Running With Pacemker - Leads and Connections

Running With Pacemaker

Hello, I had a Dual Ventricular Pacemaker implanted on August 28, 2009. It has been approximately 3 weeks since the implant. My condition was Stage 2 WenkeBlock or AV blockage. The type of pacemaker implanted had 3 leads into my heart. Two of the leads were screwed in and the third was laid in a vein in a coil position. The cardiology center I am dealing with on my pacemaker has not dealt with runners much before in the past and I can only get limited information.

In the past and up to the pacemaker implant, I ran approximately 60-70 miles a week. I have ran many marathons and ultramarathons. In the last 5 years as my condition was diagnosed, the running was very difficult and my times decreased. Also, I was very dizzy and lightheaded and was on the verge of passing out at times. The decision was made by my doctor and me (very reluctantly) that it was time for the pacemaker. I do better now and can go up stairs without dizziness and such. Since the implant I have the normal bruising and swelling. It is getting better. My post recovery has been a lot of walking the last 3 weeks. I have this concern that the one lead that was laid in my vein will come out with vigorous exercise. Has anyone had this type of procedure with the lead in the vein? I want to get back to my running now but don’t want to mess up the lead. I was very vocal to my doctor that I did not want to lose my running with my pacemaker. Am I being over cautious? I would appreciate any type of input.

11 Comments

CRT Leads

by TLRun - 2009-09-16 01:09:25

Hello:

Thanks for the prior two postings!!! I appreciate it. I did not have Cardiac Arrest. I am not the most techical person when it comes to all this and probably dont have the language completely correct.

Those were my options toward the end. The concern was complete AV heart blockage. As a runner, I had a very low resting heart rate of 34 (prior to pacemaker). The concern as noted was complete blockage especially while I was sleeping. So, it was either the pacemaker or Cardiac Arrest. So, there was not much of a choice!!! - The Pacemaker. I was feeling really crummy too at that point, dizzy, felt like passing out, etc. That has gone away now although I still somewhat dizzy. I know I need some tweaking.

You both seem to understand my situation with the third lead being in the coronary sinus and to stimulate the the left ventricle. Am I being over cautious about that lead into the heart ( laying in the vein) and coming out? Have you heard of that before?

Thanks

Tom

3rd lead

by Tracey_E - 2009-09-16 02:09:19

Honestly, I've never heard of a third lead when you simply have an av block. I have an av block with a resting rate in the 20's without the pm, same symptoms you experienced, and have had a 2 lead device for 15 yrs now. To the best of my knowledge, that is generally how av block is treated. The third lead is, as Inga said, usually for patients with heart failure or low ejection fraction from a lack of synchronicity between the left and right ventricles. An av block is a block between the sa (atria) and av node (ventricle), the link between left and right ventricles doesn't usually need assistance.

Here is a description of how the leads are run and how it works
http://www.webmd.com/heart-disease/heart-failure/cardiac-resynchronization

Once you heal, you should not have to worry about the leads coming lose. They very occasionally come lose the first few days but it's rare to happen after that because scar tissue holds them in place.

You will probably find that your energy level is a lot higher once you heal! When your resting rate was 34, odds are good your atrial rate was higher than that and your body wanted more oxygen than it was getting.

Third Lead

by TLRun - 2009-09-16 03:09:14

Thanks for your information. I guess my concern is the third lead and that is only in the vein and coiled to prevent it from coming out. The other two leads as you have described are screwed in. But the third lead was just laid in the vein. Do you know or anyone have this type of scenario of the third lead. I guess I am concern once I resumed running that the third lead(laid in) will come out. Any input from anyone???

Thanks

Tom

CRT device

by golden_snitch - 2009-09-16 11:09:51

Hi there!

Do you have heart failure? Just wondering because the pacer you received is a so-called CRT device (cardiac resynchronisation therapy) and is usually given to patients who are in heart failure. The third lead is placed in the coronary sinus, and it's supposed to stimulate the left ventricle.

Besides not understanding why you got this type of a pacer for a Wenckebach heart block - which itself is not that often an indication for a pacer implant (only when you're symptomatic), the Mobitz type has a worse prognosis regarding progression into complete heart block - you should be fine when running. I know a couple of pacer patients who run marathons, and they are all doing good.

