Any other mountain bikers?

Hi all-

I'm now 2 weeks post-op from my placement of my Boston-Scientific ICD (Resonate EL w/ dual chamber pacing capacity).  I'm a 43 year old w/ no known health issues.  I mountain bike competitively, and had just finished a big training block and mtb stage race the month before this happened, and felt stronger than I had in my 20's. 

On the day things happened, I felt great. I had done a 4 hr trail ride the day before, but am pretty diligent about rehydrating/staying up on my nutrition, and didn't feel anything in terms of symptoms that things weren't right. I stayed late at work that day for a meeting. In the meeting, while entirely at rest, I had a witnessed cardiac arrest. I'm a nurse anesthetist, and my coworkers present were 3 other nurse anethetists and an anesthesiologist, w/ a code cart & defibrillator immediately available.  We work at an outpatient surgery center directly across the street from the large academic medical center that we are affiliated with.  They got a perfusing rhythm back after 6 minutes of CPR, 3 shocks, and a dose of epinephrine.  
 

I'm super lucky to have been where I was and with the people I was with. On a regular day, I would have been by myself, riding my bike in the woods or driving home. I am so grateful for that aspect. My work up didn't show anything crazy-- clean coronaries, mildly suboptimal electrolyes, but the primary culprit is thought to be mitral annular disjunction (diagnosed via both U/S and cardiac MRI, and found to be 7 mm). I had never heard of it before, but have since read way too much about it, and it fits w/ what happened.

Now that I am in the aftermath, I'm trying to figure out how things will play out. I was started on nadalol for antiarrhthmic benefits, and it dropped my HR to the mid-30s, which was tolerable/could still maintain reasonable BP while lying in a hospital bed. But it did mean that I needed an ICD w/ pacing functions, and I am currently paced w/ a back up rate of 50.  Each day has gotten a little easier, in terms of feeling more energetic, and I am up to walking 5-6 miles a day. But I really want to see how it will go to get back on my mountain bike in the next month or so. 
 

1)  Anyone mtb and feel like their device interferes w/ arm/upper body movement on the bike? When I ride, I feel like I stand about as much as I sit, and there is a lot of variable strain on my arms, particular on climbs/techy terrain compared to road/gravel biking.

2) How do HR zones compare? Am guessing that everything will change, and that I will not be competing at the same level that I did previously. Are you still able to generate similar power/intensity on a beta blocker, even if it is harder (read: impossible) to hit same max HR?

3) Do you wear anything protective over device while riding?

I'm overall feeling okay, but have def had some moments of feeling really down about the life changes. I'm optimistic that I will be back to riding my bike-- I have a big bike trip w/ my husband planned for September, and my cardiologist told me that I should definitely plan to still do the trip, so I have his blessing! But this transition period is a little rough.

5 Comments

Welcome

by Gemita - 2023-06-01 09:17:54

Just wanted to welcome you to the Club after your frightening experience. As you say, you were certainly in the right place and with life saving colleagues when it happened.

I had never heard of a Mitral annular disjunction before seeing your message, but I see it is a structural abnormality of the heart in the mitral annulus ring, generally defined as an abnormal displacement of the location of where the posterior mitral valve leaflet inserts onto the left atrial wall and the left ventricular wall.  This abnormal attachment allows the mitral valve to become hypermobile which can result in ventricular arrhythmias.  I attach a link which you or other members might find of interest, (if you haven’t already seen)!  Please copy and paste into your main general browser to open.

Your progress will depend I suppose on how well they can keep any ventricular arrhythmias controlled with meds in the future, to prevent any unnecessary shocks, as well as watching your condition and looking out for any other mitral valve diseases.

I hope any meds you will be given will help to calm any arrhythmias without causing difficult symptoms which might prevent you from reaching your full potential to really enjoy your sport.  There are quite a few mountain bikers here and I hope they will see your post and can help to answer your specific questions.

As a member with arrhythmias and on a beta blocker, I do find they reduce my capacity to exercise and tend to make me feel quite lethargic and “heavy” a lot of the time but working with my doctor I have been able to find the right dose and medication to suit.  Beta Blockers, especially at higher doses are not always well tolerated, so it will be trial and error until you find something to suit you while keeping you safe.

Many members find they are able to compete at the same level as before their implant, depending on their general health and heart condition of course, so I see no reason why you won’t be able to challenge yourself again and enjoy your sport Sparky once you are fully healed.  You sound extremely healthy to me and that is the way you are going to stay

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9411994/

welcome

by Tracey_E - 2023-06-01 10:57:16

1. As you heal more, it should settle in so it's less in the way. 

2. Your zones will be completely different now. Unfortunately learning them will be like starting over. It will take weeks, possibly even months, to adapt to the beta blockers.  I tend to ignore the numbers and go by how I feel. If I can talk but not sing, that's where I want to be. What my rate is at that level of exertion varies. 

