Not sure I understand this

Greetings to all. So here's a weird thing. I got the surprising info at a clinic appointment last January that I had complete heart block and needed a PM. In my infancy on the subject, I actually thought "oh, that's cool, level 3, good thing it's not level 1, that would be worse".  Lol--like I said, my infancy.

Since then, I've made my peace with it all, and know it's part of my reality. Seems like I've had it forever.

At an appointment with the technician/EP staff last month, to discuss adjustments for palpitations (I was paced 100%), the technician saw my heart block wasn't complete. Did an EKG to confirm her findings. So the settings were changed to "support when needed". I was so confused by it all, I really didn't have the list of prepared questions I usually am armed with.

My question to you all--I assumed that the heart block road was a one-way street. How could I possibly show up as not 100% blocked when, during the last 2 evaluations, it was? No, I don't think I'm being cured but was wondering about this curious happening. 

Thanks to all of you experienced folks helping the newbies and to new folks--the idea really does get easier to accept. Hang in there. 


Second degree

by AgentX86 - 2019-12-04 23:27:55

Well, when they did an EKG before. your AV node wasn't working. This last time, it was. An EKG is only a snapshot. It can't tell what goes on between. Did they do a Holter monitor on you? This is a mini-EKG (not a full 12-lead) that you wear for an extended period (a day to,perhap even a month). They can then get a better picture 6what's going on.

An intermittent conduction is called a second degree type-II heart block. This is still a dangerous situation, so a pacemaker is still necessary.


by Tracey_E - 2019-12-05 09:57:13

Most of us with 3rd degree block pace pretty close to 100%. It's possible to be in block most of the time but sometimes the signal gets through, or it's possible to move between 2nd and 3rd degree block. I don't know why she'd change the settings, tho, the pacer is always going to give the heart a fraction of a second to beat on its own, for the ventricle to beat when the atria does, before it paces. Maybe she increased that delay? You shouldn't feel any different. Whether you're in block a few minutes a day or all day every day or somewhere in between, the pacer is always going to jump in and fix it as needed. 

Thanks for the feedback

by CR - 2019-12-05 12:08:37

Interesting! I just thought complete was kind of a forever thing and was quite surprised to hear there could be any variation. Couldn't find anything online about it so thought I'd ask the "experienced" among you.

I believe the delay was increased & I'm doing a 48 hour Halter in a few weeks. Had to cancel that over Thanksgiving weekend cause of the darn weather here in Wisconsin. A 45 minute drive in a blizzard, potentially into a ditch, might really make my heart get back on track though. :)

Obviously, one for the "still getting all this" column. Thanks, all. 


Heart block type

by AgentX86 - 2019-12-05 15:04:44

Try this site:


Or try a search on my subject line


by MrTech - 2019-12-05 19:16:56

Intermittent CHB isn’t too unusual. One can flick between that and 2:1HB or even normal 1:1 conduction (less common) . As time continues though it does tend to go one way though and one can find it will generally progress to permanent CHB. 

Its not a bad thing to try and let heart do it’s own thing when the can, so kudos to the professional for checking properly and try minimise pacing where possible.

 Extending the AV delay will allow more time for a ventricular beat to be sensed (Obviously can’t say exactly what your ECG was showing). 

See what you Vpacing% next time but don’t be too surprised if it’s still close to 100% given you have already been in CHB before. 

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