holter monitor test

[jonathan82]

Hi. I got another holtor monitor done and it says I had 1 episode of type 2 second degree hear block. It also says multiple pauses under 3 seconds was seen.  My cardiologist says I don't need a pacemaker but when I look this up it says pacemakers are required for this in most cases. I am 31 years old only and now very worried. I guess i want to know if there is anyone who has this and does not have a pacemaker. One other thing it says is an episode of wenckbach phenomena. Please anyone with info would help

[Iva_87]

Hi,
I would go seen another option. Pacemaker isnt that rare at second degree block u r right. Anyway you need to be well followed as block no two can progress to number three. But thats more likely a precaution, if it would be vety dramatic you wouldnt be home! (Thatswhat I sayto myself..im 32 and having only svt :) best luck and no worries

[itdood]

I don't have any specific experience to pass along.  I just wanted to mention that given the profile of no symptoms (asymptomatic), frequency, age, and overall heart-health, the opinion you received is well established protocol.  What I mean is, what the cardiologist has recommended to you is considered a best practice given all the info they've collected on you.

Another step you can take is to seek a second opinion.

[Bromley]

Hi. I don't have a lot of information to share. You can look up a basic description in wikipedia, and online.  From what I read there, second degree heart block is where you occassionally miss a beat due to a blocked p wave. There are two types of second degree block described in the article. In type one the p-r interval increased from beat to beat until one beat is missed, and then the whole thing resets again, with the p-r interval going back to its original period. This type is named after a person by the name of Wenckebach. The article states that this type of affect is often precipitated by something going on within the AV node. A p-wave is what you see on an ecg when the atria contracts. Electricity is conducted from your natural pacemaker throughout the atria first, it then goes thru the av node and is conducted into the ventricles, which causes a beat to occur. If you have block, conduction stops before reaching the ventricles.

In type two second degree heart block the pr interval  (time between atrial contraction and ventricular contraction) does not increase, but you miss a beat occasionally. The article states that this is usually caused by something that is going on below the AV node (i.e. in the bundle of HIS). The article at Medscape elaborates a bit more on some of the differentials.

I do not see anything that says that second degree heart block can be of a transitory nature, but in principle, I do not see why it could not. If someone were to take the wrong drugs for instance, it seems like it would be possible to create "artificial" second degree block. The article does mention digoxin.

In addition I see some materials here that point to out of balance electrolytes. You can also find some discussion on non-conducted premature atrial complexes.  All of these seem to be rather benign,  potentially reversible causes of heart block.

You'll need to work with your doctor to understand the cause. Do you know what precipitated this?

[MichelleP_3811]

I don't have any advice to give on heart block as I don't have it but I guess I would ask you what are your symptoms?  Are you having difficulty functioning?  Are there more symptoms then what you experienced while wearing the monitor and if so what are they?  In general I think the cardiologist may be being cautious about putting in a pacemaker because you are young and it is a lot to deal with the rest of your life.  If you are functioning well he may believe it is OK to wait.  You can by all means bring your concerns to your doctor to get more clarification and understanding about your condition.  As well you can go and seek a second opinion.  I suspect your heart is otherwise healthy and can tolerate what is going on but for your peace of mind I would question the doctor further to explain your case specifically.  Take care and hope others who have your issue can contribute.