Recent Diagnosis

Hello!  I was just diagnosed with Second Degree AV Block after an EP study with Procainamide.  I still don't understand why I need a pacemaker since I am asymptomatic.  My original cardiologist chose not to do tests as he was very conservative but when he left the practice the new doctor did multiple tests and finally an EP study.  I am not in denial but I was wondering if anyone had a second opinion on whether they needed a pacemaker or not.  I am very careful about making medical decisions but I believe there could be other options.

I would appreciate any feedback from anyone that has been in my position.

Thank you


Second opinion

by Gotrhythm - 2023-09-07 19:30:09

If you have doubts about whether you need a pacemaker, and you want a second opinion, then by all means you should get one. You need to understand how a pacemaker would benefit you.

We often joke about how we're in the club nobody wants to join. Though none of us chose to have the heart condition that led to getting a pacemaker, I think it's beneficial when we feel like we did choose to get a pacemaker.

Sometimes, just talking to a different person opens the way to ask new questions.

One of the questions you might want to ask is, "What will happen if I don't get a pacemaker?"


by Lavender - 2023-09-07 21:07:44

I had no choice in getting a pacemaker. I think it's harder when you have the opportunity to mull it over and decide. Other than an EP study as you had, I wonder if a thirty day monitor might help to catch any pauses or weird stuff going on while you sleep or that you might not notice?

 I'm not sure who you would get a second opinion from if you already have seen a well regarded EP. 

Why did the new dr choose to do the EP study? There must be something that led you to a cardiologist in the beginning. 

I was told that this stuff is progressive. You might not need one this minute but a pacemaker could be in your future.  

other options

by Tracey_E - 2023-09-07 23:36:05

Your options are wait or don't wait. These things do not go away on their own, they sometimes stay the same but more often get worse with age. There are no meds or other fixes. 

Many of us find we are not as asymptomatic as we thought. We decline gradually and write the symptoms off to stress, etc. Then we get paced and realize a regular heart beat feels pretty darned good. My rate dropped gradually over several years so I didn't realize just how bad I felt until I felt good again. Then one day it tanked and was 22 when I was admitted for emergency surgery. That's not the easy way to do it!

If you aren't comfortable with the decision, get another opinion. It doesn't sound urgent. Things I would want to know are how low you get, particularly when asleep when you don't feel it, and how long you stay that low. If you are dipping very low at night, or not going up appropriately on exertion, the low rate and subsequent lack of oxygen, is hard on the organs. When we are young, the body compensates. As we age, it takes a toll. So sometimes being asymptomatic does not necessarily mean you wouldn't benefit from pacing.

What else was seen during your EP Study?

by Gemita - 2023-09-08 06:21:32

Hello Ricki, I note that you had an EP Study with Procainamide which is an anti arrhythmic medication.  Are you actually taking Procainamide regularly to treat an arrhythmia?  Certainly having a pacemaker would help your doctor to treat any rhythm disturbance with medication that could potentially reduce your heart rate to dangerously low levels or cause symptoms of heart block, so from that point of view a pacemaker may well be in your future.  This was one of the reasons for my pacemaker, since my heart rate plummeted from my heart rate lowering meds and by getting a pacemaker, my doctors could maintain a steady, safe heart rate at all times when treating my arrhythmias.

With electrical disturbances, and arrhythmias are just that, having treatments like an ablation or taking powerful medication, may cause problems with both our Sinus and AV Nodes and a pacemaker is often required as a result.

I too am very careful about making medical decisions.  I too had an EP study to determine the best course of action.  I got a second opinion.  My first cardiologist wanted to wait and see, but my symptoms/arrhythmias (intermittent) at the time were not picked up by short term monitoring.  This all changed when I received a Reveal Linq implant monitor which gave my second Cardiologist/EP more information about the nature of my arrhythmias.  It was concluded that I had severe bradycardia induced arrhythmia, pausing and occasional syncope and that a dual chamber pacemaker would help.  I have never looked back.

If you have no symptoms, then doing nothing is an option, but clearly from your post you have electrical disturbances, perhaps arrhythmias which need treating.  Did your doctors explain what was seen during your EP Study and was IV Procainamide used to try to stop any arrhythmia present?  They used IV Flecainide during my EP Study to stop my Atrial Fibrillation and to get an idea of the dosage needed to maintain normal sinus rhythm.  My EP Study found lots of arrhythmias, originating from multiple sites.

I would certainly ask more questions of what was found before making any decisions.  I hope for the very best for you

2nd Degree Block

by Penguin - 2023-09-08 12:33:18


I took months to decide, so you're not alone. IMO it's wise to take time over a big decision like this. It's difficult to go back once it's in your chest. 

 I agree with Gemita mentions re: the role of other medications that you may be taking and being sure to discuss how these may have affected your heart rhythm and results . 

Also, re: results.  2nd degree AV block can be Mobitz I or Mobitz II and there will be other causes too.  The latter is the more serious with high risk of progression to complete block.  Mobitz I or Wenkebach however is, as I understand it, less serious and may not be symptomatic.  

There's always a caveat to these things so I won't stick my neck out, but I would ask your cardiologist / EP about the type of AVB that has been found and whether or not it is a) caused by meds or anything else and b) if it is due to Mobitz I.  This 'may' help you decide whether or not a pacemaker is necessary. I'd also ask about the likelihood of progression to Mobitz II or complete block. 

I see no problem with seeking a second opinion if you feel unsure.  

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