Heart Rhythm Conditions – Welcome to the group

@pamandgreg Whoops, I don't know what I was thinking. Yes, the official report says you DO have bradycardia. I'm happy you caught that...and are paying attention more than I. (Where's that red-faced coughing emoji?) 😀

Bradycardia is officially any sustained HR measured that has a rate under 60 BPM. Many cardiologists think that number should be revised downward at least five points. This is because of the 'fitness generation' and their penchant for racket sports, running, cycling, etc where their fit hearts routinely are running below 50 BPM, often below 40...!!! And they're perfectly fine, no syncope or shortness of breath. What is not evident in the information you provided is how low, how long. And did you, during the measuring interval, feel any symptoms that could reasonably be attributed to 'bradycardia' when your monitor recorded the lowest heart rates? Does your heart respond readily to increase demand, such as rising to your feet from a seat and maybe climbing stairs to a bedroom? These are important questions that could mean your official 'bradycardia' is really of no consequence. But............if you have a history of stumbling, fainting, wheezing and feeling unwell, swollen ankles, etc...these could be signs of an HR that is simply too slow for your needs. And you have just posted that you do indeed have some minor episodes of shortness of breath. This could be ectopy or valvular function/deterioration problems.

chickenfarmer has lots of experience and learning under his/her belt, so do have a careful read, please.

I am sorry I misread your earlier statement. Sin in haste, repent at leisure.

Gloaming, Good info. I'll add mine to the mix. In 2024 I was racked by PACs - as many as 8 in a 30 sec smartwatch trace, which I calculate to be above 26% for my 60 bpm rate. The symptoms were there; I called them AF Lite. (I use AF as i've had diagnoses of both Aflutter and Afib). I was post ablation by 6 years. My AF is paroxysmal with infrequent AF occurrences however during the high PAC episode, I noted more AF sessions. I searched Dr Google which led to articles similar to those you cite although the Japanese study seems in more detail. I recall two points from the article search: 1. Frequent PACs are a precursor to Afib and 2. Best treatment is ablation. After presenting my traces to Ep he offered another ablation or a med - deflectilide, which I understand works like a chemical ablation. i was at the time experimenting with thyroid hormone levels with some success, so I deferred on his suggestions. Since, I have been successful with adjusting the levothyroxine level - the PACs and AF episodes have ceased. https://pmc.ncbi.nlm.nih.gov/articles/PMC2680813/
I'm an engineer with no medical training but here's what i would do if I were Greg, in conjuction with my EP:
1. Chase the hyperthyroid possibility. With a lot of PACs I had low TSH(hyperthyroidism); after adjusting my TSH to around 5, which is upper limit of normal range, the PACs and AF episodes stopped.
2. If thyroid isn't it then consider an ablation. THe reason I suggest that is I've read and heard from EPs that AF gets worse with age if left untreated. My ablation was cryo; I understand the pulsed field technology now available is safer and just as effective or maybe even more so as EP has less concern about damaging adjacent heart tissue or esophagus.

Thank you for your insight and quick response. I do have one point that I don't understand; you said that the "results do say no bradycardia, evening with that one low reading"

That is how the results were communicated to me from my Cardiologist.

NSR 61.79% - meaning I was in "normal sinus rhythm" 61.79% of the time while wearing the heart monitor (1 month).

SBrady 33.40% - meaning my heart rate was below the target rate of 60bpm for 33.40% of the time during that same month time frame.

SVE 4.80% - meaning, I assume, that my heart was pausing as you described 4.8% of the time during the month.

I have experienced the pausing with both high and low heart rates but the occasions when my heart is slow tends to result in some degree of shortness of breath.

@pamandgreg First, I am NOT an expert in this...no training. None. However, I believe that SVE stands for 'supraventricular ectopy', meaning.....probably.....PACs, or premature atrial complexes. You get a pause, then a catch-up beat that is especially powerful and feels like a surge or a thump in the chest.

Those results do say no bradycardia, even with that one low reading. It depends on what you reported was going on at the time. When they read the data, they also try to match any recorded events of note. If you were asleep, or seated, slouched, relaxed, hadn't eaten in three hours or had a coffee or a soda with caffeine....a reading of 36 for a fit heart is not out of the ordinary. My HR would often fall to 38 after bounding up two flights of stairs to a washroom. Climb, sit on the john, waited 30 seconds or more, then took my pulse. 38. I call that a great recovery, not bradycardia. And when physicians took my pulse for some reason, they'd raise an eyebrow and ask, 'Are you a runner?'

