At what point does the sinus pause/compensatory pause become a worry?

[DaveT81]

Hi guys, I've had issues with small runs of ectopics for a couple of years now. Had a year or so of relative peace following ablation in 2017. But since becoming I'll with ME/CFS in 2018 I've seen a gradual increase in ectopics and runs of them. Usually when lying down at night.

One thing I have noticed is that over the years the compensatory or sinus pause (is that the right term for this?), i.e the lone flat line after the spikes has been getting longer. Initially it was maybe 0.8ms now it's hitting 1.4s at times. And man, can you really feel those.

Question is, when does the length of those 'pauses' become a concern? I mean, it's already a concern for me now as when the heart beats again after those gaps it's like being kicked in the chest and I get a little light-headed and breathless.

I had had s break from them mostly, for a few weeks as I was taking a lot of electrolytes but just at random they started up again about 6 days ago when I lay down in bed. I experience a few throughout the day but they almost always kick in big time when I've been lying down for 20-30 mins at night and increase in the frequency from there.

[Buffafly]

I used to get the big thump and found it very worrying but it isn’t to a doctor. The time to worry is if you have 3 second or longer pauses, but somebody once reported their monitor showed 8 sec pauses and they lived to have a pacemaker fitted! But I know they are very disturbing 💜

[DaveT81 in reply to Buffafly]

Oh my god, 8 seconds? That just sounds awful, even thinking about it. I think I may have hit 2 seconds at one stage in the last week and even then, it's like you're experiencing a massive, pregnant 'pause' in your whole body, before it pounds back into action again. So disturbing.

I'd read 3 seconds somewhere too, and another said 5. So I guess if it starts to regularly breach that 3 second mark, I can legitimately hassle my cardiologist/GP again about it. Just hope it starts to calm down again soon. Had little activity for weeks, and it was bliss. Thanks!

[bantam12]

I think my pauses were about 5 seconds, I now have a pacemaker 🙂

[DaveT81 in reply to bantam12]

Wow okay, so mine are nowhere near then. Still, no less terrifying at the time!

How long did yours go on like that, and did they gradually increase over time?

[bantam12 in reply to DaveT81]

It took 6 years for a Cardiologist to take any notice of me ! the first one I saw just said it's nothing, stress, anxiety ya de ya go away 😡 then a new Cardio, loads more tests and 14 day monitor showed the problem, I have constant ectopics, svt and 2nd degree heart block, pacemaker has definitely made a difference although I still get ectopics and the odd pause before pm kicks in. If you are symptomatic keep pestering for something to be done about it.

[RxMe]

For what it’s worth, the a-systole alert on my loop recorder is set at 4 seconds.

[DaveT81 in reply to RxMe]

Wow, okay. So a long way to go for me yet then!

[Coco51]

Having had the same problem and picked it up on the Kardia, I had a long talk to the Arrhythmmia Nurse about this. He said that pauses of up to 3 or 4 seconds are ok. For a time mine were about 3 secs. Longer, say 5 or more, can lead to fainting for some people - he said. But he was very reassuring. Mine are less bad now since the ablations. I too have a back up pacemaker not for the pauses, but because my HR was dipping down to 36 at times.

[The_Lord_is_with_Us]

I wore a heart monitor for two weeks about 10 years ago. Heart was jumping all over the place. Hurky jurky ... pauses ... I thought for sure I had AFIB. Then when I went in to consult with the Cardiologists about what was found, he said no AFIB and nothing but PVC's and other ectopic beats which are a non-issue. I was shocked, but sent home with no treatment.

However, I discovered on my own that 300 to 400mg of a triple magnesium complex twice a day smoothed my erratic heart beats out to normal. I was quite surprised and very happy. The erratic beats never returned.

[DaveT81 in reply to The_Lord_is_with_Us]

Yeah, initially I felt that taking magnesium supplements was Angelo but lately just felt little benefit. Some days I'll take 1700mg magnesium and also get a bath with magnesium flakes and still those ectopics will take off on me all day.

While I've not been in full afib since 2017, those ectopics can very much be a ruiner of days.

[chicolini]

How do you calculate seconds? Ie on a kardia recording ? I get some loooong pauses too

[DaveT81 in reply to chicolini]

If you count each of the larger boxes after the spiky activity (ie the boxes that make up the flat line) each of those usually represents 0.2 secs. So 5 boxes equals 1 second.

[chicolini in reply to DaveT81]

Thanks very much Dave. 😀

[Tennisking]

After my first pvi ablation I had regular 6 second pauses recorded by a nurse. It was a very traumatic period, and resulted in me coming off Flecainide altogether, and eventually a second Ablation. I remember grabbing onto whatever nearby to stop myself from passing out.Currently, during episodes, I experience 1.5 second pauses that are captured on my Apple Watch. Not pleasant, stressful but more manageable!

[DaveT81 in reply to Tennisking]

Oh no. 6 seconds? That's must've been awful for you. Pauses up to the 2 second mark have been bad enough.

I think I'd find them easier to handle if it was easier to identify the reason they were occuring.

[Khatpi in reply to DaveT81]

Sounds like it's time for a visit to your EP. I too had 8 sec pauses, on the OR table while they were placing my Pacemaker. Best thing for me. Hope you seek help asap. Sarah from San Diego