Powerlifter facing a long break?

I'm getting my ICD changed over to a PM in a couple weeks and I recently returned to powerlifting. I had my first ICD put in a couple years ago. I was active during the recovery and returned to fitnes 4-5 months after the implant surgery. After a few months of mild fitness I got into doing bodyweight movements and added heavier weights to my resistance training. At the beginning of this year, I returned to powerlifting and progressively returned to the heavy weights the powerlifters are known for.

A couple months ago I had a checkup and a problem was addressed that's been hard on me since the initial ICD implant (with three leads). They called it t-wave over sensing. My HR gets up to around 130bpm and is forced down to RR without warning. At 130bpm my device thinks my heart is beating twice that rate and forces my rate down. The Dr did a stress test after trying a beta blocker for a week to see if that would fix the problem but it only got me to 140bpm before sending me to my RR. Their solution is a dedicated PM and swapping the ICD lead with a PM lead.

This is a real patience test for me and I can take things slow but whats the bare minimum recovery time for someone active after a lead replacement?
I can stay away from moving weights but I would love to at least return to cycling asap, and maybe after a while doing bodyweight movements. How soon after a lead placement can I even raise my arm to get things off the shelf in my kitchen?

*My first surgery I was surrounded by hospital staff who said no to everything for the first year and a half. I'm almost convinced they only deal with people who sit in front of a tv all day.

6 Comments

EP

by firekurt - 2017-11-16 00:12:56

I've been dealing with three and most recently (the fourth) is the first one who's been actively working with me to solve this mess. The Medtronic reps along with EP #4 decided that I have a greater chance of getting a shock in error than ever actually needing a shock in an emergency situation. Previously they implanted the ICD because I was in rough shape. Now after attempting several adjustments and the medication, they concluded that they need to swap out the ICD with a PM so I can return to an active life (and they can make the needed adjustments to the programming to accommodate the activity). I'm only 34 so I have a lot of active years left.

recovery

by Tracey_E - 2017-11-16 09:57:49

If you get a new lead, you shouldn't raise the arm overhead for 2-6 weeks, depends on the doctor. I was told lift no more than 20 pounds and no overhead for 4 weeks. Other than that, you can and should use the arm normally so the shoulder doesn't freeze. You shouldn't have any restrictions on cardio after, whatever you feel up to, tho my doctor told me last time  to limit getting too sweaty until the incision was well healed due to infection risk. I'd never heard that before, but it didn't kill me to chill for a couple of weeks. (I'm a bit impatient and don't sit still well, that may not have been my reply had you asked me at the time lol)

All ICD's should be able to pace also. They give ICD's when you are at risk of dangerous arrhythmia. Have they determined that's no longer the case??

ICD

by firekurt - 2017-11-16 13:13:21

Hi Tracy! Glad you responded.
The issue with the ICD is that there's a point when it sees a dangerous HR, and it was explained to me if they turn down that sensitivity, there's a chance the unit would not respond to a dangerous HR. I attended the PM clinic for a test to see what point the ICD would shock me and they put me out for that for obvious reasons. That data allowed them to work within that sensitivity range. They thought the problem was solved by adjusting the program. I was insistent they put me on a treadmill so they could see what was happening. They did and tried overriding settings while my ICD was fighting my high HR. The T-wave on the printout, is adding another 'beat' to anything sensing so it's confusing the device to think my HR is twice as fast as it really is. They tried turning off the shock function but they can't turn off the over sensing feature and that's the problem. Even with the therapy shock feature turned off the device still wants to correct the HR.

They took the data into the weekly EP meeting to see if anyone could think of a solution. I was called and asked to try a beta blocker that would hopefully suppress the problem T-wave. I did that for a week and returned to another treadmill session to see the result. The beta blocker only helped a little but the ICD response was still the same and other program functions were adjusted at that time but there was nothing left to fix the issue.

The EP presented the results at the next meeting (Medtronic reps also attend). The solutions were to reposition the atrial lead that's capturing the problem T-wave, but that has no guarantee. Remove the larger lead the ICD uses to deliver shocks (larger conductors), the ICD, and instal a pacing lead with a dedicated PM. They all agreed that (after my initial heart surgery) the ICD was the best option at the time. Since I've rebounded so well and I've been active since there's a greater chance of my ICD delivering a shock in error than me ever needing a shock to reset my heart rate.

The IDC lead could be left in and not connected but they're saying because I'm only two years since it was put in, it would be easier to remove now than leave it in. At the moment I have three leads with the ICD.

Sorry for the lengthy response. I figure the details help get the point across =o)

good advice

by Tracey_E - 2017-11-16 18:40:07

Sounds like you have a really terrific team! Responsive, willing to think outside the box.

Taking out the lead now is a good idea, much easier to do it now than down the road.

Fingers crossed this is what you need to get back to full activity! 

good advice

by firekurt - 2017-11-16 19:21:31

The people helping me now have been great. Getting to this point has been a rough ride. If I didn't take time to study everything and really get involved I would be a lost cause.

I'm looking forward to the remedy. Getting a dedicated PM is good news. The past couple years of limitations have been very time consuming, and stressful.

Thanks

by Myeo - 2017-12-03 21:13:37

I’m in here on behalf of my mom. She has had her PM since ‘87. 

Yes if you are thinking of removing the leads do so before it gets too enmeshed which is mom’s issue now. Her leads have become worn out & sending ‘noise’ to the PM which doesn’t fire when required because it mistakes the ‘noise’ from lead as her own heart beating. 

We will be meeting surgeon today to discuss re-leading. 

You know you're wired when...

You trust technology more than your heart.

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