2:1 exercise induced block advice

Hi All - first post!

Hoping there may be someone else coping with a 2:1 exercise induced heart block?

Backround: Lifelong reasonably fit chap. 42 YO, 1.83 m tall and usually 66 -70 kg. Started a specific training programme at the end of last year and could not get my heart rate to rise above around 150 bpm as it would get to around this figure then drop in half! Seemed to get very tired out, very suddenly and then recover just as quickly. Put it down to being unfit "for me".Thought it was Heart Rate Monitor (HRM) - unfortunately not, it's my dodgy ticker! Battery of testing revealed my heart block, but thankfully with no underlying heart disease. Cardiologist thinks it was caused by bout of pneumonia I'd had that probably affected my heart, as I had never had any health issues prior to this. I had HRM graphs from prior training that were entirely normal.

I can do "easy" warm up type rowing (or cycling, running etc) and all is normal with HR at say 130 - 140. When I attempt to step up to actually feel like I'm doing some real exercise my HR will halve to say 75. I can keep going and my HR will increase but only to around 95 & I will be really blowing hard. When i warm down and my HR recovers to the normal pattern - usually at 65 bpm (then it jumps up to 120's) I recover very quickly.

My cardiologist told me that a PM would not help me, but doing some research on this forum is making me think that view may not be 100% correct?

I am now not doing all the things (windsurfing, cycling, rowing) I used to really enjoy as I end up really breathless until my heart gets back into its normal rhythm.

Do any of you recognise my symptoms and have then elected to have a PM implanted? We're you "mended"? My heart is "normal" when not exerting myself so I can understand my cardiologists reticence to do anything to me. However, it's been a year of not much exercise, it's getting me down and I want to do something about this permanent state of inactivity.

Any advice is greatly appreciated

Spin

5 Comments

SNAP

by PAMMY - 2013-11-24 07:11:42

Hi Spin - that is exactly what was happening to me. I have run the London marathon 14 times when suddenly I was having dizzy spells when out running and my legs would turn to lead. As soon as I stopped after a minute or two when my heart rate went down a bit I felt okay again. Turns out that I too have a 2.1 block which only happens when my HR gets to around over 140 bpm.
My cardiologist said he was willing to give me a pacemaker if I thought my quality of life was affected by not being able to run. It has taken me 12 months and several postings on this website to eventually decide to have one and I had it implanted 5 weeks ago. If you look at my previous postings you will see what other members on this site advised or gave their opinions - some good and some not so good.

I am still not convinced yet that I have done the right thing. I have been out for a few runs and I am still struggling to go uphills. I am hoping that it's because my settings aren't quite right (or I have lost my fitness!). I have been back 3 times to be 'tweaked' and they are very patient with me and trying their best to get it right. At least I can run further than before without having to stop. They have set my upper limit to 180 but I think I probably go over that. If you decide to have one make sure that it is a pacemaker that can be programmed to at least 180 bpm.

Whereabouts from the UK are you from? I am from North Wales.

I will let you know if I eventually do get to being able to run as I used to. Good luck with any decision you make.
Pam


Kind of...

by rnff2 - 2013-11-24 10:11:45

I was riding my bike one morning and became SOB and had palpitations. I brushed it off because it got better after a few minutes. Then the next couple of days it continued to happen and seemed to much more frequent with less and less activity. Found out I was in and out of 2:1 AVB, my block worsens the when my heart rate increases. I had an EP study done, and it was determined that a pacemaker would benefit me. Thinking back I had been having similar episodes for months that I just brushed off because they didn't last and quickly went away. I also have underlying cardiomyopathy and have had 2 heart surgeries, so that makes me a little different. I have had my pacemaker about 6 months now.
I will say that if you do decide to get a pacemaker make sure you get a high upper rate and it's set to tract at a high upper limit. When the pacemaker kicks in and is pacing AVB it will cut your heart rate in half when it hits the high tracking rate. And as you have experienced a sudden drop in HR isn't fun. Mine was set at 160 and while I was having a stress echo my HR hit 160 and then suddenly dropped to 60. After that experience I convinced them to increase my settings and its now set at 210. I have been told 2:1 AVB can be difficult to manage with a pacemaker because you end up pacing the ventricle and long term that isn't always the best thing.
Continue to do some research, maybe go for a second opinion. Its a big decision...I still hate the thought of having my pacemaker, BUT, I also know that it does make it easier for me to be active, go to the gym and just go about my life without concern.

Good luck with your decision.

av block

by Tracey_E - 2013-11-24 10:11:58

Your situation is very similar to Pammy's, definitely check out some of the discussions we had with her prior to her making a decision. I don't know why a dr would tell you a pm would not help, it absolutely would. AV block is pretty simple- the signal does not get through to the ventricles, the pm completes the broken circuit so the heart beats in sync when this happens. Of all the problems fixed by a pm, this is the easiest. There are reasons why a dr might not want to give a pm to someone young and active- some are legit and some are not,imo- but that doesn't negate the fact that a pm fixes av block.

The question is whether it's worth it or not, and only you can decide that one. My personal choice is to do whatever it takes to stay active. Once we lose muscle tone and fitness, we don't easily get it back. My av block is congenital (which means the pm for me is not optional), but I will do whatever it takes to stay in the best shape I possibly can. I was born with a wonky electrical system. I am not about to compound my problems with weak muscles or clogged arteries. But that's just me. We're all different. There's certainly no rush. I'd start with a second opinion. Have you had a Holter monitor to see if your rate dips or goes into block other times than exercise? Good luck making a decision!

