ECG help please

[SUPERSTARDJ01]

Can someone tell what this means???

Further to my recent letter regarding Mr xxxx.  He has now had a 24-hour ECG that was done on 17 August 2009.  It showed extreme bradycardia with a mean heart rate of 38 beats per minute, maximum heart rate 85 beats per minute around 6:35 a.m., minimum heart rate 28 beats per minute around 8:50 p.m.  The trace shows extreme bradycardia with probably no atrial activity seen, probable atrial standstill with junctional rhythm or complete heart block.  The heart accelerated to 85 beats per minute only briefly around 6 a.m.  We have not detected atrial fibrillation or wide complex tachycardia.  The accompanying diary reports occurrence of palpitations, the feeling of missed beats, hot flushing and occasional shortness of breath.  This extreme bradycardia may explain raised blood pressure readings in view of the probable increased pulse pressure that is caused by the bradycardia.  The maximum heart rate occurred at around 6 a.m., the accompanying diary reports lifting a freezer through the house at that time.  The heart does not appear to accelerate during other activities.  I will organise to review Mr xxxx clinically, discussed the result with him as he may require organising permanent pacemaker insertion.

[Wisconsin2007]

I'm with Irene, that a pacer will bring your heart rate back up to where it ought to be.  A resting heart rate of 38 is not unheard of, but you usually only find that in super elite athletes.  Since yours was a mean heart rate of 38 for the entire 24 hour period, and a minimum of 28, it makes sense that the doctors want to help you to restore a more normal rhythm.

@stutter - I wonder if it was a simpler device, something with only 2 leads, where almost any motion can create artifacts.

[stutterheart]

My interpretation is that your heart rate is very slow in the morning, probably as you sleep. The AV node stops firing, the doctor hypothesizes, and a junctional beat (a beat originating elsewhere) gets things moving again. I'm surprised that the doctor is not more certain of the morphology. How many leads do you have? If you have a normal 6+ lead, I don't know why he would be guessing about the morphology.
What is your age?

[ireneo]

It makes sense that a heart rate that slow, that consistently will need pacing to bring it back up to a more normal rate.