Wide QRS

[President2012]

Hi, Quick bio. I have PAF since 1961. I had a pacemaker fitted two years ago for sick sinus and am on 2.5mg Bisop. I was due to have an ablation in January but it had to be cancelled as I damaged by quadriceps tendon in a fall. I cannot sleep very well with pain so I have been taking 2 mg Melatonin over the past few nights to help me sleep. I have not had an an fib episode since Christmas day.

I woke up during the night with a strange feeling. My resting pulse is 60 BPM (the PM will not let me go lower) but during the night it was 80 bpm. I dug out my Kardia which has. not been used since the pacemaker was fitted. It said I was in normal sinus with wide QRS. Some time later it said I was in Normal sinus with SVE. Next time it said I was in A Fib. Now it is constantly saying NSR with wide QRS. and 80 bpm I don't know if the Kardia is accurate if you have a pacemaker . Does anyone know if this will convert to normal sinus itself or should I go to hospital or ride it out My pacemaker is not monitored by the pacing clinic

[Buffafly]

I would get that checked out as there is more than one explanation, some more serious than others.

[President2012 in reply to Buffafly]

Thanks. I tried to talk to my EP today but he was in the Cath Lab all day.

[Buffafly in reply to President2012]

When I suddenly developed wide QRS I was told I should have gone to A&E but if you feel fine it’s probably ok.

[President2012 in reply to Buffafly]

Thanks. I feel tired because I did not sleep last night. I hardly feel anything. I have to check now and then to see what is happening. Ou A&E is a nightmare. I will see how things are tomorrow

[ForensicFairy]

Im not sure you can rely on the Kardia as you have a pacemaker but in saying that, it does seem something is happening.

I have loads of wide QRS due to having a left bundle branch block. It’s never been an emergency for me - it does make me breathless and my heart rate does increase a little with it. Probably because of the strain of the heart pumping with the left ventricle being a little bit out of sync with the right.

The P is the atria contracting and the QRS is the ventricles contracting so any expansion shows a delay between right and left generally. The delay can be multiple things (for me it’s the LBBB).

I’d definitely give your doctor a call and have a chat. If you feel unwell at all, then head down to the ER.

[President2012 in reply to ForensicFairy]

Thanks. I sent one of the traces to Kardia for a report. It has just come in and says normal sinus with First degree AV block and wide QRS. I have never had anything like this before. I did have a wide QRS report once but my EP was not worried. I shall contact someone tomorrow hopefully

[ForensicFairy in reply to President2012]

Good luck. Let us know how you get along.

[CDreamer]

I quite often get readings of sinus with wide QRS but my EP doesn’t seem concerned and says it really hard to tell from Kardia reading if you have a pacemaker as if the pacemaker is kicking in - that will affect the reading so it could well be the pacemaker.

[President2012 in reply to CDreamer]

Thanks. I was wondering about that but if my pacemaker normally kicks in if I go below 60 bpm then with a rate of 80 bpm it oils nit be pacing. Unless the lead to the ventricle is pacing. I do not know enough about this to reach a conclusion myself. I sort of think I am not in any immediate danger but will check it out.

[CDreamer in reply to President2012]

It will also depend upon the type of pacemaker - mine is CRT so both ventricles are paced and that may be the reason. I suspect that the Kardia algorithms cannot distinguish - which is why the say it shouldn’t be used with pacemaker.

[President2012 in reply to CDreamer]

Good point. Mine is dual lead

[Tapanac]

well as you probably know your pacemaker if it is a 2 lead only stops your heart from going too low. Normal setting is 60 although my husbands is 70 so if heart goes below those figures it kicks in

However unless you have the special pacemaker which is sometimes set at 130 ish it cuts in so if heart goes above that figure, your pacemaker will stop your heart racing., but not many people have this PM

So I know from my experience though that (like this last two weeks) I had gone into tachycardia and it showed up on my BP machine (not a kardia just a normal bp and pulse machine)

80 bpm is not massively high though I’m told not to worry unless it goes above 110

If you are very worried or have chest pain or difficulty breathing then call an ambulance or if quicker get someone to take you to hospital

Hope I have explained ok

All the best

[President2012 in reply to Tapanac]

Many thanks my pacemaker paces below 60 and over 130. My problem was that when reverting back to normal sinus the HR was a steady 80 bpm whereas it would normally go back down to 60 bpm plus it would then go back in to AF and then some time later go back to normal sinus with a wide QRS, I was not worried about the rate as a number as it is not high but the fact that I was stuck in that number which is unusual for me plus the back and forth between AF and NSR. Anyway, all is well now.

[Tapanac in reply to President2012]

Oh I’m glad all is well now for you. Stay well 🌺

[President2012 in reply to Tapanac]

Many thanks. You too

[Tapanac in reply to President2012]

I guess you have a three lead pm and that sounds so good stopping your heart going too high or too low. The Rolls Royce of pm’s

Mine is only a 2 lead snd stoppd going too low

I’m not sure whether it’s the leads or the pm itself

All the best

[President2012 in reply to Tapanac]

Thanks you too

[Ppiman]

I believe that a wide QRS indicates (often) a left- or right-branch bundle block. These seem common as we get older, and more so if other cardiac issues exist such as your SSS or having a PM fitted. If you have LBBB, then, to my knowledge, no AI based ECG device such as the Kardia can interpret the ECG well as the LBBB makes the ECG very difficult even for an expert to read. At least Kardia often reports "wide QRS", whereas my Contec PM20 (excellent in my view) either shows "arrhythmia" or, NSR (both of which are correct). My Wellue ECG sadly can get it all wrong at times and sometimes even reports VT. The cardiologist I see tells me it's all caused by my LBBB.

I have not only LBBB, but also daily multiple atrial ectopics and fortnightly AF and, even though my doctor claims all my symptoms (all of which I cope fairly well with) are from the arrhythmia, it is really when the LBBB starts up that I feel the most symptomatic with mild SOB and a general lack of energy.

Steve

[President2012 in reply to Ppiman]

Many thanks Having some tests but ECG has shown NSR with no wide QRS, Ectopics or block. Echocardiogram coming up

[Ppiman in reply to President2012]

I believe that a wide QRS can be hard to determine as, like PAF, it comes and goes.

When you get your results, please let me know!

I apologise for several missed typos in my first post.

Steve

[President2012 in reply to Ppiman]

Don’t worry about typos I could not even get a date correct. It will be a few weeks before more tests but EP seems unconcerned. Take care. Niall

[Ppiman in reply to President2012]

Hi Niall - that is the best news to get, that an EP is unconcerned!

Steve