Climbing, Swimming and Strength Training - Safe to do?

A lot depends on the exact placement of the lead

by crustyg - 2024-06-21 09:26:57

It *is* possible to have leads placed in such a way that they can be crushed underneath the clavicle.  Experts who do lead placement all the time (and not just surgeons who do the odd bit of easy surgery for the cardiology team) know all about this and make sure that this doesn't happen.

I swim, do yoga, pilates and have no issues with lead damage.  I get more discomfort from old-fashioned garden shears due to the repetitive movement (bunching) of muscle under my PM pocket (and, no, it's not a rippling slab of Arnie-like pecs).

Could my activities produce problems: in theory yes.  But I prefer to live my life and not merely exist because I'm worried about some theoretical risk that might cause a problem.  I'm far more likely to get into trouble road-cycling...

If/when I damage a lead from poor placement and my active life-style then I'll have to change my approach.  Until then I'm doing what I want to.

Safe to do

by piglet22 - 2024-06-21 09:38:39

No-one will be in a position to say that your activities are safe to do, other than you pacing team.

Someone might say that they've lifted weights for 20 years and suffered no ill effects, but that isn't you.

I used to road cycle without ill effect but another member reported feeling unwell after MTB riding.

Flex leads for long enough and they'll fracture. Copper work hardens.

Ask your team how many repairs they've done because of patients activity 

exercise

by Tracey_E - 2024-06-21 10:58:03

What I was told is it's the repetition more than the movement itself. Leads are designed to move with us. If you're planning to train for the Olympic rowing team, that's probably not a good idea. If you want to occasionally go kayaking or rock climbing or do pull ups at the gym, it's low risk. 

Some people are careful and still end up with leads wearing out prematurely.

I am not careful. I did Crossfit for 10 years. I still lift but my shoulders prefer lots of reps on smaller weights so I had to give up my beloved barbells. I have always been told to do what I want and have never held back. I had one lead replaced at 15 years. My other original lead is just now showing signs of wear at 30 years old.

As crusty said, placement is a factor. If it's very close to the clavicle, the risk of damage is higher.

That said, there are no guarantees and there are no studies so that we know exactly what is safe. Ask 10 doctors, get 10 answers. It comes down to what you are comfortable with. Some people avoid heavy weights overhead, pull ups, etc. Me, I want to do what makes me happy which is being active and trying new things and pushing myself. If there is collateral damage, then I'll deal... then probably go right back to doing what I was doing before. So far, it has not backfired on me and after 30 years of pacing I'm just now facing my first complication (how to handle the bad lead on my next replacement, no more room in the vein and extraction will be complicated due to age of the leads). 30 years is a pretty good run, and I consider this just a bump in the road. YMMV.

Replacement Leads

by Philmtb - 2024-06-21 11:26:22

Your comments are very interesting and I am keen to continue to lead the same active life as I always have. I have been told I am far too active by treating doctors and that's why I developed Heart Block in the first place, by pushing my body too hard.

Regardless, I don't want to make unnecessary sacrifices as life is too short for that. Tracey_E, you said you had a lead replaced after 15 years. I was told that if a lead broke, I would need to have new leads inserted on the other side and the pacemaker moved to that side. If it happened again then I would be screwed as I would have few options left for a replacement. It sounds like they removed yours (or was there space for an extra lead) although they aren't able to do the same with the 30 year old lead. Good luck with that and it will be interesting to know how they deal with it.

jeez

by Tracey_E - 2024-06-21 12:03:10

No, they do not automatically just move to the other side if a lead goes bad! Wow, what awful, out of date advice.

Nowadays, they extract and start again on the same side, assuming the veins are still in good shape. If that doesn't work, they can also add a new lead (most veins hold 3-4). And if that doesn't work, leadless is advancing quickly. In a few more years you may find that when a lead goes bad, they simply switch us to leadless. There is a small number of people getting leadless when they don't have room to add and extraction isn't possible (mostly people like me who have been paced decades). Give it another 10-15 years, and it should be commonplace.

