next it feels like fast skips, then back to normal. The longest my "skips" have lasted constantly was 35 seconds years ago.

When I was younger it was worse.  I avoid MSG, caffeine, and alcohol.

[MichelleP_3811]

Hmm, are you sure you have an svt?  An svt means that you have episodes of faster than normal heart beat.  The skips and jumps are ectopic beats.  Sometimes you can get a few in a row which can be deemed an svt but in general an svt is when your heart is fine one beat and then all of a sudden the next beat it is racing upwards in the 200s and then in one beat it is back to normal again.  have you had anything like that?  I wonder if they caught some sort of short run of VT which is a run of pvcs together.   Having 3 is considered a run but not at all a concern in a healthy heart.  Like the ep said, they don't treat it because it would be too hard to initiate and keep going and they need to be able to do that to know where to ablate but keep an eye on things and if you notice it feeling like it is thumping a lot in a row for quite a while or you start to get worrisome symptoms then go back to the doctor but in general you should have nothing to worry about so long as you stay heart healthy and manage your stress and anxiety.   But I wonder if you have pvt not psvt.  You might want to clarify that with your doctor.  Even so, it really sounds like for the most part you have isolated beats anyways which are not a big deal.  I think a lot of people with pvcs have an occasional short run of them.  I think it is more common than people realize but it is nothing to worry about unless it becomes more persistent.  Odds are it won't. Also, tt is very likely the 3 second pause was while you were sleeping.  I have read that in athletic men that happens so try not to fret.  Doctors like to be safe than sorry.  The pause should evaluated by a cardiologist but I am pretty certain you will be told not to worry.  But do keep us posted.

[JohnniSmith]

Hello, thanks for the reply.

I'm not exactly sure when the heart pause occurred.  It showed up on the ZIO patch monitor I had on for two weeks. I'm assuming it occurred when I was asleep?  I'll find that out when I see the cardiologist.  If it occurred when I as awake I didn't notice it.

All in all my PSVT is tolerable.  Normally I have a few skips here and there, usually lasting a few seconds.  I can go days without anything.  I can feel them but they don't bother me.  I've never felt light headed during an episode.

Back when I was 19 a cardiologist told me I couldn't have ablation.  After a month long holter monitor I was told they probably couldn't find the source.  It would be like chasing my tail they said.

I'm already on a beta blocker so I can't see them really doing anything else (concerning the 3 second pause).

The only thing that bothers me is that this 3 second pause showed up.  It's enough to concern my Doctor and he told me to make an appointment with a cardiologist (which I have done.)  I guess it's freaked me out a bit.  Our bodies are so fragile it seems.

[MichelleP_3811]

As a fit male your regular heart beat is likely pretty low so a pause of 3 seconds may be something you can tolerate just fine which is the biggest factor in treating any sort of heart block.  Did you have any symptoms?  Feel as though you would pass out?  If not then keeping an eye on things may be all that is needed.   Quite frankly I believe the only real treatment for it is a pacemaker and so you would need to weigh that with your symptoms.  I am not a doctor but suspect in the absence of concerning symptoms the cardiologist will take a keep an eye on things approach.  

The other thing I will comment on is that svt will not go away even with meds.  Odds are it may get more persistent as you age.  You are about the age mine started to get more frequent.  I had very rare episodes most of my life until my late thirties when I started to get it quite often. How often do you get episodes of svt and how long does it last?   I had mine finally ablated in my mid 40s and haven't had an episode since.  I do still get pacs and pvcs but those are a whole different issue and I do not have an amount that is of any concern to a doctor so I just ignore them.  Well best of luck with the cardiologist and keep us posted on how you are.