Pediatric Heart Expert Forum
Bradicardia
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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Bradicardia

Hi
My 15 yr old son has had 2 blackouts unknown cause, he had a loop recorder implanted in july he has  frequent episodes of bradycardia as low as 38-40, when it's this low he is obviously very tired,  he's a little overweight not athletic in any way... Tuesday his 'box'  was read for the first time. nothing abnormal was shown on it, and he will be seen again in 4 months...

Our  cardiologist said 'yes'  his heart  beats slowly, but it is in sinus rhythm, and because of his age, unless the rhythm changes or he has another blackout, he will not consider a pacemaker.

How low does your  HR have to go,to be noted as marked bradycardia  on a loop recorder??
Do you agree with our cardiologist about a pacemaker??

Regards.

p.s  there has been 4  sudden deaths  in my family... also his ECG has very obvious early repolarization
773637_tn?1327450515
Dear Macca,

I cannot make a clinical determination about your son without seeing him and obtaining more history.  I do recommend that he ensure that he is keeping adequately hydrated, including have 32-48 ounces of water or milk daily plus a salty snack, not skipping meals, and eliminating caffeine.  However, by definition, the normal heart rate range for someone his age is approximately 60 to 120 beats per minute.  A pacemaker is a serious procedure, and should be avoided unless all other options have been exhausted.  The real question is whether he had any blackouts during his recorder period and was there any correlation to what his heart rate did during those periods.
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Thank you for your  reply,

First syncope in March,
2nd one in April, loop recorder implanted july nothing noted on it except bradycardia. He has had 2-3  pre syncopes  his HR was around 35.  Extreme fatigue dizzyness, poor concentration.

His  2 older brothers also have bradycardia  around 40-45  not symptomatic.. He and his brothers have had a  drugs challenge, Brugada was eliminated, Early Repolarisation Syndrome  was aggravated. Blood research is ongoing.

An endocrinolgy work up was  normal.  With 4 sudden deaths in my family,  3 of them complained of extreme fatigue before it happened. I am really quite concerned to wait for another full syncope to happen.

Thanks  again for your  input....
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773637_tn?1327450515
Dear Macca,

For completeness sake, other things that need to be ruled out include long QT syndrome and arrhythmogenic right ventricular dysplasia.  However, I would presume that studies for these have already been reviewed in him.  For patients with cardioinhibitory syncope, in which the heart rate falls during an episode of syncope, selective serotonin reuptake inhibitors as well as stimulants have both been effective.  I understand your concern relative to the familiy history, although these would need to be placed in context (i.e. were they adolescents or adults, did they have coronary artery disease, congestive heart failure, or other acquired heart disease, etc.?).  These are questions that your cardiologist should be able to go over with you and to decide whether your son is at that kind of risk.
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Marie M Gleason, M.D.Blank
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The Children’s Hospital of Philadelphia
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