Heart rate bottoms out, pauses and then comes back

[COBradyBunch]

A few months ago I had an episode where I passed out for no known reason and with no warning.  Went to the ER (I am a 50 year old male, very good cholesterol, good stress tests and ekg's, slightly elevated bp (130-80) and need to lose about 20 lbs.  I did have Rheumatic Fever at age 7 but was told there was no heart damage.  Also have intermittently been diagnosed with an RBBB which sometimes is there and sometimes isn't but when they first noticed it they put me through everything up to and including a Thallium Stress Test that came back perfect.

This past weekend I had another blackout, no warning, no symptoms before it happened.  Wife took me to the ER again and same thing, everything looked great.  After a long discussion with the ER doc we decided to hold me overnight for monitoring.  About 4:30 in the morning, as I felt myself falling asleep suddenly I was awakened by a lot of activity in my room.  Turns out my HR had plummeted and I actually had a pause of about 6 seconds during the event where my heart didn't beat.  It came back on its own and the beats all looked perfect sinus except for the fact that it seemed to go to sleep for a while.  Same thing happened, again as I was sleeping about two hours later.  Immediately they wanted to put a pacemaker in but had no ideas on the root cause of my issue since all the tests came back clean (they did ekg, cardiac echo, head CT, did all the blood work, checked my previous tests from my physical I had had just a month before) and when I was not in an event everything looked great.  My normal resting HR is usually in the low 60s and I work out 3 times a week at around 85% and usually once a week pushing 90% without any issue of chest pain or abnormal shortness of breath.

Anyway, after a full day of research, talking to my GP, talking to my cardiac care nurse, two other cardiologists and everything else I could think of I decided that simply due to the syncope episodes I would probably have to have a pacemaker but still wasn't committed.  When I decided to take a nap on it and had another event, this time with a 9 second pause preceded by a 4 second pause and followed by a 6 second pause it was decided the pacemaker would go it.  There were no tachy episodes involved in any of the brady or in any previous tests so now I am paced for anything dropping below 50 and it is set to monitor for anything tachy but not to do anything about faster HR's so I can begin excercising when I heal from the surgery.

My problem is all we have done is treat the symptoms and I am a root cause person.  As an IBS sufferer (IBS-C) I already have one unexplained condition (which I usually control with diet and fiber although it has been acting up recently).  But now this syncope/brady thing is another mystery that has been treated but not explained as to why it is happening.  While I have resigned myself to 30 or so years with a pacemaker it still doesn't make me not to want to know what went wrong and if there is another way to prevent it from happening in the future.  Any ideas?  My docs are shrugging their shoulders and seem now that the pacemaker is in not all that interested in finding out why this started in the first place.  

[stutterheart1]

Right. I don't think they'll find the cause. The study of this sort of thing is very very young. Better 30 years with a pace maker than 30 days left in your life.

[ireneo]

I'm not sure they'll be able to find the cause. If they decide you have such and such type of heart block, fine. But will they ever know why you developed a heart block? Probably not. Some things are idiopathic, just arise from nowhere it seems.

I'm glad you have the pacemaker now which will kick in when your heart decides to take a nap of its own. You don't want to live with that uncertainty that you might pass out at any moment.