I Must Not Understand Complete Heart Block

Can you guys help me? When I got my PM 12 months ago, I was Dx as 2nd degree Mobitz Type 2 heart block. During a recent check-up, my Dr turned off the PM for a moment and I nearly fell off the table I was so extremely dizzy. He said I have now developed complete heart block with no escape rhythms. I'm pacing 100% in the ventricle and around 10% in the atrium.

What I dont "get" is questions on this site from people wondering if they need or should get a PM because they have complete heart block. How can one live if the electrical impulse between the chambers is completely blocked? Is it because the electric impulses ARE getting through to one chamber? (In my case the atrium.) I thought I understood my doctor to say that I am totally PM dependent. Did I misunderstand?

While I'm at it, I am now also experiencing diastolic insufficiency (or failure). I'm taking Lasix for that (really helps) but more treatment may be necessary for that problem too.

I love reading and learning on this site. Help me understand what's going on.

Thank you!
Niecey

3 Comments

Complete block

by golden_snitch - 2015-01-05 02:01:36

Hey!

Patients with a congenital complete block usually have a quite good escape rhythm from the lower part of the AV-node or the His Bundle. Their heart has never known a normal rhythm, and so it has adjusted and found ways to compensate for the block. So, these patients can often wait for years, until they really need a pacemaker.

Actually, the vast majority of heart block patients does have an escape rhythm. You very likely, too, if your EP had waited a few more seconds. It sometimes needs a few seconds to kick in. The lower part of the AV-node can produce such a rhythm, the His Bundle can, and also the Purkinje Fibers. Your heart has a lot of backup systems. And there are some patients in whom that escape rhythm is good, running at around 50bpm or even more, and in some it also speeds up when they move. So, of course these patients can wait and do not need an implant immediatly.

Personally, I do not like those doctors who always point out how VERY dependent one is on the pacemaker. There are different definitions of pacemaker depedency out there, and there are indeed doctors saying that, as long as there is an escape rhythm, even a complete heart block patient is NOT completely dependent on the device.

I have a complete block, an escape rhythm of usually around 30-50bpm (I do get dizzy, too, when they test it), but during my last pacemaker replacement my heart stopped completely. I still do not consider myself to be pacemaker dependant. For me, pacemaker dependancy is when you drop dead in an instant, if the pacemaker is switched off.

Inga

2nd degree

by Tracey_E - 2015-01-05 07:01:07

It's common to progress from 2nd to 3rd degree. I agree with Inga, it's highly unlikely you have no escape rhythm. Had they waited a few more seconds, your heart would have kicked in. My underlying rate has been anywhere from 20 to 60 when they've checked, it's never the same twice.

Suddenly going from pacing to one of the back up systems Inga mentioned is going to feel bad, esp at first until it kicks in. When you are in block and are not paced, your heart is used to compensating so some people get by ok. I was born with 3rd degree block and lived with it until I was 27. My heart rate was always 44. It never went up, it never went down. Whatever my sinus rate was, my ventricles just plugged along at 44. Now that I'm used to a normal rate, 44 would feel really awful, but when that was all I knew, it got me by.

Here are some great animations that explain how the heart beats normally and how it beats in block
http://health.sjm.com/arrhythmia-answers/videos-and-animations

A Common Misconception

by donr - 2015-01-05 12:01:19

Nicey: This is really meant for those who are Newbies to being a PM Host. I think you understand this.

People get confused with the terms "Completely Dependent" & "100% Paced." Anyone who is Completely Dependent is 100% paced - but the opposite is NOT necessarily true.

There is a whopping difference. You can easily be 100% paced, yet nowhere near be dependent. Inga nailed it when she said that to truly be Completely Dependent, you have to die if the PM shuts down. I am nearly 100% paced (99.5% in the Atria), yet not even remotely Dependent on my PM to live - I'd just feel crappy if the PM went south on me.

Donr

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