If none of that works, they can go to the other side. 

Extraction has come a long way in the last ten  years. The lasers they use have come a long way, they have new sheaths that make it safer, and the number of experienced surgeons has skyrocketed. 

When my lead went bad, extraction was newer and higher risk, and I had room in the vein, so I chose to add the new one and cap off the bad one and gamble that extraction technology would advance before I needed it. I was also in my mid 40's then so I was hoping that if I could go another 10 years (which I have), that my next set of leads would be my last and I'd only have to extract once. So now I have 3 old leads in there. I am meeting with someone who does a lot of high risk extractions to see if getting them out is an option. My first choice is extract and go to leadless. Second choice leave the leads in and go to leadless. Third choice is extract and get new leads. Last choice is move to the other side. That order may change depending on what the high risk guy has to say. My ep is on board with my current preferences. 

sports cardiologist

by Tracey_E - 2024-06-21 12:12:07

It sounds like you would do better with a sports cardiologist, one who is experienced with and supports athletes. 

I see an adult congenital ep, so he sees a lot of people like me paced for a lifetime. He avidly encourages me to stay fit because that's the best thing I can do for my heart. He's ok with whatever activity makes me happy because that's what I'll stick with. His experience and advice is very different from a doc who has mostly sedentary elderly patients. 

It's ok to doctor shop to find one that's a good fit. It sounds like yours is not a good fit. And has no idea how far extraction has come in the last 20 years. (still rolling my eyes that they would tell you moving to the other side is the only option)

A Safety Net Exists

by Philmtb - 2024-06-21 12:53:16

I can't begin to tell you how much bad advice I've received and how frustrating this has been for me. Therefore, it's really great to have this forum so that all this knowledge can be shared.

Obviously, I have been affected by the fear of wearing my leads out and having no other options but for moving to the other side. I was told that the leads would be sealed in by scar tissue and the veins too weak for removal. Incidentally, during this conversation, I asked about the leadless pacemakers and I was told it was only an option for older patients as there was no way to remove old ones and therefore not enough space for more than one replacement. I see you live in the US so maybe your health system is a few steps ahead of the one in Spain. 

I am now trying to find a Sports Cardiologist here who is more in tune with younger, athletic people and can give me more up to date advice.

Many thanks

leadless

by Tracey_E - 2024-06-21 13:15:18

The Micra, by Medtrronic, is left in and new ones added, yes. They are the size of a grain of rice so in theory the heart can handle quite a few of them. I'm 57 now, which my ep considers young, so he does not consider this an option for me because it's unknown what will happen if you get 3 or more in there. 

The Aveir, by Abbott, is intended to be removed when replaced. That's the one we are looking at. 

I supposed it's possible if something is unusual about your veins that they could not extract. But most people they would extract. It's common in UK and Germany, perhaps that would be an option if it happened?

Great Info for Newbee

by Andiek11 - 2024-06-21 17:56:22

Would not have thought to ask some of these questions as I work towards my 12 week check-up, so I'm glad this thread exists.  My philiosophy in general developed when I was a teen who mucked-up her knee in gymnastics in high school and was told I might never get full range of motion back in that joint.  I did, and it was probably because they told my parents this but never me, so I wasn't burdened with any limitations.  Thus my phiilophy of, "don't tell me my limitations and I won't live down to them."  True it is always important to listen to what others with knowledge have to share, but at the end of the day we have to take responsibiity for our own lives and make the decisions we feel make the best sense to us.  (Can't wait to get back to overheard, repetitive motions like rowing and swimming!)

Swimming

by Runsalot - 2024-06-22 09:31:03

I researched swimming with a pacemaker prior to my implant and found that people suggested having the pacemaker implanted deep and low....ie., under the pectoral muscle. The surgeon agreed. Following surgery early April my upper arm was pretty bruised up and sore for a couple of weeks but I am now back to swimming, weightlifting and building my fitness back to 3 days a week total 10k swimming to attack those +70 age group triathlons next season!