Returning to Competitive Cycle training

CHB should be easy to treat with a PM

by crustyg - 2024-06-19 17:14:56

If that's all that's going on.  PM detects A-activation, and then fires RV lead a short time later if there's no activation sensed - quite a few people have ventricular activations driven by the AV-node - it's what normally keeps patients alive who develop sudden complete heart block - only slowly.

If you're seeing dropped beats (detected how?  Feeling radial pulse, apex beat, smart watch, finger-tip pulseox?) and they are genuinely dropped beats then either your PM needs to be adjusted or there's something else going on as well.

Be careful about claiming dropped beats when measured by a smartwatch - most of them are basically useless for irregular pulses.  Finger-tip pulseox is often much better, actually feeling a pulse is the best.

Unless your EP-doc looks after a semi-pro cycle team it's unlikely that (s)he has much experience with athletic PM patients.  You've already seen the silly (too low) maxHR that your PM was set to track to - now happily revised upwards.

Get hold of your PM settings and any Holter records that they have for you, and any ECGs that have been done in the last year, and get someone to work through them with you.  See if you can make friends with the EP-techs who program your PM - they usually have a vast amount of experience and can explain a lot of what they see.

Ask yourself: now that you've got a sensible max tracking rate on your PM, do you feel able to train towards your previous levels of performance (remembering that you've not trained for some time and you're a year older....)?  Because if the answer is 'yes' then don't worry too much about some dropped beats at this stage.

Best wishes.

cycling

by Tracey_E - 2024-06-19 18:26:06

A few thoughts

It may not actually be dropped beats, but smaller beats you aren't feeling. Your pacer should be set to make the ventricles beat every time the atria does. If it's truly missing beats, they can tinker with the delay and give the ventricles less time to do it on their own.

A treadmill (or stationary bike) can be very helpful in fine tuning our devices. So can a holter monitor. In my case, we found out I have some minor sinus issues that were masked by my av block. Once we realized what was going on, they were able to adjust programming accordingly.

If you have access to a sports cardiologist, they'll have a lot more insight.

If you don't feel right with your current settings, don't wait for your follow up to go back. Call them now. Athletes are a lot trickier to program, and no two of us are alike, so it's normal to take a few tries to get it right. 

Cycling

by KHammond - 2024-06-20 10:12:52

Could be PVC's?  Premature Ventricular Contractions.  I had similar symptoms as you (very active as well) although I described mine as skipped or unusual heartbeats.  Started having them about 7 months after my dual lead PM implant. On my resulting checkup my Medtronic Pacemaker recorded that I was having PVC's and a low dose of Metroprolol now has it under control.

KH 

Cycling & Missed beats

by Philmtb - 2024-06-21 07:46:37

I would like to respond to the comments above and it once again proves that this forum is one of the best ways to find answers as I realise that most doctors just perform the operation and have no interest and / or time to help people further to live their lives to the maximum, especially those out of the normal demographic. Basically, they have kept you alive, job done. It is now abundantly clear to me that I have to be proactive in my research if I am going to get back to where I was before my operation.

I did a few longer cycle sessions at the beginning of this week (60 km - 100 km) in hot conditions and this may have contributed to the missed beats (taken the radial pulse manually). I have also been experiencing constant pressure in the chest and abdomen area and so I have taken a couple of days off riding (I checked with my GP and BP, HR, O2, breathing were all normal). As a result, the pressure has eased and my pulse is not skipping and appears normal again.

I have not used a Holter monitor before but will certainly request one if I have repeat symptoms. 

In terms of Cycling performance, I am at 73% of the power levels from where I was at in October 2023, when I had the operation. My average HR has increased 10-15% per ride. I obviously lost fitness during the initial months and so a big part of these numbers is due to reduced training time.

I will continue to push towards a full recovery - I realise that this is a slow and delicate path - but it is good to know that we all have a great support network here.

Cycling

by KHammond - 2024-06-21 09:03:35

If you are 100% paced in your right ventricle then you are at risk for dyssynchrony and a decrease in heart efficiency.  Since my dual lead implant in Aug 23 I have been 100% paced  in my RV and my left ventricle ejection fraction has dropped from 65% (mid range normal) to 50% on an echocardiogram and 43% on a Cardiac CT scan. My mitral valve regurgitation also increased from mild to moderate, another possible result of dyssynchrony. I can't quantify my drop in performance but I feel some dyspnea with exertion and a loss of fitness.  My cardio team is currently evaluating whether or not I should have CRT-P therapy to try and reverse the problem.  Maybe ask your cardiologist for some diagnostics to evaluate your situation.

Good luck, I know it is disheartening to lose the hard earned fitness level you had before the PM.

KH  

Cycling

by Philmtb - 2024-06-21 09:32:06

It certainly sounds like you are being well looked after KHammond! Despite my background in Sports Science and Coaching & Fitness, my doctors have not been willing to discuss any specifics of my Pacemaker settings despite my constant questions. 

Interestingly, I asked a long time ago about my Ejection Fraction (EJ) but it was waved away as irrelevant. However, from your answer above it seems very relevant. I have had to find another doctor as the first one who performed the initial operation was clearly not up to the task. Hopefully, I can try again with the second doctor, who changed my settings, and seems more receptive. 

It is very important to know my degree of ventricular pacing and if there is any dyssynchrony, as well as my EJ.

I wish you luck with your situation - CRT -P Therapy would mean an extra lead to your heart so not the easiest solution.

EF

by Tracey_E - 2024-06-21 11:06:56

According to my ep, 5-10% of paced patients end up with lower EF over time. He feels many of them would have had eventual reduced EF with or without pacing. If it doesn't happen in the first 5 years of pacing, he almost never sees it happen later. A yearly or every second year echo will keep an eye on EF. If it does start to drop, there are treatments.

After 30 years of pacing 100%, my EF is exactly the same. 

Here's the thing, tho, yes it's possible pacing may cause a drop in EF. However, not pacing will do much more damage to the heart.  With av block, the atria is beating normally but the ventricles aren't getting the signal to beat so the heart fills with blood (atrial beat) but the ventricles aren't pushing it out in a timely manner. Think overinflated balloon. The benefits of pacing far outweigh the risks.