Return to cycling

Hi,

I had a pacemaker fitted due to heart block 2 weeks ago. I'm a keen road cyclist - usually on the bike 2 hours a day during the week. At weekends I go windsurfing. I'd rate my previous level of fitness as in the top few percent for my age (43). The heart block came completely out of the blue - no warning signs at all. 

The cardiologist is aware of my avid cycling. He's said to stay off the bike for 3 months to avoid damaging the wires. Reading all the documentation it seems most guidance says to get back to normal after 6 weeks, so I am not sure why I'm being told to wait double the time.

Has anyone else been told to stay off cycling (or other endurance sport) for such a long period of time? Any ideas why he might be particularly worried about me? I'm seeing him next week so just want to understand a bit more so I can query this. 
 

thanks

chris


 

 


10 Comments

Cycling

by Hbcapital - 2022-06-19 08:25:05

I also joined a pacemaker support group on Facebook and the general consensus from patient's doctors is 8 weeks before resuming normal activity. However, some doctors say to wait 12 weeks if resuming swinging sports such as tennis, golf and even lifting weights.

I never saw a comment about staying off a bike for 12 weeks. Your doctor may be concerned about a fall from the bike.

It doesn't make sense to me...

by crustyg - 2022-06-19 12:40:43

I'm also a keen cyclist: PM + leads inserted on Wed, out for a gentle ride on the Sunday.

It *does* make sense to avoid a level of any activity that would make you sweat hard while the wound is healing and the dressing is still present.

The leads are actually fixed in two places: the heart muscle and the thickened region (in the lead) close to where the lead heads down into the axillary/sub-clavian vein - and it's *just* possible if you really stretch the arm+shoulder on that side that you can pull the lead(s) tight between those two points.  But it's really unlikely, for two reasons.

1 Leads come in different lengths, and your EP-doc should have selected a length that provides significant slack to allow for each heartbeat, and you'd have to be hanging on for dear life by your arm to really pull these two points apart.  Perhaps (s)he thinks that's what windsurfers do - pretty sure the good ones use a body harness to relieve this load.

2 Modern leads are *usually* actively fixed by a small metal helix/screw at the heart end, which is screwed into the heart muscle itself.  Over time this lead-heart muscle junction will be reinforced by fibrous tissue as well, but the primary screw connection is pretty tough.

I asked my EP-doc how many athletic PM patients he had, and the answer was one other (at that time).  It seems that less than 10% of PM patients are really athletic, so unless your EP-doc consults for a pro-cycling team it's unlikely that (s)he has much experience of the needs and expectations of the really active patient, particularly the cycling ones.  I would suggest that your manufacturer/model of PM is also evidence of this - but perhaps you'll be lucky.  The EP-techs that I see say that they hear good things about Biotronik devices, if the CLS is tuned properly.  My Accolade was specifically tuned for road cycling (took about an hour on a static bike, five separate 'runs' between tuning adjustments).  I have SSS+CI.

If all you have is CHB then you may not need much more.  However, I think it's likely that you have more going on than just CHB and that whatever process damaged your AV-node is likely to a) progress, b) affect other areas, like the SA-node.

Best wishes.

Thanks for responses

by fanatic278 - 2022-06-19 13:31:33

Well I do hope my pacemaker reacts the way I want it. I was cycling fine the week before the incident so it would suck big time if some settings in my PM stops me from eventually getting back to the same level. The cardiologist said he picked the best one for me, and the tech guy from Biotronik said it was the best and he'd worked for all the major manufacturers over 23 years. At the time I had no choice or knowledge about these things - was faced with a do or die option. Trying not to focus on things I have no control over and just want to forget about it and get on my bike to be honest. 

Three months

by AgentX86 - 2022-06-19 14:20:14

Three months is very unusual. it's usually four to six but listen to your cardiologist. There may be some good reason he wants you to hold off. It's one of those questions to be asked at the time. The big thing is to make sure the wound is completely healed but, again, he may have other concerns.

Seems long to me!

by dogtired - 2022-06-19 22:09:22

I'm scheduled in a month and ride also,  I was told I could hop on my trainer 1 week after if I felt up to it but take it easy and swimming would be OK after wound fully healled 4-6 weeks (full arm extension OK)  I would ask your EP what his concerns are.  Are they unique to your situation.    Is he aware of the arm position when ypou ride?  Windsurfing is entirely another mater, waterstarts will cause pulling with arm extended and a high spped face plant may impact your PM.  I also wonder if the high speed chop will cause your PM to pace your heart higher than you need.  I'd be surprised if that can be tuned on land!

Another outlier with PM

by Ahilltopper - 2022-06-20 20:33:43

Last year I was diagnosed with heart block (intermittent), and like you, I'm an outier in my age group (66) for activity and fitness level.  Being an outlier tends to confuse cardiologists somewhat because neary all of their experience is with patients who have much lower fitness.

