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
Written by
Ruaraidh
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I had a pacemaker fitted for Mobitz Type ii heart block just over a year ago. I should say first that I am much older than you (65), and I think my unpredictable heart rate (mising beats, changes in rhythm) was probably worse than yours, as these things could occur at any time of day and were noticeable more often than not (i.e. not just occasional).
One thing that may be reassuring from your point of view is that this wasn't seen as very urgent by the NHS - after the pacemaker being recommended, I waited six months before it was fitted. I had the impression the specialist thought the greatest danger was that the condition might worsen so that I passed out while driving, but he must have thought this wasn't imminent as he didn't advise me not to drive. It was never suggested that there was a danger of death - from what I've read online there's a further stage of heart block, at which point there's more reason to worry. (I know that there are websites which make Mobitz Type ii sound more alarming than this).
I did have slight light-headedness before the pacemaker was fitted, and have felt better since then. Perhaps your specialist and GP feel your condition hasn't progressed far enough to justify a pacemaker, it might put your mind at rest to ask them. It may be that the condition can be unproblematic for many years - one of the pacemaker monitoring staff told me that I am one of their younger patients!
Please let me know if there's anything you would like to ask,
Tim, I’m so grateful for your comment and reassurance. I agree it is described as quite sinister online but unlike other arrhythmias there’s not much available to find out why. Wish there were more resources on it so I could better understand the implications of Mob ii.
I’m under no illusions, i am very lucky and obviously comparatively healthy and well but have a propensity for anxiety, so I hope your condition is stable and you are in good health.
Twenty some years ago I presented to the ER with a heart rate that would speed up and then slow down into the 30’s. The EKG showed a Mobitz II block and I was referred to an Electrophysiologist. My block would come and go and then just disappeared altogether. I was on beta blockers at the time and it was attributed to the meds. Fast forward several years and once again I had the same symptoms, landed in the hospital same diagnosis but with Inappropriate Tachycardia thrown in. Once again after several days my heart rate returned to normal and that was that. The electrophysiologist just said if it happens again call me.
Other than some PACs/PVCs and the tachycardia the low rate didn’t come back- that is until 2007. I had another “attack” and this time the symptoms were much more pronounced. To the hospital yet again but this time my block was diagnosed as a 2nd Degree AV Block. I was living in a different state at this time and the electrophysiologist felt I should have a pacemaker placed because of the risk that I could now progress to a 3rd Degree (complete) heartblock. My heart was still intermittently in and out of the 2nd degree block, but because I was so symptomatic this last time I had the pacemaker placed.
So, I guess the fact is your type of block could progress as mine did, but I have also heard that for some people it does not. The Mobitz II type heart block as I understand it is NOT life threatening. It’s only when it progresses as mine did over the years that the risk of a complete block could threaten your life: passing out while driving, falls, etc. If you haven’t seen an electrophysiologist, May I suggest that you do. Wishing you good health!
P.S. I am 67 years old and this all started when I was in my early 40’s.
Thank you so much for your kind and lengthy comment, I am hugely appreciative and very reassured to hear that by your understanding it isn’t in-and-of-itself considered to be life threatening.
Please if you have any other reassuring anecdotes I’m all ears lol.
I will definitely seek to contact an electrophysiologist, thank you. I hope your condition is stable and you are well
At 77 years old I noticed arrhythmia fairly constantly, 24 hour holter indicated Second Degree Type 2 heart block. They fitted a pacemaker within a fortnight. I thought this was life saving stuff, just Google heart block and you see what I mean. But as the surgeon was fitting the pacemaker he said: "We're only fitting this as a precaution, if you were 25 we wouldn't bother". And I have sinus node disease too. So what do you believe? It certainly confirms the heart is the strongest muscle in the body. I have two Pulse Oxymeters that show heart beats, one often drops to 27bpm for a few seconds, then I presume the pm kicks in and sends it back to normal. On the other Pulse Oxymeter these temporary drops in bpm don't show up, just stays constantly at normal. Strange. Explain it we can not.
Hi Ruaraidh, I am new to this forum so just reading your question now. Please may I ask how you are getting on? I was diagnosed with mobitz ll a couple of years ago but I was rushed in for a pacemaker op the same week, reason being my dropped bests were lasting over 4 seconds which could cause fainting. I never had. I didn’t have any symptoms except a high heart rate. I hope you’re doing much better, esp with the anxiety
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