Pacemaker

[MonteCristo]

Hi,

After reading the thread entitled "Ectopic Heartbeats" and not wanting to take over the thread I decided to post the question here.

Four weeks ago I was fitted with a pacemaker after having 3 unsuccessful cardiac ablations for episodes of tachycardia that I would experience only when exercising. I now have complete heart block (complete block the electrical conduction between atrium and ventricle), this could have been doctor error during the second ablation but there is no way to prove that.

I am a Cat 2 cyclist and have raced on teams in Italy and Spain and I would like to continue to train and compete but I don't know if it's really a possibility. Does anyone have or know of anyone with a pacemaker? How has it affected their cycling and training? Is it possible that I can work with a coach or will they now see me as "damaged and too frail" to take me on as a client for fear of "hurting me"?

It is interesting what one poster said in the other thread about 5 - 10% of trained athletes will develop an irregularity whereas in the general population it's about 1% (not quoted exactly).

Thanks everyone.

 

[Matt P.]

Hello,

I work for one of the main manufacturers of pacemakers and implantable cardioverter defibrillators, and work with pacemaker patients everyday. While it's not common to have pacemaker patients who are elite athletes, it's not unheard of (most pacer patients tend to be old with different indications than yours). You didn't specify what kind of tachyarrhythmia you had, but judging from the fact that they ablated your AV node (resulting in the complete heart block) and you now have a pacemaker, not a defibrillator, it's probably an SVT (supraventricular i.e. "above the ventricles") or atrial arrhythmia. Generally, they may try to ablate the pathway in the atrium that causes this arrhythmia, but since that didn't work, they ablated the pathway down to the ventricles to eliminate risk of high ventricular response, resulting in your new "pacemaker dependence."

The pacemaker is very advanced - the ventricular channel will "track the atrium." In other words, if your heart rate is naturally going 120 bpm (originating from the sinus node in the atrium), the pacemaker will sense this activity in the atrium and pace your ventricles at the same rate after a programmed AV delay (usually between 120-250 ms). If your atrium goes into an arrhythmia (i.e. the atrium is going above a programmed rate, nominally around 175 bpm), the device will "mode switch," meaning it no longer "tracks" the atrium. It is then in a non-tracking mode where it depends on an accelerometer sensor to determine the rate to pace the ventricles (i.e. if it detects a lot of motion, it will pace your heart faster than if you were at rest). Therefore, you can still participate in sport. However, given your unique condition as an elite athlete, the device will probably need a lot of special programming to be done, which is by no means undoable; just may require a bit of patience on your part as the tweaking is done. One thing to bear in mind is that your cardiac output may go down a little bit since the pacemaker initiates the ventricle's depolarization differently than the normal conduction pathway, resulting in slight dyssynchrony between the right and left ventricles. Also, if you're experiencing regular atrial arrhythmias during exercise, you won't be getting the normal atrial kick during ventricular filling, which may also decrease your cardiac output by about 20-30% (cardiac output = Stroke Volume (liters/Beat) x Heart rate (Beats/minute) = liters/minute)

As far as working with a coach, it's definitely something to speak with your doctor about, but I'd imagine as long as you get your doctor's approval you shouldn't have any trouble securing a coach's services. Hope this helps; let me know if you have any more pacemaker-related questions!

-Matt

 

[amyconnor]

In Netherlands several runners with pacemaker devices participated in a several-month long training exercise that involved running for up to 2000 km. A professional coach, several cardiologists and a technician — all with running experience — conducted this exercise along with constant medical checkups during the training. They used commercial HR monitors to assess runners heart rates in three stages: rest, during exercise and long-distance running. Sensing and pacing functions of the pacemaker system were tested during training sessions as well as during the race. They also used ChampionChip and the Polar RS800 heart rate monitor for possible interference with the pacemaker. This training was to prepare guys for either a full or a half marathon. All runners successfully completed half or full marathon without problems. It looks that long-distance running is safe for athletes with pacemaker implants. Now, if one mile of running equals four miles of cycling, you are pretty safe, however, monitoring the device and your hart during circling seems to me good idea. Just to be safe.
As of "about 5 - 10% of trained athletes will develop an irregularity" you are correct. Unfortunately athletes do develop heart problems mostly athletic bradycardia (heart enlargement) and tachycardia. They are not really life threatening conditions, but still I would be cautious. You never know!

 

[MonteCristo]

Hi Matt,

Thanks for the reply, I'm sorry I didn't get back sooner, I had forgotten that I posted here.

I was told I have/had 'low atrial tachycardia' (I am translating it from Spanish and it's not my native language, I have never heard of this tachycardia), but now I am experiencing some other things when I try to ride or exercise but I beleive it's due in part to some of the settings. I have the Rate Response and Accelerometer turned on and I don't think I need them. My doctor said that my sinus node is OK, not great and not bad so I can't see why I would need them turned on. Whenever I move I can feel my heart rate increase disproportionately so that when I ride I get close to upper limit of 150 really easy and without the corresponding effort. Now I am starting to experience some flutter or what feels like tachycardia (I hope it's not) when I ride.

Since the upper rate is programmed to 150 does that mean when the atrium goes above that the pacemaker percieves that as and arrhythmia and starts to pace it back down? Also the upper sensing rate is set to 160, what is it?

Unfortunately my doctor is very conservative and he doesn't really understand the needs of an athlete (he had the upper rate set to 130 and believed that to be fine for me, as a competitive cyclist what can you do with a max rate of 130?) He is the only one down here in Costa Rica so I can't really go to someone else, so I am heading to New York to talk to some other doctors. Any advice or questions that I should ask? As you said I may need some special programming and I wan to find someone that has this knowledge.

If you'd like some more info send me a private message and I will give you my email address.

Thanks.

 

[180mmCrank]

Wow what fantastic answers - I am blown away. I am psyched that the forum has allowed this kind of exchange. Wow

 

[MonteCristo]

Wow what fantastic answers - I am blown away. I am psyched that the forum has allowed this kind of exchange. Wow

Mmmmm...what do you mean?? Do you mean the lack of complete negativity, inuendo, and insinuation?

 

[180mmCrank]

Mmmmm...what do you mean?? Do you mean the lack of complete negativity, inuendo, and insinuation?

Yes - and the fact that i think this thread might have really made a difference for someone - that's kind of cool I think.

 

[RichmondP]

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[fatandfast]

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[GailBibeau]

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[David 007]

OK at 75 coming up I can hardly descibe myself as an elite athlete but I did ride the event called Classic Cols three weeks ago which is 6 of the big Tour de France climbs in 3 days (includes La Madeleine, Telegraph, Galibier and Alpe D'Huez.) I do something like this every year, still ride a few timetrials and play league table tennis. I have had a pacemaker for borderline AV Block since 2004. My cardilogist told me that if I had it fitted I would get no more symptoms (I had been getting dizzy spells) and he was right. The only problem I have had was on one of the checks the technician set it wrongly and it was pacing when it did not need to. That felt weird.
The interesting thing is that at 75 my theoretical maximun heart rate would be calculated to be 145. I am now using the Garmin Edge with the heart rate monotor and interestingly when I am working out (usually on a 60 mile loop which has 910M of climbing) it goes up to 140 immediately as I live at the bottom of a hill and my average over the 60 miles is around 135. What I am not sure about is, is it the pacemaker that is doing the work or my heart? It never goes above the 140, which suggests that my heart will not go that high so the paker is doing the work? it hits it and stays there unless I am going down hill. The point for our Elite Cyclist is, Pacemakers are definitely OK!