Help at last!

by Spin - 2013-12-04 05:12:14

It is rather good news to hear that I am not alone with this rather unusual issue, as you all seem to know exactly what I am talking about. (If any talk of needing extraneous electrical equipment stuck inside you to keep you alive can be quoted as "good news"....but you know what I mean)!

It becomes frustrating when every time one explains a particular pathology to numerous medical professionals the first thing you hear back is "I've never seen that before". I started to think I was a one off. I've had loads of tests: 48 hr Holter, Coronary CT, MRI and nuclear medicine scans and Treadmill VO2, to try and isolate what was going on.

I've read through all the various posts that relate to Pams' situation and I can certainly see that "something" could possibly done in my case too. Rnff2 I think you are correct in stating that pacing the ventricle long term is not the best option....that is the reason my cardiologist was rather off the idea of a PM for me. To give him his due, I suspect he was also waiting to see how much the situation affected me both physically and mentally, again, rather like Pam. If I went and banged on his door after a couple of months shouting "FIX ME", I'd probably already have a PM now. One other factor that might be leaning him against a PM is that during all my tests, they found that I had a myocardial bridge (one of my coronary arteries goes into and out of my heart, rather than just remaining outside the muscle). This thins my artery, but I have never had any problems with it. Plus, I've had it since birth and I've hung around this far, so it can't be too bad!

I've been attempting to fix myself, firstly by doing as little as possible, to see if everything settled down and just returned to normal - rather optimistic I know, but it had to be worth a try. When that didn't work I "started from scratch" gradually staging up my exercise intensity and length, but trying to keep my heart rate in its normal rhythm. The more insightful readership of these posts will no doubt already be aware that both these plans failed completely, hence the need for me to search out this forum and seek advice on the next step forward! So I already feel a little more positive as this little step has at least been successful, so thank you for taking the time to read and comment, Pam, rnff2 and Tracey.

I'm continuing to try and search for as much information as I can on the subject, but these 2:1 exercise induced blocks seem to be quite rare, in terms of studies. I am certain the HB itself is not rare at all, it’s just that most people who had them would never know they had anything wrong with them unless they are wearing a HRM or actually taking their pulse. Telling a Dr that you "do some exercise and then get really out of breath" just sounds like you are unfit! My other half is a Radiographer and even when I told her what was happening, she initially said that this could not happen and I just needed to train a bit harder and I'd be fine! This is part of the dilemma I'm in: I do appear to be fine for the majority of the time. It is just that all the stuff I did that kept me fit, I did for fun and because I really enjoyed it - not because I felt I needed to keep fit. Windsurfing is the big one for me. Not long ago I was very SOB, in the sea, in a Force 6. It was a bit scary to be that breathless and have to get it together to get back to shore. In this situation prior to having my HB you just need to calm down if you are getting pounded, take some deep breaths and all is well. When you try that and you just end up very, very, breathless instead, it’s no fun. Pam - the lead legs/arms thing is unreal! I have never experienced anything close to it (used to race bikes too, 100 miles + was not that unusual when training - never had anything like this, they literally feel HEAVY). Result......I just have not been out on the water, because I know I really can't do that without a fairly strong chance of either A: needing help to get in, or B: drowning. Neither option is currently on my "must do" list. Outside of exercise though, I honestly have no problems at all, no dizzy spells, no SOB, nothing.

A PM would make work somewhat more complicated (and without being too specific, I have to take medicals and I fly a lot - don't panic - I'm not a Pilot)! So as this decision could potentially affect my career, it is not an easy call to make as to what to do next. I really want to do the things I enjoy, but right now I can't do that to any extent of my previous ability and therefore it is not much fun. I have always been active and I think my recent glum state is down to this is down to this inactivity. With every respect to the bowling/fishing community, I can't see that I would find these more fitting pastimes quite so enjoyable.

What to do?

Spin

Pam - I'm down on the South Coast but at least in the same country (although, not right now, hence the delay in response).

Me too!

by G8tordave - 2020-11-30 18:19:18

I just joined the pacemaker club as I am a candidate for a PM.   I am an active 58 YO Male.  Up until 5 years ago I participated in triathlons, weight lifting, cycling classes, and competitive tennis.  6 years ago I purchased a garmin device for my bike to track my rides which came with a HR monitor.  I would notice when going up bridges or other extreme biking and my HR would increase to 160, it would drop to 80.  After sending back 2 monitors and questioning the HR on my apple watch I mentioned it to my dr at Mayo clinic who I see once a year for an annual checkup.  He ordered a stress test and sure enough at 160 it dropped to 80.  2 years prior to that I did a routine stress test and my HR got as high as 200 when they completed the test.  I have seen several Cardiologists.  My HR will only drop at high intensity workouts.  The majority of the Doctors don't see a reason to get a PM yet as I am completely asymptomatic.  "There is no obvious correctable cause, and it likely reflects intrinsic conduction system disease"  My diagnosis of 2:1 AV block is "currently not a significant issue from a functional standpoint, espceially since he is asymptomatic in the absence of exercise or activity."  I have also been diagnosed with His Purkinje disease, moderate to severe.  I continue to exercise, but the intensity is not there anymore, which I really miss.  During my 5 mile walks I will occasionally go into a run to get my HR up to 150ish and then slow down. Every now and then I don't slow down soon enough and my HR will drop 50%.  The same thing happens if I play tennis and get a little too competitive during a big point.  Will a PM solve the drop and allow me to go back to enjoying increased exercising again?  The thought of putting a foreign object into my heart which has to be replaced just rubs me the wrong way!  Any comments would be most appreciated.  Thanks, Dave

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In fact after the final "tweaks" of my pacemaker programming at the one year check up it is working so well that I forget I have it.