Sinus Pauses

[Poci]

3 weeks after a bilateral Maze procedure I had two sinus pauses, one lasting 3secs and the other 6 secs, while sleeping. I have no symptoms. My heart rate while awake during the day is on the 70s and 80s. My heart rate appropriately goes up with exercise.  I use a CPAP machine for sleep apnea. Should I stay away from a pacemaker?

[Poci]

Hi. This is immensely helpful. It allows me to put things in context. It re-assures me of the possibility of VTachs, etc to be related to OSA. Thanks you so much for the links.  Truly appreciate your feedback.

[Mom2four85]

I've had arrhythmia's and fainting since age 9 largely ignored until I was 42 but didn't develop sleep apnea until July and dx August 22, 2009 but had no symptoms - no snoring, no sleepiness, I always had energy and felt fine so I was quite shocked I had it.

I don't know how long I've had VT but an EKG showed I was in bigeminy back in April 2007 but I have no way of knowing if I it was VT before.

I know how long my pauses are because my ICD records all my rhythms and I didn't notice anything about sleep apnea/VTach episodes relating until this past June when I fainted and went to the ER and the EP there asked me about my OSA.

I've had anywhere from 1 - 15 second pauses during sleep http://www.medhelp.org/user_journals/show/305961/Sleep-apnea?personal_page_id=861727 with hr's up to 242 and 41J shocks but my ICD has sensed my hr as high as 425 (http://www.medhelp.org/user_photos/show/226191?personal_page_id=861727) and was told this is probably due to OSA episodes.

either way, it's best to rule out sleep apnea even if you don't have any symptoms just to make sure; as well ruling out SSS and anything else that may be the culprit.

[Poci]

Thanks again for your great insight.  Yes, a lot of strange things happen during sleep-even to healthy people-just that they do not have it monitored.  I will get a new Sleep Study soon (as the last one was around 5 years ago).  I am hooked up to a cardiac monitoring system for a month, trying to get data on what is going on with my heart, hoping I do not have to go to the ER before that.  Again, grateful for people like you who can share thoughts.

[is_something_wrong]

I'm happy the reply was useful. Thank you.

Must be the first time I've heard about a prophylactic Maze procedure, but your doctor probably had his reasons.

With sick sinus syndrome, you often have extreme sinus arrhythmia, several pauses at daytime and often an abnormal response to exercise (heart rate too high, too slow, suddenly drops during exercise, etc). It's good that your heart rhythm during exercise is fine.

Lots of strange things may happen to the heart rhythm during sleep and the range of what's considered "normal" is quite wide, but I'm pretty sure that a 6 second pause doesn't fall under "normal". Sleep apnea may definitely cause slow heart rate and pauses, so you should get that investigated. A Maze procedure may, as far as I know (but I'm no expert so I'm a bit on thin ice here) prevent a (beneficial) atrial escape rhythm during pauses.

Maybe you should ask for another Holter test so you can see if this is developing?

[Poci]

Thanks for your response and the tip about Dr. Park. I will check it out. Would you know how frequent and of what duration were your VTach episodes? For how long you had them before getting the pacemaker?

[Poci]

Thank you very much for your useful feedback.  I am glad that you had the same thought about whether or not the pauses are related to SA or the Maze. That is exactly why I was reluctant to aggressive treatment like a pacemaker without knowing the cause of the pauses. I did not have AF. The Maze was done as a prophylactic measure to void potential AF in the future.  Are you familiar with that?  

[Mom2four85]

You can also ask Dr. Stephen Park in the sleep disorder community.  I attended a web seminar that he did a couple of years ago, where he answered alot of questions on sleep apnea but he also knows alot about arrhythmia's and SA.

He's the one who pointed me in the direction of VTach episodes for me during sleep when my cardiologists & EP ignored them.  I have a pacemaker for my bradycardia episodes; which helped greatly with my pauses at night since I can't tolerate any of the masks.

Def write down any questions & concerns you have and ask your doctor.

[is_something_wrong]

You should ask your doctor if the sinus pauses are related to sleep apnea or the Maze procedure. You should also ask your doctor what the cause of your atrial fibrillation was. A pause of 3 seconds during sleep is borderline to normal but 6 seconds is quite long.

I don't think you'll get the answer on your pacemaker questions on this forum :) That's something you need to decide through discussions with your cardiologist. What I think is important is to find out if you truly have sick sinus syndrome, another disease which requires a pacemaker, or if this will go away with time, or with treatment of the sleep apnea.