Athlete Heart Syndrome - Pacemaker Limitations??

I am as 72 year old accomplished USCF Mastersd cyclists with many medals. In my 50's I trained 350 MPW - now down to 200+. I developed all the symptoms of "Athlete Heart Syndrome". Rest heart:32, sinus pauses 2-3 secs., one at 5.8, syncope, AF. Cardiologist recommended pacemaker. Set at low trigger of 45. Since its installation I get the sensation of muscular myopathy and don't seem to be able to perform at my expected level. I used HRMs for years for HR based training and the Conconi test to define work range.

12 Comments

350 MPW?

by TLR - 2012-03-07 03:03:41

Wow, fair play. I am just getting back into cycling and doing about 120-150, ok so a lot of that is off road on a MTB, but 350 is (or was) awesome.

Can't comment on the settings, haven't got a clue as I don't get into all the settings and stuff, but if you're down to 200 then something is wrong. I appreciate there will never be the same heart performance as pre-device but that is quite a difference.

Good luck.

You too, Eh ?

by Tattoo Man - 2012-03-07 03:03:41

Hi BB, this topic comes up so often. So many sportspeople report a drop off in performance after they get a PM. For some its a question of programming and have found that they need to be pretty insistent, indeed a bit of a pain in the *** to get the attention that they need.
For myself I beleive my settings are fine, but still feel that I should be running better...I would like to know what underlying psychological drivers might lurk in there that somehow hold you back.
I'm a 'retired' Time Trialler..10 to 100 against the clock, my best '10' was 22.27, not fast but quick enough.
I wonder how many have done the Conconi test and actually lived to tell the tale ?? (joke)
Frank touches on some good points (as always)....push for some upgrades.

Tattoo Man

More on PM diddling

by BikeBun - 2012-03-07 05:03:11

Thanks for comment. Just had a device check. Complained about retarded feeling just walking up steep hill. Some changes were made when the report of 98% in AS-VP mode came out. I said What??. Was told it was heart block!! I was incredulous. Something is wrong here. More diddling and it'ss worse. Tempted to have the damned thing turneed off to see differrence. Just not convinced cardiologists know how to handle AHS.

you would see the difference

by IAN MC - 2012-03-07 09:03:57

Hi BB .. if you "have the damned thing turned off " you will definitely return to the way you were..pauses, syncopes etc. Is that what you want ? it doesn't sound a good option to me.

Ian

Turn the Damned Thing Off - Not

by BikeBun - 2012-03-07 10:03:49

Turning it off is my knee jerk impulse. Don't worry, not about to do that without serious reflection and advice.

Should mention that my syncope was only light headedness until July 2010 when I totally blacked out and hit the floor at my daughters.when I got up way too quickly. Scareed the hell out of everyone - me too. That incident prompted the PM install and started this new life journey.

Question

by ElectricFrank - 2012-03-07 12:03:48

You mention the trigger of 45 bpm with your pacer. This only has an effect during periods of resting activity or pauses. This shouldn't have an effect on your active level. However, the pacemaker has options that do affect your active phase, and it is common for cardiologists to include them unnecessarily. A couple of common problems are setting the Upper Tracking Limit too low for your ability, and activating Rate Response. These interfere with your natural sinus pacemaker which may still be providing optimal function for you.

You might ask to have a programming session with the Medtronics rep. They have a program that gathers data while on a treadmill and use it to optimize your settings.

frank

athletics and pacemakers

by kawwyn - 2012-03-08 03:03:31

You do want to find a pacemaker tech familiar with athletic settings...there is some tweeking that can be done, but, like Electric Frank i'm wondering what your top and low rates are set to? I had to have mine increased because when I worked out at the gym I needed a higher rate but my BP would bottom out when I reached my max rate and the pacer stepped in to "fix it".

This was oppositely frustrating weight lifting as I would be "at rest" but needing bursts of oxygen. I then had to be still for a few moments after a few reps so I didn't get to lightheaded.

