Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your uploaded Holter report and would like to explain that you should relax!

It is true that some ectopic complexes (extrasystoles) are present, but coming to real numbers;

- there are only 11 ventricular ectopic complexes (PVCs), which is quite an insignificant number without any clinical relevance,

- 166 supraventricular ectopic complexes, which are a small number.

Even though 4 supraventricular runs are present, they could not be considered dangerous or life-threatening (the majority of supraventricular arrhythmic event are not life-threatening and could be considered benign).

It is necessary to carefully investigate the nature of these supraventricular runs; the contrast with the surrounding rhythm and rate (before and after arrhythmia termination); whether they have produced clinical symptoms; the underlying setting (whether you have been on any physical or psychological stress), etc.

- Wenckenbach episode (type I second degree AV block) is reported as present; but no specific data on its frequency, time of occurrence, associated rhythm background, etc. is referred.

It is very important to differentiate Wenckenbach form other arrhythmic events, such as a blocked premature atrial contraction, etc.

Wenckenbach phenomenon doesn't appear to be dangerous or life threatening and doesn't deserve any specific treatment.

So, coming to this point, to make it clear and short for you, I could conclude that nothing dangerous or ominous seems to be revealed from your Holter report.

Just some infrequent arrhythmic and conductance disturbances that need to be further investigated.

Some additional tests are recommended:

- cardiac ultrasound,
- complete blood count,
- blood electrolytes level,
- thyroid hormones level,
- fasting blood glucose,

Also, it is recommend to review your recent history of any drugs prescription, level of anxiety, and what is more important your actual clinical symptomatology (complaints).

You need to discuss with your doctor (cardiologist) on the above mentioned issues at the time of your appointment, as nothing seems to be urgent.

Hope to have relieved some of your uncertainties!

Anyway, if you have any further questions, feel free to ask me again.

Kind regards,

Dr. Iliri

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Brief Answer:
Opinion as follows:

Detailed Answer:
Dear BAYLEY,

I would explain you that with that small number of ectopic complexes (supraventricular and ventricular), an EP study doesn't seem to be indicated at first.

But, if those supraventricular runs becomes frequent and are well delineated (involvement of an accessory pathway, a macro-circuit inside atria, or arrhythmogenic focus suspected), then EP study could be helpful.

Also, if Wenckenbach episodes are real and probably associated with higher degrees of AV block, a suspicion of a hidden sick sinus syndrome could be raised. In such case, if your episodes of fainting are confirmed to be related to AV blocks, then pacemaker implantation would be a rationale option.

On my opinion, I would rely on further (and more prolonged) heart rhythm monitoring (probably a loop recorder, event recorder) to properly being able to discriminate the reason of your clinical symptoms.

Besides the above recommended tests, an exercise cardiac stress test would be helpful in providing additional information on heart rhythm and rate behavior.

I remain at your disposal in case you need a second professional opinion about eventually performed tests.

Kind regards,

Dr. Iliri

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