Best wishes,
Inga

should be fine

by Tracey_E - 2009-09-16 11:09:52

Why did they go with the second ventricular lead? I'm not familiar with the restrictions when you have a third lead, but there are many runners and several marathoners here with two leads. Just give it 4-6 weeks before you try anything high impact, and make sure you clear it with your doctor.

You will probably find that the settings they send you home with are going to need tweaked in order for you to get a good workout. If you find you tire easily or still get dizzy, ask to be checked. The standard settings are for sedentary and sick people, not young active people.

If you weren't able to do what you want to do, it was the right decision to get the pm! I also knew for years before I got mine that it was coming. That was 15 yrs ago and I've never felt better.

third lead

by golden_snitch - 2009-09-18 01:09:00

Hi Tom!

A friend of mine has a CRT device like you do, and there has never been a problem with the third lead in the coronary sinus. She's actually on her second CRT now, the first one's battery lasted about 5 or 6 years. Don't worry, from what you have told us about your diagnosis, you don't even need the third lead. I hope it's switched off because otherwise the battery life is shorter (a pacer with three leads working needs more energy than one with just two leads).

Could it be that you take part in a study? I have heard of some studies which are designed to find out if a third lead reduces the risk of developing heart failure which is usually associated with dual-chamber pacers.

About cardiac arrest: The risk of suffering a cardiac arrest due to heart block is very, very low, especially when it's "just" the Wenckebach type of second degree heart block. With the Mobitz type the risk of going into complete heart block is higher than with Wenckebach block.
Our heart has a pretty good "back-up system" even when the AV node blocks completely. The ventricles can still beat on their own, the rate is somewhere between 15-30 beats per minute. It's low, and of course you can't lead a normal life with this rate, but you won't die. There are a few people who go into cardiac arrest with a complete heart block but those often have an underlying heart disease like heart failure, cardiomyopathy, or have had a heart attack before etc.
Some children have congenital complete heart block, but may not need a pacer for many, many years. I know some, and they had their pacer implanted in their teenage years or even later; before they lead a perfectly normal life although having a permanent heart block. So, there is a backup, and you will most likely not suffer cardiac arrest.

All the best,
Inga

Third Lead

by TLRun - 2009-09-18 09:09:48

Hi Inga:

Thanks for the information!!! You obviously know more than I do about all of this. Every time it is explain to me I pretty much get lost.........I am a numbers person...an Auditor. I am lost in the medical field although my mother is an RN. Anyways, I like to take a family member with me to help me when I can....they live far away.

The doctors office initially diagnosed the problem about 5 years ago as it first showed up with my running. My times had just dropped off signifcantly and I was really struggling. The inital EKG showed the problem. Well, through time, the EKG got worse. I went through all the many tests a few times like everyone else has. On my last treadmill test, I could only reach a max heart rate of 100 bpm at a very steep incline. Shortly after that, I started to get alot of dizzy spells and thought I was going to pass out. Getting up at work from my desk and walking to the copy machine was getting to be an adventure. I would have to stop and let my heart catch up as everything was spinning. My running was a mess. My quality of life was terrible at this point. I fought the implant of a pacemaker for 5 years.
So anyways, I am puzzled about the third lead. The best it was explained to me is that is needed to resync my heart. I just started back running yesterday and feel much better already although I am out of running shape now...LOL. Going up the stairs is a breeze and going to the copy machine is a piece a cake.

I try to ask alot of questions and know I drive them nuts at the doctors office. I delayed this for as long as I could. My resting heart rate was down to 34 but this is somewhat misleading because I am a runner. But again, they stated the risk of cardiac arrest was very high for me with my deteriorating condition. I am probably leaving something out.

I appreciate any input!!

Thanks!!!

Tom

out of sync

by golden_snitch - 2009-09-19 03:09:06

Hi Tom!

Oh well, that sounds awful, but I can understand why you fought the implant for five years.

