Any Runners or Cyclists Out There Who've had an ICD Implanted for V-Tach?

I'm a brand new member of the Pacemaker Club.  I'm a 60 yo male, a lifetime runner and cyclist, and had my first pacemaker implanted, a Medtronic Cobalt XT DR MRI Surescan with dual leads, this June.  My basic heart history is that a few years ago it was discovered that I have scar tissue from myocarditis of the LV.  Soon after that I developed afib which progressively got worse and I had to have an abation to stop it.  The ablation succeeded.  After implanting the ICD, my EP told me that the scar tissue from the myocarditis and ablation caused the V-Tach (though I think there's more to it than that).  I'm on Eliquis, Plavix, Lisinopril, and Metroprolol.  My pacing modes are AAIR and DDDR.  Rate response is switched on.  Upper tracking rate is 140 and lower is 50.  I'm paced in the RV less than 0.1% and in the RA 56%.  Monitoring over the past few weeks has not revealed any arrhythmias.

The trouble is, I'm having a hard time finding out much information about my future as an endurance athlete who has had V-Tach and now has an ICD.

Before the V-Tach incident which led to the pacemaker implant, I went running and was a mile into my warmup when I felt faint and had to stop for a few minutes.  I'd never had that happen in all my years of running. After a few minutes of rest, I was then able to carry on with the rest of the three-mile run without incident.  Then a couple weeks later, I did a hard interval workout on my bike: 10 X 400 meters with about 100 meters of rest between.  Felt fine during the workout.  But during my cool down ride home, I felt faint.  So I got off my bike, sat down, and took my pulse.  No pulse.  I considered calling for help, but figured that this was similar to what I'd gone through two weeks earlier.  Sure enough, the sensation of fainting went away (I didn't pass out) so I rode (easily) the rest of the way home.  At home, though, I was breathing hard, like I was still in a workout.  Using a handheld cardiac monitor, which displays EKG, hr, and provides a diagnosis, I discovered that I was in V-Tach.  My hr was 235; I waited a bit, took another reading and it didn't change, so I called the paramedics.

The paramedics and ER staff failed to slow my heart rate down using Adenosine and Amoidarone, but finally succeeded using Procainamide.

I was transferred to an ICU; met with EP the next day who said he would give me an ICD implant.

7 Comments

ICD, Ventricular Tachycardia and endurance sport

by Gemita - 2021-07-28 04:31:23

Milerun, I am so sorry to hear of your experience.  I am not an athlete, although enjoyed competitive dancing when younger.  I can understand your desire to want to continue with your activities, but I would be concerned about exercise induced VT and other arrhythmias and activating your ICD if you push yourself too hard.  May I respectfully ask what advice your EP has given you so far?

Short bursts of non sustained VT for an athlete with no heart disease could be considered normal, but evidence of sustained VT and needing an ICD is more concerning and I wouldn't know what to advise.  You might try asking for a referral to Cardiac Rehabilitation.  They have some excellent therapists with sound advice and at least you can be keeping yourself "safely" fit until you and your doctors can hopefully work out the best path to follow.

I wish you luck and a warm welcome to the Club

V-Tach

by AgentX86 - 2021-07-28 12:56:51

Endurance sports are hard on the heart. Fibrosis is a common condition, though usually shows up as an atrial tachycardia (primarily Afib), rather than ventricular.

A-Tachs are usually not serious, though the symptoms can wreck one's quality of life.  V-Tachs are life threatening, which is evidenced by the need for your ICD. You have to take this very seriously, even if it means giving up your competetive sports.  Whether your conditiun requires such a drastic step is medical advice, for whihc we don't have the data or expertise to make any kind of evsluation. This is a good question for your EP.  He can either say anything from "no way!" to helping you get bsck on your legs.  he's the one to ask, though.

Limitations on Athletes with V-tach

by milerun78P - 2021-07-28 13:58:12

Gemita and AgentX86, thank you for your supportivenss.  I'm very happy to have found the Pacemaker Club and had been combing through it for several days before becoming a new member.  It has helped considerably to educate me about life with a pacemaker in general, and about the many technical aspects of pacemakers, more specifically.  There is much I still need to learn, of course.  But I'm glad to have found a place that helps me not feel so alone in this new life.