3. I do not mb but am very active. I have never bothered with any type of protective gear. They are made of titanium. I've taken some hard hits. Once I snagged the edge of the box while scaling a wall in Spartan race. We will bruise up long before the box sustains damage. 

Check out this facebook page. It is full of competitive athletes, including mb, who have come back from a wide variety of cardiac events. 

https://www.facebook.com/groups/cardiacathletes

mountain biking

by Julros - 2023-06-01 20:31:03

Hi Sparky, 

You are the same age as my son, and he enjoys mountain, road, cyclecross and gravel biking. His device is subpectoral, so that his backpack doesn't rub. He's had ups and downs, but mostly ups. He takes a low dose of beta blocker (metoprolol) and can do what he wants. His main issue is avoiding broken bones and collisions with automobiles. He doesn't have any extra protection other that a helmet and gloves. 

I personally have chronotropic incompetance, so I depend on my pacer to speed me up. Unfortunately, road biking is not well detected by my device, so my cycling heart rate is 80, but walking is 110. I could see if the clinic could fine-tune, but the tech won't listen and I'm tired of arguing with her. 

Hopefully, your clinic can get you dialed in, although it may take a few visits. 

Biking

by The Rose - 2023-06-04 02:19:06

Hi Sparky,

Delighted you were blessed and are still ready to go.

Switch to a very different clinic for adjustments.  That said, your pacer leads need to cure, so if you ramp up too fast, that may cause issues down the road.  If she refuses, ask why or call the device maker.  I found many more questions were answered from the actual device maker.  They can't give medical advice, but they can explain settings.  You may be unique to that technician.  Now, my doctor is my technician.  

I have a speed bike, so I'm hoping this assists you, realizing we sit in different riding positions.  However, I also frequently bike hands free at lower speeds, so my position a bit equivalent.  My normal speed is about 16 mph to 21 pre-surgery, and coasting is 13 mph (unless some very handsome Marines are training on the path, but then I'm guessing my heart beats much faster during that exercise... lol).  

I've biked once since my surgery, and then only did speeds between 11 and 14 mph.  It was fine regarding arms/shoulders/neck/chest.  I did 5 miles total.  However, it wore me out completely and I struggled the entire time with breathing and a bit of heart.  I'm still not able to do all the exercises and physical bits from pre-pacer. 

That said, on bike day, the dr indicated that my heart raced up to 150 about 1/2 hour before I started biking and was fine during and after biking.  I'm guessing the heart race up was due to my "saddle up" again excitement.  

My pacer was installed at end of January and I'm still not feeling well.  But I'm an anomaly.

I know you'll do fine with your mountain bike and wish you many wonderful experiences during your healing and beyond.

The Rose

Hello

by nickhu - 2023-06-15 19:38:53

Hi

I haven't been on the forum here for a while but I thought I'd check to see what was new and saw your message.  I'm a qualified cycling coach, ex state champion mountain biker and I also race and ride cyclocross, gravel, road etc.  I've ridden and raced my whole life.  I got diagnosed with SSS a couple of years ago and had pacemaker implant Feb 2022 (Boston Scientific).  It was definitely quality of life changing and got me generally back to feeling like I did pre-HR issues.  To answer your questions:

Interfer with upper body movement - no, not at all but takes a few months to get used to.

HR Zones - I'm not sure about with an ICD, I imagine you'll need to retest to set your limits when you are feeling up to training again.  For me as I had bradycardia HR zones are meaningless now I have a PM so I use powermeter on all my bikes. 

Protective device - no.  Thought about it quite a few times as pretty sure it would hurt like hell if I landed on it.  I have crashed a few times off road but normally I land on my elbows (very scarred) so landing on the inside of my shoulder is less of a concern.  I did rig up a foam disk and shoulder strap thing at first to put on before descending but I ended up carrying it and never putting it on.  My latest thought is to sew up a compression undershirt with G-form hip pad, havent' done it yet though.

 All I can say is it took me a while to get my head around the idea of having this thing inside me and I put off surgery for months, however once I made the decision I can honestly say it was the best thing I ever did.  One thing I would say is that it takes a while to get it dialed in, I had to go back to the tech 4 times so far to get it adjusted and it still isn't perfect - I find after about 2hrs the PM decides I have had enough fun and stops increasing my HR as it should for a while, during which time it is really miserable riding.  Then it seems to kick back in and it is all good.  Have an appointment in August hoping to get it sorted then,  Minor in the overall scheme of things.

Let me know if you have any other questions on cycling with a PM.

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