If they told you that the CRT was needed to resync your heart then there probably was something wrong with your ventricles because they normally beat insync even when you have a heart block. And this beating out of sync then surely has put you at a higher risk for cardiac arrest. As I said one can go into cardiac arrest with a complete heart block but it happens not very often. It's usually a short cardiac arrest, you pass out, but then the ventricles kind of re-start the heart with this low back-up rate. Unlike when you go into cardiac arrest due to ventricular fibrillation (chances to survive that are lower).

One has found out that dual-lead paceing can be linked to heart failure. It happens that the second lead in the right ventricle paces too much although the av-node is working most of the time ("unnecessary right ventricular pacing"). Studies have shown that patients who have this problem, more often develop heart failure than patients who are not paced in the right ventricle or have a very low pacing percentage in there. Of course, for patients who have complete permanent heart block the risk is there, too, but it's harder to work this problem out since they really need 100% pacing. Anyways, what I wanted to say is that there are studies and new approaches to reduce the risk of pacing related heart failure, and I have heard that some patients who do not have heart failure, yet, still get the CRT device just to make sure that their ventricles stay insync. Also, a study has just been published that shows the benefit of a CRT device for patients with mild heart failure (EF still higher than 35%, normal is around 60%, people ending up needing a transplant sometimes only have 10% or even less).

If you want to find out if you really need the third lead, then you can probably ask for a treadmill test with the third lead switched off and one with it switched on. If you feel even better with the third switched on, then leave it like this. If the third lead doesn't make any difference, you could think about switching it off as this would prolong battery life.

Happy running! I'll go and see the Berlin Marathon tomorrow :-)

Inga

Yes you can!

by Cyborg Runner - 2009-09-19 07:09:58

Please read through my various assorted posts, I have written about my various running exploits over the past year. I had my pm implanted last August during a catheter ablation gone awry. I had two more ablations after that to finally correct my arrythmia, Two weeks after my 3rd ablation I ran a 20:54 5K, not blazing, but considering my down time, proved that I was going to come back.
This past weekend I ran on an ultra team in the Blue Ridge Relay, I covered 6 legs in 24 hours, 33+ miles.
The answer is definetly yes, you can come back, more than likely faster than before. Stay insistent with your docs. I am fortunate that the leading doc at my cardiology clinic (the Sanger Clinic in Charlotte, NC) is a competitive marathoner and runner, so he "gets it".
Best of luck to you. You are your own best advocate.

Thanks Cyborg Runner

by TLRun - 2009-09-20 11:09:09

Hey Cyborg!!

I have read through your various postings. Amazing!! I am impressed that you made it back so fast. Did you have soreness and such coming back so fast. I am back running after 3 weeks post implant surgery. It is going well but getting soreness at implant area.

As I explained at my doctors office, I did not want my running to suffer. They explained it would better which it is, just still recovering though. Unfortuanetly, my Cardiologist(pacemaker) is not a runner. He tries to understand but he is pretty impatient and doesnt have much for bedside manners. The good part is that the Nurse Practioner who is just a wealth of knowledge is who I see most of the time. She is a swimmer so she understands it. Also, she is in complete sync with the doctor on what should be done. Actually, I think the Cardiologist is much more agressive than her.

Anyways, this site has given me more information than any web site or literature I read...I did alot of research. It is great to find fellow runners!!

Thanks For the Input!!!

Tom

Thanks Inga

by TLRun - 2009-09-20 11:09:32

Hi Inga:

Thanks for all your great information!! You are wealth of knowledge and support!! I really appreciate it. Again, I am kind of lost on all of this but learning the terms and such. Not that it is has never been explained to me many times, I just get kinda lost.

Yes, I am going to do a treadmill test in few weeks and see what is going on. In the meantime, I am going to wear heart rate monitor during my running to see what my heartrate is during my running. That third lead does puzzle me to no end!!

Berlin Marathon??? Cool!! I watched the World Championship on T.V. as they were from Berlin. What a beautiful stadium. Where you there? I was in Germany about 20 years ago....Frankfurt, Stuttgart, Heidleburg and yes I went to Munich for Oktoberfest. I enjoyed the Chicken and PomFrittes(am I close on that one?) I really saw alot of the country just by running from small town to town. Very picturesque and green.

Anyways, I am back running.....slowly. I feel great but getting some soreness from the pacemaker area. Oh well!!

Take Care

Tom

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