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junctional rhythm 26y.o. pacemaker?
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junctional rhythm 26y.o. pacemaker?

Hello, I'm a 26y.o female who has a history of svt induced by exercise- had two unsuccessful ablations because the tissue is on my regular electric conduction path- these were when i was 18 and 19 years old.  In august all of a  sudden I felt lightheaded frequently when doing activities and not.  I ended up fiinding out I was in junctional rhythm heart rate in the 40s and 50s.  When sleeping my heart rate goes into the 30s with occasional 2-3 second pauses.  It was found I was hypothyroid and was treated with synthroid and my symptoms resolved and was in normal rhythms according to a heart monitor placed on me for a week.   7 months later I am again in junctional rhythm- tested for lymes which came back negative except one IGg band 23 which isnt enought o be positive but being treated anyways in case lyme carditis.  After treatment still having occasional lightheaded episodes (no fainting).  Thyroid is still slightly off and now we are waiting to my level to return normal and then see what my heart rhythm is.  However, if it isnt back to normal and I'm not feeling well I'm told I will need a pacemaker....is there any other casues for junctional rhythm?  Any comments that you can think of?  Just frustrated and scared even though I am involved in the medical community.  Any help given- I am thankful.
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forgot to mention that echo was normal, stress test was done and my heart rate climbed approprately to 170s......usually with junctional rhythm your heart rate doesnt increase like that!
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1124887_tn?1313758491
Hard to answer your question. To me it appears they are borderline. And I am no expert.

A lot of strange things in the heart happens during sleep. The sinus node is, and should be, slowed down, which can cause other "pacemakers" in the heart, including the AV node, to take over. This is called escape rhythm. Atrial escape rhythm, nodal (junctional) escape rhythm and even ventricular escape rhythm can occur during sleep and is considered, to a certain degree, normal phenomena.

Pauses during sleep should not be longer than 3 seconds.

It's good that your heart rate responded properly to exercise.

The fact that your sinus node stops during activity is abnormal. This MAY indicate so-called sinus node dysfunction, which is, in severe cases, treated with a pacemaker.

Your cardiologist must answer if the findings are significant/serious enough to warrant a pacemaker implant. This is difficult for us, as patients, to decide.
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