I now have a new pm with a more sport like setting that seems to have cleared things up but every once in awhile, especially if I am dehydrated or starting to get sick, or my heart is just acting up again (there was a reason i got that darn PM in the first place and it is ever changing) all of that goes out the window and i'm on the phone to my cardiologist again.

Why performance might fall

by MEP - 2012-03-11 10:03:13

Remember, the PM lead to the ventricle (bottom of the heart) triggers a beat that is not normal. It is kind of backwards, or inside-out. thus the muscle may not contract in the coordinated fashion it did prior to the PM. In my case, I have complete heart block and ALL beats are "uncoordinated". I note about a 10-15% loss of power. I used to maintain 190-200 watts on the exercise bike. Now I'm 165 (for one hr). It just means I have to work more on technique.

Mike

Fellow cyclist...

by COBradyBunch - 2012-03-14 02:03:48

BikeBun and TLR, first of all a shout out to my fellow riders. As for my pacer (third anniversary coming up) and cycling I went through a bunch of crap when I first got it. Arguments with my pacer tech mainly until they got my settings right. Had me way to high for my min rate (I have been diagnosed with SSS and intermittent block) and then had my max rate set way too low. Took almost a year to get my settings where I felt normal on the bike and in hard workouts. Pacer tech wasn't pleased but the doc told her to listen to her patient who had been using HRM's for years (used to also be a spin instructor) and knew where his heart should go a hell of a lot better than she did.

Overwhelmed with gratitude

by BikeBun - 2012-03-27 11:03:55

I am so grateful for all the meaningful comments I've recioeved. Perhaps we can help the cardiologists better understand athletic hearts. An article I found on the internet entitled " Athlete's Heart Electrocardiogram Mimicking Hypertrophic Cardiomyopathy" is a very good read. Gave a copy to my cardiologist: don't think he ever rread it.
I insisted the tech set my low check to 45 (not 50 or higher) because my (old) body was adjusted to a low/mid 40's rest rate. I'm not aware of a max control. Haven't done intervsals because of L1-4 fusion surgery lon 4/26/11 to fix as pernicious sciatic pain I had developed. Affected my walking but not biking - but life became miserable. 100% now and happy.

Keep up the dialogue.

mis-set pacemakers

by Mitch - 2012-03-31 05:03:58

I have had the medtronic pacer for about 5 years now and did have a lot of trouble getting it adjusted properly. The resting rate was way too fast and the #%&* cardio doc. would not lower it. I found a tech in Colo. that understood cyclist and runners and he reset the low from 65 to 45 (still a little high) and the rate response was the big one. When that was reset I no longer had dizzy spells when I would top out on a hill and ease off of stop at the finish of a time T. The upper limit was also too low.. My rate prior to the pacer was 175 and the set was at 150 it is now at 170. The medtronic tech told me it almost always takes 2 or more visits to get them set right. He said mine was an "out of the box" and he has never seen that work. I think that the settings is the most common problem that comes up with new pacers.
Now at 77 I still get up to the 165 range on sprints or some hills. I averaged 300MPW for 32 weeksof last year
and had a total of 12165 miles got in a few 400mile weeks. Did the Durango farmington loop century in 5 hr flat.Just dont be willing to accept the way they set you up without good explanitions. and Always be ready to get a second opinion. On my check ups I still get techs that want to reset me! Also had one that tried to tell me that the old 220 minus you age was correct and I was set 25bpm to high made him show me the screen before he turned it off to be sure he had not reset!

PM settings

by Jackcoul - 2013-09-26 07:09:20

I'm having some of the same problems with my pm. I'm 74 and an avid mountain bike cyclist. I have sss, bradycardia. I have a medtronics RVDRO1 Revo MRI. The low setting is 60bpm, which seems to be working ok. I still get a little dizzy when I go from a sitting to a standing postition, but not bad. The problem is with the high setting which is 150bpm. When I'm pushing hard my heart rate goes to 150 and will not go any higher and I just hit a wall. I went to my cardiologist and the medtronics tech said the the pm can not be set any higher. Doe's any one here have any information on this??
If it cant be set higher what pacer do you think would work better?
Jack Coul

You know you're wired when...

You always have something close to your heart.

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