1078286 tn?1423609114

How Serious (CPVT, multifocal PVC's and NSVT runs)?

I have been a serious competitive cyclist for 30 years. I had EP's and ablations twice for AF. Based on a yearly activity monitor used during cycling a cardiologist did an EPS and the next day inserted an ICD which I deem to mean possible serious ventrical problems. My echo's showed good function. At  rest I have normal sinus rhythm. My EP has apparently never treated an endurance athlete with a strong fully functional heart. I have started Flecainide 100 mg per day. My research found European studies of pro level cyclists with some of the same problems I have. The ones with no CVD didn't die from the ventrical arrhythmias in the period of the study. I am not wanting to give up cycling but think the Doc;s proposed Flecainide with Beta Blockers will destroy any possibility of remaining competitive. I am 72 and can still keep up on the training rides. I am wondering if the ICD is enough to insure survival if I get a ventrical tachycardia? Currently they have lasted for a max of 6 beats.I am trying to learn about this condition as much as possible. fastcarbon
4 Responses
1423357 tn?1511085442
Have we talked before?  I think not.  Many years ago, I was a nationally ranked amateur cyclist, specializing in sprint track cycling.  Ironically, a very bad crash in a city criterium effectively ended my amateur cycling career.  I crossed trained with short track speed skating, and excelled at that for many years.  I'm still coaching today and competing in an old man's division.

At 64 I'm less concerned about winning today than I was in my younger days.  I take beta blockers as well, and find that I can put these old man balls to the wall, but that it requires more warmup than before to get my heart of to speed. If I go out there and push it with a thorough warmup, I get that cinder block weight feeling in the chest.  Definitely, Flecainide and beta blockers will take you off your top form.  I cycled and skated for many years with any medication for my SVT for that very reason.  I was also concerned about blood testing as well and didn't want to  infuse any doubt whatsoever in my performance.

I looked at it this way:
I was having a great time competing and had a case of trophies and medals to display.  But was I benefitting monetarily from this?  On the contrary, I was flying or driving about the country on my dime.  Age was beginning to stifle my performance, and when I realized that, my family and health suddenly became more important.  I began with beta blockers, and eventually ended up in the cath lab having an ablation for my lifelong SVT. I think you have to put priorities into perspective and do what's best for your health.  I'm in really good shape for 64 (see my photos), but light years away from the superb condition that I was in during my competitive days.  I offer to you that while I still feel like that today, the kids can still blow my doors off while barely breaking a sweat.

I'm wondering if you have received any ICD intervention yet?  I've been told it's like some coldcocked you in the chest, and quite unpleasant as well as dangerous if you happen to be on your bicycle at the time.

995271 tn?1463924259
ICDs are pretty good at shocking VT back to baseline.  It's not perfect though.   My understanding is that they do not directly detect VT.  The threshold to shock is based purely on rate, and this threshold rate is set by your doctor, and it usually requires some tuning to prevent false-positive shocks.   You have to know what your VT rate is, which to me, doesn't sound like a pleasant set of testing to get through! Since you still hyper-train, your training rate might be higher than your VT rate.   very complex, will require a lot of tuning, trial-error.  makes my head spin.

The other thing I've heard, is that certain types of arrhythmia become more common the longer they sustain.  Somehow the electrical pattern becomes imprinted.  

I used to hyper-train in my 20s-30s.  It was tough walking away from the competitive part but I'm in a better place with just a moderate amount of  healthy exercise.  There's the point where it is no longer benefiting health and becomes destructive.  That's when it's being done for achievement, not for health.  But I think some people may still have the expectation that more is better.

1078286 tn?1423609114
Great to hear from you. I haven't received any indication that my ICD has fired. My greatest concern is that I may be giving up too much based on an EP that acknowledges he has never seen an EPS like mine and has no endurance athletes in his patient lists. He was educated at UCLA, Stanford and Yale so has credibility but I am concerned with his lack of specific experience.
1078286 tn?1423609114
I got the ICD a week ago and am not allowed back on the bike yet. I am not really concerned about a few jolts to set this thing up properly if it allows me to train up to my max heart rate. A rep from St. Jude dis a setup with a laptop which she called "pacing" where I felt the heart speed up twice. I see the EP next week and you can be sure I will ask plenty of questions. I am doing as much "google research" as I can. As the Doc has never treated an endurance athlete my main concern is that he may be too conservative. I do wonder if anyone out there has found a cardiologist who has worked with high performing endurance athletes with similar electrical issues?
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