Understanding a Holter Report

[macca61]

Hi all  

I have posted in the past concerning my 15 yr old son who  has been investigated for 2 sudden syncopes, with lots of episodes of symptomatic  bradycardia..40- 45  Not at all athletic.  

He has recently  had a repeat 24hr HOLTER.. My problem is I am English living in a small town in France, my french is not always the best. The test was done at our local hospital, and  the results will be sent to the University hospital 120km away.. I have found this to be a slow procedure...

HOLTER   REPORT.

QRS  87803  in  22.14 hrs

BRADYCARDIE:  x 100  Total length  1hr.13    minimum  30    avr  63  (all day long,  not just night time)
PAUSES:  0
LONG PERIOD: x 137   RR =2130ms


VENTRICLAR EXTRASYSTOLES EVENTS:
isolated  491
doubles  16
runs  1
Total  526

Bi & Trigenimy  4&0
Tachycardia: 0


SUPRAVENTRICLAR EXTRASYSTOLES EVENTS:
isolated  355
doubles  284
runs  463
Total   3313

Bi & Trigeminy  0&0
Tachycardie: 0
Unstable  RR  x 25   Total length 1hr10.

CONCLUSION

No ventricular arrhythmias.
HRV significant
Bradycardia   with episodes of Second-degree AV block & Luciani Wenckebach periods at night.

Can someone interpretate the results for  me, and advice me if I have to push hard for a follow up appointment.

Thanks.

I hope I have done a good translation......






                                    

[is_something_wrong]

Absolutely possible. SSS is not only seen in older people. But again, it's hard to tell from the numbers.

[macca61]

is it possible this result, COULD     be   sick sinus syndrome or tachy/brady????      even though he is only  15yrs, (SSS  is usually seen in older people)

[is_something_wrong]

It's not entirely uncommon, but most people with bradycardia do not have atrial fibrillation.

[macca61]

Do you know if it is common to have runs of atrial fibrulation,  with episodes of bradycardia???

[is_something_wrong]

RR of 2130 msec means 2.13 seconds between one heart beat and the next. Which means a heart rate of approx. 30. The atrial beats are the sum of premature atrials and those noted as ventricular (which they are not)

[macca61]

Hi

thanks for your thoughts,  The  holter was done on a normal school day,he rarely notices palpatations if has any ....  the next day he had a repeat stress test, it was classed as within normal limits, although he couldn't finish it because of fatigue.

The block apparently came and went all day long, he has had many ECG's but it has only been caught on this  holter.

Can you tell me what number represented the   premature atrial beats?? could this be anything to do with early repolarization?? and   do you think  a   RR  2130ms  is normal

Monday  I will chase up an appointment at the university hospital.

Thanks again

[itdood]

yep, that's what I was thinking.

[is_something_wrong]

It might be. At least that happened on my Holter.

Heart rate was slow at night, AV node had long refractory time, a PAC hit and was blocked. Looked funny, but it was actually completely normal.

[itdood]

is_something_wrong, I wonder if the AV block is in reaction to the atrial ectopics?

Also I think they already said the 2nd degree AV block is Type 1.  To diagnose type 1, atrial rhythm has to be regular, which it doesn't appear to be but we'd have to see the strip.  If the AV block is occurring during irregular atrial rhythm, there might be other causes why the P waves are being blocked.

[is_something_wrong]

Sounds like mixed findings, some are normal and some are not, but of course, your/his doctor should interpret it.

You can ignore the "ventricular arrhythmias" as those are supraventricular arrhythmias conducted with so-called aberrancy, which often happens. He does have a lot of premature atrial beats and runs. Which are normal and common, but he seems to have a lot of them. They can be experienced as palpitations, but they are usually not dangerous.

His heart rate is fairly slow and the AV block at night is fairly common in well-trained individuals, again, it may be normal and it may not. Make sure he does not suffer from atrial fibrillation, though. The report is a bit unclear regarding that.

Did he have symptoms during the test? If so, when? It's important for his doctor to know. AV block is, as mentioned, fairly normal at night but not during daytime. If he has events of AV block at daytime, this may be to blame for the syncopes.

Also, the report doesn't specify how rapid his atrial runs were. If they are very rapid, that may also be to blame for the syncopes. This is important to determine as treatment is very different.