strange pattern

Have any of you had this experience? A normal heart rate of about 70. Buuuutttt, a rhythm that goes like this: Beat, beat, beat, significant pause, beat, beat, beat, pause. Basically three beats followed by a totally missed beat. The pattern varies to 4 or five beats with a pause and then goes back to the three beats and pause pattern. The other symptoms include the urge to cough and a queasy felling in my chest but no pain. I am supposed to get an event monitor tomorrow (been waiting a week for it). I can go a few days without the odd rhythm and it can occur at random several times in the same day, usually only a few minutes but sometimes much longer. My pacer does not seem to recognize what is going on or possibly the pacer delay time is set too long. It hasn't happened when I am exercising. Fun and games with a PM haha.

4 Comments

Wenckebach?

by lbdina - 2013-11-06 03:11:28

Could this possibly be Wenckebach 2nd degree AV block? From what I have read, this can cause 3:2, 4:3, 5:4 behavior (P:QRS ratio). That seems to be what you are describing. Not sure about the symptoms.

I read about this in Rapid Interpretation of EKGs by Dale Dubin, MD. He says the PR interval gradually lengthens until the last P wave fails to conduct to the ventricles, causing a missed beat, usually in a fairly repeatable cycle. You might do a Google search and see if it describes your situation.

Lou

Not Enough Data to...

by donr - 2013-11-06 05:11:17

...offer an opinion. Need to know the following:

1) Kind of PM you have - single or dual chamber.

2) the only diagnosis I can find for you is buried in a comment several yrs old & it's SSS plus Brady.

3) Do you recognize PVC's readily? You commented that you had none at the time you mentioned your diagnosis.

I have to assume here - you have a dual chamber PM, meaning the PM can influence the performance of the Ventricles. IF - IF that is the case, it would protect you against any 2nd Degree block.

The PM cannot protect you against PVC's because they come EARLY & the PM has no way of predicting the future, which it would have to be able to do. It also has no way of preventing events to occur - unless they are a pause of some sort.

What you have described to me reads like a string of PVC's in a pattern. One of the ...geminy family (Bigeminy, trigeminy, etc.) They can be annoying & because it is a pattern, you tend to notice it. If you do have that, the PVC can seem like a totally missed beat. Unfortunately, (or fortunately) if your PM is functioning properly, it will NOT let you ever skip a whole beat.

I had this exact same series of events one Sunday AM when awakening & it is very attention getting - mainly because of the pattern. I have PVC's by the thousands every month & never notice them, but that one reached up & grabbed me by the stacking swivel. (stacking swivel - a term that only a pre M-16 rifle vet would recognize)

Don

hi don

by BillMFl - 2013-11-06 08:11:15

I think you may have hit it on the head. In my profile I list my Medtronic dual chamber, Versa DR. I only pace in the atrium and have good conductivity. I wondered why my pacer was not interrupting a long run of pauses if they were actually pauses. The pacer should sense the delay and after a very brief time fire the ventricle, thus preventing the loss of a complete beat. My pacer checks have revealed numerous pvcs and some vtach but usually short runs of several mins. You are very correct in the attention getting. I had never had that exact feeling before. I can feel some of the brief pvc runs as a brief flutter sensation. But that is not anxiety provoking. A twenty minute run of trigeminy (?) is very unsettling the first time you experience it. When it happened again two days later I stayed calm and just observed what was going on so I could relate it to my doc. The good news I guess is that PVCS are much less serious than a dropped Ventricle contraction. Thanks for sharing your experience. I do believe I had some runs of at least 5 which may be more significant?

PVC Runs

by donr - 2013-11-06 08:11:45

The worst PVC run is a run of Bigeminy - that's a lot of PVC's over a long run. When I first was admitted to the hosp leading up to my PM, I had that. I really felt washed out & nearly did a face plant in a bowl of pasta in a restaurant a block from the hosp. Saw the pattern on the monitor & still felt like a limp dishrag. The farther apart the PVC's are in your HR, the better off you are.

Don

You know you're wired when...

Titanium is your favorite metal.

Member Quotes

Yesterday I moved to a new place in my mind and realized how bad I felt 'before' and the difference my pacemaker has made.