Expert: David Richardson - 8/8/2006

Question
Dear sir,
I'm 18 years old.Two years ago I was monitored for a period of 24 hours (HOLTER).
During this period my average heart rate was 46 BPM with a maximum heart rate of 130 BPM and a minimum heart rate of 17 BPM.
During the monitoring period there was 1 abnormal beat detected. It was a 2 second pause.It was detected when I was asleep.
There were no successive abnormals detected during the monitoring period.
There were 6 tachy episodes ranged from 120 BPM to 130 BPM and 105 brady episodes ranged from 17 BPM to 40 BPM.
Now after two years I was monitored for the second time.
During this period my average heart rate was 74 BPM with a maximum heart rate of 145 BPM and a minimum heart rate of 40 BPM.
This time also, a 2.44 second pause was detected and this was detected when I was asleep.
My Doctor said I'd better wear a pacemaker.I'm so worry about this.please tell me what should I do, and what's my problem?
Thank you very much.

Answer
Dear Mr.Sarmadi,

The problem is called sinus bradycardia and sinus pause, but that's just Latin for what you already know, that your heart beats slowly sometimes.  I'm doubtful about need for a pacemaker if you have no symptoms like fainting.  Braunwald's Heart Disease, the standard textbook of cardiology, says an artificial  electronic pacemaker is indicated only in symptomatic patients or those with a sinus pause exceeding 3 seconds.  And a minimum heart rate of 40 is not at all too slow.  45 awake and 35 asleep are the accepted normal lower heart rates.  Your heart is beating faster now than two years ago, so you can expect further improvement as you grow older.

Please write back if this note doesn't answer all your questions.

David Richardson