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

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 long 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, but the longer they are the worse it feels. I have managed to catch a few with Kardia and ECG watch but, obviously, they're not all the same so I can't always catch the really long ones but I know when they 'feel' longer.

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.

We're dealing with the same kind of discomfort with ectopics. They usually come for me at rest and, as you wrote, the sensation is like being kicked in the chest. Awful.
FWIK, the most usual "compensatory pause" keeps the HR as it is. I mean that, on a tracing, the normal beats could be superposed, the ectopics in between don't change their place on the line. At rest, our HR slows down, so the pauses between the beats are longer and, therefore, those after an ectopic are longer too. The beats in our chest are felt loudly while laying down too. I'm often believing my wife can feel my bumps through the mattress...
I know there are other kinds of "compensatory pauses" than the "regular" type, but I'm no expert. You might have other issues too, and a good EKG tracing would help, of course.
There are better posters than me here to help you.
Wish you the best.

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Pompon
We're dealing with the same kind of discomfort with ectopics. They usually come for me at rest and, as you wrote, the sensation is like being kicked in the chest. Awful.
FWIK, the most usual "compensatory pause" keeps the HR as it is. I mean that, on a tracing, the normal beats could be superposed, the ectopics in between don't change their place on the line. At rest, our HR slows down, so the pauses between the beats are longer and, therefore, those after an ectopic are longer too. The beats in our chest are felt loudly while laying down too. I'm often believing my wife can feel my bumps through the mattress...
I know there are other kinds of "compensatory pauses" than the "regular" type, but I'm no expert. You might have other issues too, and a good EKG tracing would help, of course.
There are better posters than me here to help you.
Wish you the best.

Thanks for your reply Pompon, and yes, yours are sounding very similar to mine. I feel as if I can almost 'feel' them through the mattress myself, along with in my ears, stomach and neck!

I'm not entirely sure what type of 'compensatory pauses' these would class as but just uploading an ECG I took with my smart watch last night. This shows 5 boxes, which I believe is 1 second. But I've recorded a few recently (just trying to find them at the moment) that have been 1.4-1.6 which leads to an even more violent 'kick' after that 'pause'.

I've read that 3 seconds is a limit, after which those 'pauses' are believed to be a concern. So obviously, I wouldn't fall into that category at the moment, but I'm noticing bigger and bigger pauses on ECGs I'm recording, going back about 18 months. The ectopics are definitely becoming more of an issue. I think I'm about 4 years out from my ablation now.

The pause in your recording is due to the PVC that precedes it. A pause is normal following a PVC because PVCs are kind of like reboots of the heart. Your ventricles have to recharge before they can contract again, so you end up "skipping" a beat. That's the flat stretch between the red lines in your recording.

Under 3 seconds is nothing to worry about and you're well under that. Over 3 is time for investigation, but there's still probably nothing to worry about unless it's causing you to pass out or feel like you're going to. At 6 seconds it's definitely time for a pacemaker.

So they may be unnerving but yours should be harmless.

Amplifying what Carey says, your normal beats are about 4.5 large boxes apart. The space between the "good" beat prior to the PVC and the next "good" beat is 9 boxes, which is the normal space/time for regular beats.

My Polar heart rate monitor does not "see" PVC beats, so you can identify a PVC as a beat that takes twice as long (or reported as half as fast) as a regular beat. You can also have this compensatory pause after a PAC.



source: p 12 [www.afibbers.org]

It's clearer with good explanations (and tracings) !


I'm often experiencing PACs in bigeminal pattern.
The sensation is that of a bradycardia with strong beats. I barely feel the PACs themselves, except while sitting or laying down.

Usually, I lay down still, my HR drops to 60 BPM, then bigeminal PACs show up. Strangely, the displayed or felt HR does not drop around 30 BPM, but at 37~40 BPM.
Is it some automation in the sinus node to compensate with a slight elevation in SR ? I don't know...

I turn on the other side in my bed, and the PACs disappear for a short while, then they come back, then they may disappear...

AFAIK, those "regular" ectopics are not dangerous, but they are really awful. They never turn to afib, in my case, but runs of ectopics often do.

The bad thing with those "benign" ectopics is that they lead to bad sleep; and bad sleep is not what we need.



Edited 1 time(s). Last edit at 02/19/2021 06:36AM by Pompon.

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Carey
The pause in your recording is due to the PVC that precedes it. A pause is normal following a PVC because PVCs are kind of like reboots of the heart. Your ventricles have to recharge before they can contract again, so you end up "skipping" a beat. That's the flat stretch between the red lines in your recording.

Under 3 seconds is nothing to worry about and you're well under that. Over 3 is time for investigation, but there's still probably nothing to worry about unless it's causing you to pass out or feel like you're going to. At 6 seconds it's definitely time for a pacemaker.