I'm also a cyclist but split by time between that and other sports: running, downhill skiing, nordic skiing, tennis, pickleball, and kayaking.  I even windsurfed for a couple years. Last year I had a couple brief dizziness/fainting episodes while running, and at the mid-point of a 40-mile-long bike ride, which I finished including a very steep hill climb at the end. At the time I didn't understand how serious these incidents were, and I attributed them to other things. My (intermittent) heart block was only diagnosed after I went to my GP, then to cardiologist, had a stress test, then wore a heart monitor for 2 weeks, and with doctor's persmission went on, and finished, an easy bike ride for me: 12-miles on a nearly flat bike trail at moderate intensity (keeping HR < 100 bpm).  The single HB episode that was detected during the 2 weeks was immediately after that ride,  and my cardiologist was very happy to have found the cause of my episodes. 

Of course I didn't want a PM.  It is hard to accept that you need one; and it takes time to get used to having it. You won't forget that it is there. The good news is a year after PM implant, I can say that my performance has improved in all my sports.  My win-loss record in the local tennis league is the best it has ever been, and I'm beating much younger guys in close, marathon matches (I admit to them I'm "battery-powered").

All of the PM's are set by default to maintain a minimum HR of 60; which is "very low "for non-fit people - most customers.  However my resting HR prior to implant was upper 40's during sleep and upper 50's during the day. So after 3 months, during an office visit I discussed this with my PA, and they reset my PM to allow my HR to go down to 50. I'm now conserving battery power - they said it should last at least 10 years now (original estimate was 7 years). 

The average cardio effort during cycling is basically time x average intensity, and of course it varies. So your EP needs to know more not just your cycling time, but average intensity and peak demand to understand the cardio demand during your rides.  A very good indicator for both is HR.  The other thing important is the strain on your chest, and potential for impact.  Cycling and windsurfing should be okay unless you are doing some intense stuff, where you might fall hard or get hit hard by an object. If you wear a life jacket windsurfing, your chest will have great protection. 

I purchased an Apple Watch 6 after I got my implant and it has been extremely helpful in monitoring my cardio activity and comparing the intensity of different rides, days, weeks and between sports. 

Good luck as you get back to your sports - it will happen soon. 

Thanks ahilltopper

by fanatic278 - 2022-06-20 20:59:26

Thanks ahilltopper 

That's very reassuring and exactly what I need to hear right now. I have to admit I have been feeling mentally low these last couple of days. I signed up to numerous forums, Facebook groups and YouTube videos, which might have been counterproductive. I'm taking a break from reading about this all for a bit (yes, the irony in responding). 

My cardiologist was very understanding about my fitness and hobbies. He did admit he only sees someone like me maybe once a year, so I think we'll be going on a learning experience together. I showed him my HR data from my Apple Watch prior to surgery, so he set me up with a 50 bpm minimum already.  
 

I mentioned windsurfing only in passing. It's the off season until December (Australia). Cycling is my main focus right now as I was supposed to be going cycling in Scotland in August. I'm going to see the cardiologist in a week so will try and negotiate something. Without cycling I can't see what sport I can actually do for the next 3 months other than walking. Logically if cycling is prohibited then so would anything that involves running around and stretching.

 

Logic

by AgentX86 - 2022-06-20 22:55:37

That logic may not hold.  If the worry is taking a header, other activities may be just fine.  Again, I've never heard of such a long prohibition for something like cycling.  The real problem isn't lead displacement (assuming a proper anchor), rather reopening of the wound.  Once that's completely healed most activities can resume.  The only activities I've heard that were proscribed after the first -6 weeks were full-swing golf and over-hand tennis service if the PM in on your dominant side. Chip--n-put golf is normally fine as is tennis if the PM is on the opposite side.

Your cardiologist is the one to clear all this with but it seems he's not all that familliar with the needs/wishes of active people and is being overly conservative.  I'd push this a bit and find out what the issue really is.

yeah logic

by dwelch - 2022-06-25 02:28:44

seems long.  The few of us that have had many devices have commented that we are back to driving after a few days.  not weeks.  (granted sleeping, etc is weeks).

The sweat and infection thing makes sense to give that plenty of time.

Remember they have a couple of things going on, one is lawsuits, malpractice, easy to say 6 months when it might really be 6 weeks, gets them out, possibly, of a lawsuit.  Which is why its hard to pin them down on metal detectors and microwaves, etc...esp the pacer companies.  

and maybe you didnt ask, but if you have to have a problem heart block is the one to have, the pacer fixes it and you, after whatever recovery period, can go back to your cycling, etc.

by now you have had that visit I assume, I hope it went well.

Negotiations successful

by fanatic278 - 2022-06-26 23:45:28

I managed to negotiate my cardiologist down to a two month cycling ban, which means I can cycle on my Scottish holiday. I'll be very slow, but that's fine by me.

I'm not going to go against his recommendation, but I still don't fully follow the logic. Rotating my legs whilst keeping my torso stationary seems pretty low risk. I was hiking up a waterfall yesterday - which wasn't expressley prohibited - although he probably would have frowned upon.

Anyway, it was a good news day! I have a target for getting back on the bike, and pacing is currently 4%, with battery life of 11.5 years left. Got to take the wins when they come.

You know you're wired when...

You have a high-tech ticker.

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