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Athlete, skipped beat sensation. Holter monitor showed second degree mobitz type 2. Should I consult cardiologists?

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I am young healthy 25 yr old male pretty athletic build. I play soccer once a week sometimes more, work out and lift weights 2-3 x a week. My resting heart rate is usually 50. I'm a it professional and sit many hours at the computer daily. I recently went to my doctor as I was having skipped beat sensation.(pvcs). Particularly worse after eating or laying down for bed and they seem to have gotten worse over the years. So my doc put me on 24/hr holter monitor last Thursday 4/12. I just spoke with him yesterday with my results. He said my heart looked really good despite occasional pvcs, however, there was one episode of second degree mobitz type 2 (not type 1) and my heart rate was also in low 30s at one point. He said I should go see a cardiologist to make sure everything is ok. Well of course, with technology these days I researched the crap out mobitz 2 and I'm pretty scared now. I scheduled a visit to see a cardio this coming week.

I have a few questions:
1. If it truly is mobitz 2 shouldn't the doctors be more worried and get me in faster to see a cardiologist??
2. Is it possible the mobitz 2 was a misreading? They thought at first it was a mobitz 1..
3. Is it possible that medication such as a PPI/pantoprazole causes my extremely low heart rate and the mobitz 2? I say this because I always have bad heart palps and irregular heart beats when I take ANY PPIs for GERD and when I stop taking them the palp severity is gone instantly. I made sure to take one the day of the holter test.
4. I'm afraid something bad is going to happen to me before they actually find out anything...

Please help. Thank you.
Posted Sun, 12 May 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 1 hour later

Thanks for writing to XXXXXXX

1. Yes, you are correct to some extent that if it is truly a mobitz type II AV block, then we should be more concerned; as it indicates a serious disease of conduction system which needs to be tackled with urgency.

2. It is very much possible that it is a mis-reading. Literature has a lot of examples where there were misdiagnosis of type II mobitz block in young athletes who were otherwise asymptomatic.

3. A PPI/pantoprazole producing a Mobitz type II block is not known. VPCs induced by this drug is not a known phenomenon, although none can deny it in a given patient. More likely possibility is that they are associated with your anxiousness related to upset stomach or you are noticing them more at that time.

4. Relax and do not panic; literature supports you. Mobitz type I block is well known in athletes and there are some controversies regarding mobitz type II block.

In summary, I would recommend you to get your Holter reviewed by a cardiologist/electrophysiologist and seek his opinion on priority.

Feel free to communicate further.

sukhvinder XXXXXXX
Above answer was peer-reviewed by
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