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heart block - slow heart beat in 2 yrs old

Dear all, my premature son nearing two years old is diagnosed with heart block from the 24hrs holter scan result, however the doctor is saiding the it is a 2 to 1 and occasionally 3 to 1 sinus block and the result is 'not that bad'.. he said that the pacemaker solution can be put on hold for the mean time but close monitoring and check up again in 3 mths time will still need to be done...

Very grateful if anyone can give any guidances/experiences on this condition...thank you all
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773637 tn?1327450515
Dear MS,

Without seeing your son's ECG or Holter reports, it is difficult for me to say what kind of prognosis this kind of atrioventricular block has.  It is unclear to me whether the block is at the sinus node or is at the atrioventricular node.  If it's at the sinus node, there may be other reasons why the sinus node is dropping beats, such as premature beats or increased tone in the vagus nerve, which can suppress the sinus node function.  If it is at the atrioventricular node, it is important to know if it is second degree block type I or type II.  My guess, based on your note, is that it is type II, although I cannot be sure.  If it is this, these patients eventually progress to requiring a pacemaker, as there is disease in the lower part of the electrical conduction system.  The timing of this depends on several things, including the intrinsic heart rate, how good the ventricular function is, if there are wide complex escape beats, if there is structural cardiac disease, and if the QTc interval is prolonging (one of the many "measurements" that we make on the ECG).  If these start to become abnormal or worsen, that may be an indicator that a pacemaker is required.  As well, the overall functioning of your son is important.  If he is not able to keep up with his peers from an activity standpoint, or is falling asleep more readily, or needing more naps, etc., this may be an indication, as well, that a pacemaker is required.  You should discuss this further with your pediatric cardiologist, so that you understand better this information and its implications as well as what things you can look for to help determine this timing.
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Dear Sir,

I am most grateful to your reply, my kid actually seem fine and have no symptom of bradycardiac at all, he plays actively, eats and sleep normally.

The below is the Echocardiography and holter report, I know it is a whole lot of details. I will remember your kindness always and thank you so much for everything. It meant a lot for someone so desperate now, thank you.


BSA:0.51M square
Measurement: Aortic annulus-1.00cm
Pulmonary annulus-1.07cm
Right pulmonary artery-0.56cm
Left pulmonary artery-0.53cm
Mitral valve annulus-2.22cm
Tricuspid valve annulus-1.67cm

MEASUREMENTS:Normal interventricular septum:
Normal posterior left ventricular wall:
Dilated left ventricular internal dimension (95th centile)
Normal Cardiac contractility
Ejection fraction-0.73
Fractional shortening-41.10%

LESION: Intact interatrial septum,tricuspid aortic valve,normal proximal coronary arteries
RELATION:Normal spatial relation
DOPPLER:Pulmonary artery flow velocity-1.06m/s, Right pulmonary artery flow velocity -1.38m/s, Peak diastolic pressure gradient across RPA -7.60 mmHg
Mitral valve inflow velocity:E wave -1.72m/s, A wave -0.61m/s
Tricuspid valve inflow velocity: E wave-0.82m/s A wave 0.61m/s
Tricuspid regurgitation jet flow velocity -1.48m/s
Peak systolic pressure gradient across tricuspid valve-8.70mmHg
Ascending aortic flow velocity -1.76m/s
Descending aortic flow velocity-1.83m/s
COLOR FLOW: No flow across interatrial septum, Mild tricuspid regurgitation, mild pulmonary regurgitation, trivial mitral regurgitation


Heart rate
35919 beats in bradycardia (1.
0 sec and 52 interval>1.5 sec recorded.
There was a single ventricular extrasystole recorded at 13:54:48. There was no ventricular couplet or run or supraventricular extrasystole recorded.
There was no significant anomaly of ST-T noted. The QTc was within normal limits. Longest R-R interval was 1.88 sec (at 00:37:52, 3:1 AV conduction)
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