I've met with my EP several times since my PM was implanted and we've discussed short term limitations on my activities, but he's been vague about my prognosis.  I was expecting him to say that I'd have to give up my endurance sports, given what I knew about V-tach at the time, but he's willing to give me a stress test in a few weeks to see what my pacing-out setting should be.. 

My goal of this writing this posting isn't to receive medical advice or a prognosis, but to discover the experiences others have had in my situation.

ICD athletes

by Julros - 2021-07-28 18:49:56

Hi Milerun! It sounds like you have good plan with your EP with optimizing settings. 

In some locations, people who have experienced a VFib/Vtach arrest are restricted from driving for a period of time, but it sounds like you have not experienced that. 

My son, who is 42, has been found to have a genetic defect that will likely lead to dilated cardiomyopathy. He also has had an a flutter ablation, and now has intermittant afib. He has been fitted with an ICD for potential VT/VF but has not experienced that, yet. 

He is an avid road and mountain bike cyclist, and has never been told to limit activities. He is starting to pace more and has had a couple of tunings to maximize rate response. 

He is living his best life and is hopeful that effective treatments will evolve if/as his heart muscle changes as predicted. 

Biking with an ICD

by milerun78P - 2021-07-28 22:29:36

Julros,

Thank you for your posting.  It's encouraging to hear that your son is active despite having an ICD.  I wish him the best of luck.

I was restricted from driving my first weeks after my procedure, but my doctor cleared me to drive again since my V-tac was exercise induced and I didn't pass out, plus I haven't had any pre syncope since.

What the future holds?

by Gemita - 2021-07-29 05:49:43

Milerun, it was helpful to receive feedback from you and other members.  My feeling is that the answer lies somewhere in the middle of all our comments which is why your EP is probably a bit guarded in giving you a course your arrhythmias are likely to take and your treatment options.  He sounds sensible and caring.  Arrhythmias, being electrical disturbances, are subject to change at any time as we know, depending on so many lifestyle factors and health conditions present.  

You have identified some risk factors for your arrhythmias: (scarring of heart tissue and of course your endurance sports).  I also note from your Bio that you had an N-STEMI which I see is caused by coronary artery narrowing, transient occlusion, or microembolization of thrombus and/or atheromatous material.  ?Related to silent AF initially perhaps?

Intensive levels of exercise is a known risk factor for arrhythmias.  The heart is a muscle and when muscles are exercised over and above normal levels, they thicken (enlarge).  I have often heard the term “athlete’s heart” which I believe refers to a natural enlargement that can happen as the heart adapts to intense athletic training.  By itself, it’s not a disease or a medical condition and doesn’t cause harm but it can be a trigger for arrhythmias I believe. 

Perhaps a sports cardiologist/cardiac exercise physiologist would be the way to go to help you evaluate whether your symptoms are related to the sport itself or to something else?  Hopefully detraining will not be necessary, even with your defibrillator?  In any event I think to stop exercising altogether suddenly could also be harmful, although I am no expert, so a lot to think about.

From your pacing records I can see you need very little ventricular support at 0.1% and that you are certainly not pacemaker dependent.  I am pacing also AAIR and DDDR modes (pacing almost 100% in the right atrium but my base rate is set at 70 bpm).  My ventricular pacing % is very low too now.  I suffer from AF with a rapid ventricular response rate which has caused syncope and many other difficult symptoms.  I also have several other atrial tachy arrhythmias and non sustained VT.  Do not believe my RR is switched on because I do not have chronotropic incompetence (inability to increase the heart rate adequately during exercise to match cardiac output to metabolic demands).

My advice, don't panic, listen to your body and work with a knowledgeable sports cardiologist/electrophysiologist to find the best approach for you to safely continue what you love best or to learn ways to modify your sport to keep you safe without spoiling your enjoyment.  Good luck

 

Holding onto Hope

by milerun78P - 2021-07-30 19:36:08

Gemita,

Thank you very much for your comments.  You have helped me gain hope.  I'm going to give my EP a chance, but I am researching other EPs who specialize in athletes, just in case.

Meanwhile, I'm being patient, learning a bit more each day, and taking gentle walks.

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It may be the first time we've felt a normal heart rhythm in a long time, so of course it seems too fast and too strong.