So they may be unnerving but yours should be harmless.

Thanks Carey, much appreciated

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GeorgeN
Amplifying what Carey says, your normal beats are about 4.5 large boxes apart. The space between the "good" beat prior to the PVC and the next "good" beat is 9 boxes, which is the normal space/time for regular beats.

My Polar heart rate monitor does not "see" PVC beats, so you can identify a PVC as a beat that takes twice as long (or reported as half as fast) as a regular beat. You can also have this compensatory pause after a PAC.

[i.ibb.co]

source: p 12 [www.afibbers.org]

Yeah, that makes sense George, thanks for your input. Your tracing looks much more detailed than mine as well!

I mean, while I do appreciate that what I'm experiencing are generally harmless from a medical standpoint, they're still hugely unnerving to experience at the time.

Exactly, those ectopics might be considered harmless but they almost always lead to terrible sleep and, thus, probably more/worse ectopics the next day. I'm pretty much up with a headache most mornings now, which I'm guessing is at least in part, due to the bad sleep the ectopics create.

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DavrosT
Thanks for your reply Pompon, and yes, yours are sounding very similar to mine. I feel as if I can almost 'feel' them through the mattress myself, along with in my ears, stomach and neck!

I'm not entirely sure what type of 'compensatory pauses' these would class as but just uploading an ECG I took with my smart watch last night. This shows 5 boxes, which I believe is 1 second. But I've recorded a few recently (just trying to find them at the moment) that have been 1.4-1.6 which leads to an even more violent 'kick' after that 'pause'.

Don't know if this matches what you feel, but I recall (originally looked at this ~15 years ago) that a PVC may not eject as much blood as a regular beat. So on the beat following the pause, the ventricles are overfilled. Then when the beat happens, it feels like a "hard" beat.

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GeorgeN

Thanks for your reply Pompon, and yes, yours are sounding very similar to mine. I feel as if I can almost 'feel' them through the mattress myself, along with in my ears, stomach and neck!

I'm not entirely sure what type of 'compensatory pauses' these would class as but just uploading an ECG I took with my smart watch last night. This shows 5 boxes, which I believe is 1 second. But I've recorded a few recently (just trying to find them at the moment) that have been 1.4-1.6 which leads to an even more violent 'kick' after that 'pause'.


Don't know if this matches what you feel, but I recall (originally looked at this ~15 years ago) that a PVC may not eject as much blood as a regular beat. So on the beat following the pause, the ventricles are overfilled. Then when the beat happens, it feels like a "hard" beat.

That may well be it! The beat following the pause feels extra hard, quite violent at times so that may well be it. Makes total sense, really I guess. May look into that a bit too. I think understanding the process better often helps to make it less scary, so thanks again for that.

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DavrosT
That may well be it! The beat following the pause feels extra hard, quite violent at times so that may well be it. Makes total sense, really I guess. May look into that a bit too. I think understanding the process better often helps to make it less scary, so thanks again for that.

My other recollection is that a PVC often feels like a "skipped" beat in the radial pulse, for the same reason. The PVC beat doesn't eject much, so you don't feel it in the radial pulse, only the "hard" follow on beat.

After my first ablation I had lots of PVCs. They were like GeorgeN has described. I had PVCs in bigeminal pattern but I didn't know I had. It was just like bradycardia at 40BPM. The beats were really loud with a nauseous sensation in my chest.
My cardiologist gave me a handheld EKG monitor for a week, and then she learnt me they were PVCs.

Now I have some PVCs, but nothing like I had back then. It's mostly PACs. And I can feel them. There's the loud beat and the little one just after. It's clear. Even a small cheap oxymeter can display them. It can't display PVCs.

pacs, pvcs, abcs, xyzs,eieios.

PeggyM

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peggyM
pacs, pvcs, abcs, xyzs,eieios.

PeggyM

Oki dokie. Thanks?

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peggyM
Pacs, pvcs, abcs, xyzs, ee eye ee eye oh.

Hi Peggy. Good to see a post from you!! How are things in Skowhegan?

Hi Peggy! I miss your paleo recipes you posted and “the list”. How can we retrieve the list? You should post all in a document or link for all the new readers and us as well.

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susan.d
Hi Peggy! I miss your paleo recipes you posted and “the list”. How can we retrieve the list? You should post all in a document or link for all the new readers and us as well.

Here you go, Susan, The LIst compilation: [www.afibbers.org]



Edited 1 time(s). Last edit at 02/21/2021 10:30PM by GeorgeN.

Thanks George!!! :-)
I forgot I had contributed on page 98



Edited 1 time(s). Last edit at 02/22/2021 02:18AM by susan.d.