My ECG readings show high degree AV block. Should I go for surgery?

Hi,

Welcome to icliniq.com.

I understand your concern.

I have gone through the reports (attachment removed to protect patient identity). Kindly attach the reports of Holter monitoring. Please mention the reason for having a pacemaker, as suggested by an electrophysiologist. Please mention whether he has done any invasive tests. On going through the reports, there are multiple ventricular ectopics and some episodes of sinus bradycardia, but there is no evidence of a high-grade AV (atrioventricular) block. In some places, it appears like an AV block due to complexes being of low voltages. In my opinion, you do not have any high-grade AV block. Your symptoms are related to ventricular ectopics. I suggest you repeat Holter monitoring, and there is no need to have a pacemaker after going through the available reports.

I hope this helps.

Regards.

Hi,

Welcome back to icliniq.com.

I understand your query and concern.

Except for your first tracing, the rest of the reports are fine (attachments are removed to protect the patient's identity). The first tracing shows T-wave inversions. QRS is not broad, and the duration is similar in all the tracings. ST difference is seen due to different voltages of the tracings. Some are at very low voltage, and the other one shows normal voltages. It does not indicate MI (myocardial infarction). The only significant abnormality is T-wave inversions. There is some blockage in the arteries, and it may just indicate a strain pattern. This device is not a standardized one for detecting ST-T abnormalities, and it is not reliable. 12 lead ECG (12-lead-electrocardiogram) is recommended to rule out ST-T abnormalities. If your previous ECG (electrocardiogram) shows some changes, then it may not be a significant finding. Sometimes, changes can be related to the machine position present at unusual sites.

Hope this answers your queries.

Regards.

Hi,

Welcome back to icliniq.com.

I understand your concern.

Except for the ECG that shows T-wave inversion, the rest are fine. There is no evidence of conduction-related heart blocks. With T wave inversion, we have to rule out the possibility of blockage in arteries, and it is different from AV blocks (conduction blockages) requiring pacemakers. Do not get confused between these two blockages. I am explaining the meaning of an unusual position now. T wave inversion can be seen normally in some leads like AVR (augmented vector right) and sometimes with age in AVL (augmented vector left). If the device position is similar to these leads, then T-wave inversions cannot be seen normally. You have done a stress test earlier. It is basically done to rule out the arterial blockage, and the probability of having T-wave inversions and the arterial blockage is low in this case. If you have done any previous 12 lead ECGs, it helps to compare them. This autocorrection is not helpful and significant. Some of your tracing taken later shows T-wave inversions sometimes. This is due to artifacts which means that there is some relative motion present between the device and body which causes distortion in the waves leading to these patterns. T-wave inversions do not show variations beat by beat, but conduction heart blocks (AV blocks) can be transient, and none of your tracings show it.

I hope this addresses your concern.

Kind regards.

Hi,

Welcome back to icliniq.com.

I understand your query and concern.

Your ECG shows PVC (premature ventricular contractions). It is usually benign, and they are responsible for your symptoms. We need to rule out the possibility of structural heart disease and ischemic heart disease, as you have done a cardiac MRI and stress test already. It helps to solve the problem. You also need to rule out the possibility of thyroid problems and so you need to undergo a thyroid profile. To avoid these symptoms, you should avoid taking excessive coffee or other stimulants. You should avoid drinking alcohol and smoking. Have adequate sleep. You need to take medications like Betablockers if you are symptomatic. So, ventricular ectopics are responsible for your symptoms, and they are usually harmless. Start taking medications if it causes trouble.

Hope this answers your queries.

Regards.

Hello,

Welcome back to icliniq.com.

I understand your query.

All your attached ECGs are fine. The sharp arrow is a motion artifact due to movements during an ECG. Also, distortions at other places are related to movements. So, there are no significant abnormalities in any tracing. Heart rate would rise with fever which is a normal form of tachycardia called sinus tachycardia, however, may not rise always. This does not require any treatment. Beta-blockers may be considered only if tachycardia is persistent even at other times, which is not the case here. With this blood pressure, it is better to avoid beta-blockers in you as there is no absolute indication, or you may have it in extremely low doses with regular BP monitoring if the treating doctor feels it is necessary. If you can tolerate your ectopics well, then you may not take any treatment, and if too symptomatic, then low-dose beta blockers with strict BP monitoring may be considered. You should also try to identify the triggers for ectopics and eliminate those.

Hope this answered your queries.

All the best.