Your 'burden' of SVE, if it is PACs, is not dangerous. Everyone has them, some more than others, and for some, who find them rising in both number and frequency, it often means a slow slide toward atrial fibrillation. I hasten to add that the burden can rise to a point where it becomes consequential if not treated, and this is where an electrophysiologist would want to take a look at your heart. Mostly, it is what you tell that person...how you sense the events, how they make you feel, and how much you'd really prefer to be rid of them, or at least to have their number strictly controlled. IOW, your symptoms matter....a lot. To most patients, THAT....is the real burden...not how many ectopic beats you get in a 24 hr period, which is how they decide when your burden is getting onerous.
https://biologyinsights.com/what-pac-burden-percentage-means-for-your-heart-health/
https://www.jstage.jst.go.jp/article/circj/85/8/85_CJ-20-1277/_pdf/-char/en

Hello,

I am a 63 year old white male whose Father had many heart related issues. I stay fairly active despite my age but have been experiencing more frequent periods of low pulse rate with usually "pausing" every 10 beats or so. Accompanied with those periods my breathing is more labored. Yesterday I had a nuclear stress test and was told I had no blockages. However prior to the stress test I wore a heart monitor for one month. I have attached the results from the monitoring below:

FINDINGS: 30 DAY EM (24 days) 12/18/2025-1/17/2026 AVG HR 61, MIN HR 36, MAX HR 143 NSR 61.79% SBrady 33.40% SVE 4.80% VE 0.01% Pause/Block < 0.01% 7 pt triggered events-no symptoms associated with Bradycardia NO AFib Minimal Ventricular ectopy SVT longest 12 beat sequence; fastest @213bpm 9 beat sequence both in the afternoon No new meds and no additional meds.

I understand that 33.4% of the time my heart was beating at less than 60 bpm. But I am not extremely clear on the SVE for 4.8% of the time. Is this the actual "pausing" I'm experiencing? If so what causes it and what if anything can be done to minimize / correct to the problem, and do these results WARRANT anything being done. I do exercise, (treadmill), pretty frequently so the max HR of 143 is understandable. Also are the 2 episodes of SVT of concern? I do not see my cardiologist until late May.

I appreciate any insight.

Sincerely,
Greg

@robbarts THere is significant correlation between sleep apnea and AF. If you haven't been tested I recommned that you have sleep test. I found a pulse oximeter that would record continuously during sleep and the resultant traces were quite intersting. everytime I hade a breathing spell my heart rate became erratic. UNfortunately the traces were only rate and not rhythm. My EP said that the results of the sleep study which showed mild apnea when I slept on my back was not significant enough to be the source of my AF episodes. I now sleep on my side and no more issues. My wife is also happier because I don't snore.
My EP took me off Elliquis after the ablation. There have been some recent studies which show that anticoagulats aren't needed for those post ablation. Not sure of your situation but recommend you read the studies OCEAN, ALONE-AF and ARTESIA and discuss with your EP.

@robbarts Along with problems the aged have sleeping, our aged minds are surprisingly active often thinking of problems that we would like to solve. I find myself instantly active mentally as soon as I awaken to turn over or to free my arm or hand and get blood circulating again if I have sagged over it and put it 'to sleep.' But most of us manage to dream if we sleep for more than 100 minutes solid. The REM cycle happens roughly every 90 minutes or so, and sometimes the dream will raise cortisol levels, adrenalin, raise the heartbeat, raise the body's temperature...all cues that also happen, or were meant to, about 0600 when so many of us naturally awaken.

If you have a health app on your phone, and your wearable device is Bluetoothed to it, that app will tell you, in all likelihood, what the duration and quality of your sleep was the previous night. This is true for Apple and Android Galaxy watch wearers. There would be a graphic depiction of timeline with columns showing the stages of sleep and their total and relative percentages of the total time slept. If you have an SPO2 analytic, like my Galaxy watch has, it will be easy to correlate the times depicted when you were in REM sleep cycle and when your SPO2 and heart rate changed commensurately. In my case, my HR spikes when I am in REM, a surefire indicator that I am dreaming and something is making my sympathetic nervous system spike...including spiking adrenaline production. As you may already know, beta-adrenergic receptors are what sometimes trigger arrhythmias, and it is the drug like metoprolol that is meant to suppress that response if/when the heart commences to fibrillate.

So, AF can be triggered by adrenaline, and adrenaline is an sympathetic nervous system's response to whatever visualizations your sleeping brain conjures up.

But, there are other possible stimuli for AF. Acid reflux or GERD can set it off. Some people have the unfortunate habit of eating late, sometimes an hour or more before bed, but too soon. Before their stomachs have digested and begun to clear the contents, the person reposes and falls asleep. But, while they are relaxed, and prone or supine, or on their right side (duodenum facing downward), their pyloric valve has relaxed, or never closed completely, and it leaks acidic contents into the esophagus. You may not awaken, but your esophagus begins to scream. You can figure out the rest.

Hi. I discovered that I have nighttime afib episodes about a year ago. I have a fitbit watch that was alerting me to afib happening at night while I am asleep. It always happens at night when I'm sleeping and I am not aware of it. It only happens once a month and lasts a few hours. My cardiologist put me on a monitor which was able to record one of the episodes.
He then put me on Eliquis 5 milligrams twice a day. I've been on that for a year and have recently switched to 2.5 milligrams twice a day because of my age at 78 and the bleeding risk. Has anyone else had to do that?
I still am not sure what triggers it although I believe sometimes it's from anxiety or difficulty sleeping at night.

@martinzerr
Hello
I'm 76; former sufferer of Afib which lasted 10-12 hours, and led to passing out. Had a pacemaker, which I don't believe was the solution--the ablation was, that I had done at a local University Health center. I don't take any prescription drugs; got off Eliquis; and quit any alcohol, which is a main trigger for Afib. I use an iPhone with program to my Cardiologist, and iWatch to monitor my heart beat. Highly recommended.

@martinzerr Thanks