Sports cardiology

As I noted in my intro, I'm a lifelong athlete (runner then long distance cyclist) diagnosed with bradycardia, 1st degree AV block, chronotropic incompetence. I had a Boston Scientific L331 implant 11 days ago.

I'm supposed to get a PET scan in about a month to rule out possible V-Tach. Assuming the best (no ICD pacemaker required) I'll then see my EP as a follow up and possible changes to the PM settings.

I'll say that my EP has been great. Very good communication, takes as much time as needed, etc. Having said that, I asked him if he did athlete focused adjustments i.e., where I'd be on a stationary bike with him and the Boston Scientific tech monitoring, and he said no, that adjustments were based on how I felt.

I know there are a number of places (Mayo, Mass General, Cleveland Clinic, etc) that do athlete focused sports cardiology. I'm strongly considering booking an appointment (likely at my own expense) with one of them but was wondering if anyone here has done that and found it to be of value.

As an afterthought, part of the reason I want to do this is I'm clearly not qualified to give feedback based on how I feel ;-) 

After my near fainting episode in early June I went back and looked at HR data for the past few years and it turns out I've had bradycardia at least since 2020. I know I've felt bad a number of times in the past few years both during and after rides. I didn't finish a long ride because I "felt sick" but explained it away as something else (heat, rode too fast, etc). Turns out my HR was 28 overnight. And that's the point: I find lots of other reasons (poor sleep, didn't eat well, heat, etc) to explain away problems. I'd prefer a more objective & analytical measurement rather than the subjective "how do you feel".

Thanks for any insights on the value of going to a sports cardiology clinic.



by PWUDZIE - 2023-08-08 00:14:55

I have a similar story and had a PM implanted 4 weeks ago due to sudden onslaught of Bradybsymptoms. I would welcome insight into seeing a Sports Cardiologyst. 

Excellent idea to work with a Cardiac Sports therapist/Cardiologist

by Gemita - 2023-08-08 02:17:33

Aintgotrhythm, working with a cardiac sports therapist/cardiologist is an excellent idea because since you don’t always recognise when you are in trouble, even when you have symptoms, you could be a danger to yourself and to others!  Working with a cardiac sports therapist/cardiologist, you will learn what you can safely do, how to “pace” yourself, to prevent triggering any unwanted events.  

Many athletes experience runs of non sustained ventricular tachycardia which can be normal, but if you have evidence of sustained ventricular tachycardia (duration over 30 seconds) and ever needed an ICD to protect you, then you may need to re-learn how to safely exercise to prevent unnecessary ICD shocks.

I cannot recommend a sports cardiologist in the U.S. but I think it is a great idea to consult one.  My husband was offered “safe exercise support” from his cardiology team over here in the U.K. after he received three stents.  Different heart conditions will require different approaches to exercise of course but it is important that you learn what you can safely do with your particular heart condition.

Aintgotrhythm, most good doctors will always want to know "how we feel".  My doctors don’t only want to see data before deciding what to do, which treatments to try for my arrhythmias (including non sustained ventricular tachycardia).  They primarily go by my symptoms.  Symptoms will determine my need for treatment whatever health condition I may have.   In the “absence” of any symptoms, particularly with an arrhythmia, my doctors would probably want to "wait and see".  Fortunately (or unfortunately) I am highly symptomatic.

Perhaps it is time to learn to listen to what your body is trying to tell you, which is just as important as those percentages, numbers, wouldn't you say?   Hopefully this is what a good Cardiac Sports therapist/Cardiologist will help you to do as well as optimising your pacemaker settings.  Please let us know how things go.

Explaining "how I feel"

by Aintgotrhythm - 2023-08-08 10:15:10

Hi Gemita,

Thanks as always for your detailed reply. I should perhaps explain my somewhat tongue in cheek comment that "I'm not qualified" to say how I feel.

As I mentioned elsewhere, I do long distance cycling events where I ride distances from 300K-500K every day for a number of days in a row. It should be obvious that there's a fair amount of discomfort and sometimes outright pain while doing those sorts of rides. Part of the challenge is being able to distinguish those that are serious from those that aren't.

There's a long standing joke among my fellow riders:

"If you feel bad, don't worry, it will pass"

"If you feel good, don't worry, that will pass too"

So every long ride is full of both - you feel good for a while, you feel bad for a while, etc., and it's the case that if you quit at the first instance of discomfort you're not going to finish many rides.

While riding (and after) I monitor how I feel very carefully, judging how serious it is and dealing with it accordingly. Having said that, over a period of years I've learned to "ignore" the times when "I don't feel very good" as being part of riding that far. So as I mentioned in my earlier post I had what turned out to be episodes of bradycardia that I "ignored" or explained as being caused by something else (poor sleep, didn't drink enough, etc).

But you're right, I do need to "recalibrate" post-implant. 

Thanks again.


by Gemita - 2023-08-08 11:45:48

I hear you!  Pacing yourself and listening to your body are not what it is all about.  I understand you have "to push through the pain" otherwise you would never achieve your goals.  Perhaps this is why you are looking for a Sports Cardiologist who will have a special interest in helping patients achieve their maximum level of fitness without triggering unwanted symptoms like arrhythmias.   It makes a lot of sense.  I hope you and other members continue to suffer/enjoy the ride.

Cardiac Rehab Program

by blocker44 - 2023-08-09 14:07:23

May I suggest that you sign up for a Cadiac Rehab program at a hospital near you. A group of trained professionals will monitor your heart rate, blood pressure and oxygen levels while you ride on a stationary bike. They can print out a report of your session for your EP. Your EP and a good Boston Scientific PM tech can fine tune the settings on your pacemaker. You will need a refferal from your doctor and your insurance will most likely cover the cost.

My first day at Cardiac Rehab they found that I had Left Bundle Branch Block, and wheeled me right in to the Emergency Room. A few days later I got a Medtronic PM. It has been a struggle to get my rate response set up correctly for me, but I am getting there.

You know you're wired when...

You can hear your heartbeat in your cell phone.

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