roberto

Hello,
I am a 48 yr old male, very physically active. Have Bradycardia of 40-48 bpm when not excercising. My rate responds normally to excercise. Symptoms of fatigue, dizziness, poor clarity of thought occur when sitting still for a short time. Symptoms disappear if I get up and move around. I enjoy running and cycling. What type of sensor ( minute ventilator or accelerometer) is the best choice for my lifestyle should my condtions worsen as I age? Would one or two leads be advesed? For now, it appears I only need help with my lower rate, not my upper rate. Are there patients whose Bradycardia heals itself?

[Michael J. McWilliams, M.D.]

Hello,

What type of sensor ( minute ventilator or accelerometer) is the best choice for my lifestyle should my condtions worsen as I age?


For cylclists, a combination minute ventilation and accelerometer sensor is often best.  Running has a lot of motion involved and accererometers are activated enough to increase heart rate. Sometimes with cyclists, there isn't enough motion to activate the sensor with accelerometers, but minute ventilation will increase.  For this reason a combination device often works best in this situation.

Would one or two leads be advesed?

If it is true sinus node dysfunction, a single chamber lead may be enough.  When the atrial lead is placed, pacing the atrium at rate of 130 beats of minute is done. If every atrial beat conducts to the venticle, the AV node is strong enough to support single atrial chamber pacing.  If there is no other evidence of AV block, the incidence of progressive aV block in the setting of sinus node dysfunction is about 1%.  you will have weigh the risks of two leads (usually pretty low) and the risk of potentially having to upgrade your device with a ventricular lead if AV block develops.  


For now, it appears I only need help with my lower rate, not my upper rate. Are there patients whose Bradycardia heals itself?

If  you are not on any medications to slow down your sinus node and you plan to keep exercising, the odds are it will not improve.  A holter monitor may show that you develop junctional rhythm at rest.  Junctional rhythm originates from between the atrium and ventricle and cause them to lose synchrony with beating -- this can cause the symptoms you describe in a healthy person that exercises.  The only way to know is to show the rhythm on holter then decrease your exercise to see if it gets better.  I would rather see you keep exercising.

I hope this helps.  Thanks for posting and good luck.

[PikaPika88]

My stress test Dr asked me go home drink a lot of strong coffee.  Next day, he put me under the scan and said "it looks much more better".  But the report didn't mention anything about the coffee works or effort!