Mobitz Type ii Questions

[Ruaraidh]

Hi guys, this is my first post, apologies for it being long, the paragraph below sums my situation up if you can’t be bothered reading. Go easy on me, I am struggling and wanting something positive to focus on.

I recently had a 3 day holter for palpitations which revealed that I had occasional instances of Mobitz ii heart block. The consultant gave me propranolol for the palpitations (worked wonders) and said nothing of the block. My GP also did not seem concerned about the block. However, all of the research I can find on Mobitz ii block suggests that a pacemaker is usually fitted due to risk of progression to complete heart block, and that the prognosis is “generally poor” for individuals left untreated. My questions are:

Am I at high risk of getting complete heart block? Is it common for people to drop dead from Mobitz ii block? What is the prognosis for people with occasional Mob ii block? Should I insist on a pacemaker being placed?

Some of my background:

24yo healthy and fit male.

I have bad health anxiety and am in the habit of checking my pulse and was aware that I was ‘missing’ beats (especially while waking up/hungover/day after working out/etc) occasionally. These missing beat periods normally only last 10 to 30 minutes (and go away as my day starts and my heart rate picks up), and normally have about 20-30 NSR beats before missing one.

I am completely asymptomatic aside from being able to feel a strange flutter sensation in my chest when having a ‘missed beats’ episode.

Thank you for reading

[Kristin1812 Heart Star]

Hi. I am sorry you are going through such worries, and you just want some answers.

I hope someone with a similar experience might reply soon, but perhaps a chat with one of the BHF nurses might be a good idea, too?

Heart Helpline team is on 0300 330 3311 Mon-Fri 9-5pm or email [e-mail]

[Ruaraidh in reply to Kristin1812]

I will definitely do this thank you

[bantam12]

I have Mobitz type 1 second degree block and had a pacemaker fitted 5 months ago, it's mostly stopped the long pauses I was getting so is a huge improvement to before when symptoms were all day every day.

[Sunnie2day]

Health anxiety - most of us here can definitely relate! After 'an event', every single twinge or 'odd turn' or ache translates to the brain as 'Danger Ahead!!'. It takes time for that anxiety to ease back as treatment plans begin to have positive effects and the anxiety usually eases off. But some of us do find a bit of specialised counselling very helpful - if your health anxiety causes you continued problems, ask for a referral to counselling. I favour Behavioural Cognitive Therapy as much of it can be self-managed after the first few sessions, and there is an excellent NHS online course (referral only, you can't Google it on the system).

As for progression of your condition, the best thing to do is make a point of asking your GP and consultant if you are responsible for booking annual progression monitoring or will they be doing the bookings - wording it exactly that way means they know you know your condition must be monitored on a scheduled basis, and they will usually mark you down for it. If for some reason they don't think it necessary and you don't find their reasoning satisfactory, you may want to consider annual consultation with a private cardiologist.

[loglegmomma]

I think my doctors are starting to wish I didn’t get copies of the reports because I tend to get more concerned about the “incidental” findings that they don’t address 😞

[Ruaraidh in reply to loglegmomma]

Yes we need to remember to trust the council of doctors and specialists. The raw data is for them to make sense of, not us

[EMBoy]

Welcome to the forum.

Sorry to hear you are having a hard time at such a young age, but there is hope for you.

I am a lot older than you (64) but was diagnosed with a Mobitz Type II just over 11 months ago and fitted with a pacemaker which has changed my life completely.

I could feel my heart missing beats and had the following symptoms - chronic fatigue and muscle weakness; breathlessness; light headedness; pre-syncope; and syncope. I collapsed while loading shopping into the back of my car and woke up with blood running down the back of my head. The paramedic spotted my abnormal ECG and they took me to hospital, where the PM was implanted. The effect of the pacemaker was immediate and it continues to get better day by day.

I am surprised that your consultant and GP do not seem concerned about your Mobitz type II as it is quite serious, and there are risks of syncope and sudden cardiac death. I think that sudden death is very rare, but you don't want to have syncope whilst driving or crossing the road.

Like you, I am concerned about progression to stage 3 block, but with my pacemaker, the remedy is already in place.

Having a pacemaker fitted must be a very difficult decision for you to make at your age, so I urge you to have a talk with a professional. The BHF nurses have an excellent reputation, and they will give you good advice. If you can get an appointment with your consultant, a discussion with him/her would help. Alternatively, your local cardiology department may have a pacemaker clinic that you could contact for advice.

Best Wishes.

[Ruaraidh in reply to EMBoy]

I am so grateful for your lengthy comment, thank you. I hope you are well and your condition is stable. Very happy the pacemaker has made a positive impact on your wellbeing.

I thankfully am completely unsymptomatic, and echo confirms absence of any structural cardiomyopathy (had good bloods also).

Do you know if the risk of sudden cardiac death exists for Mobitz ii alone or is this risk due to the capacity for Mob ii to progress to third degree/complete block?

If a pacemaker is required I am not nearly as concerned thanks to your reassurance thanks again and if you have any more reassurance handy I am all ears!!

[EMBoy in reply to Ruaraidh]

Thanks for your reply. Apart from a mild aortic regurgitation, my echo was also normal as were my bloods.

At my age, sports are out of the question, but I live an active and productive lifestyle, thanks to my pacemaker.

If you need to go down the pacemaker route, you won't regret it. There are people with pacemakers who run marathons or play other sports and live normal lives.

I wish you the best, whichever way you choose to go.

[Ruaraidh in reply to EMBoy]

Thank you so much, all the best

[Grst in reply to Ruaraidh]

This is misinformation. There are two types of Mobitz II. Wenckebach and Hay. Only one of them is serious and requires treatment (the Hay kind).