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Avatar universal

SVT correlated with slow HR recovery during moderate exercise?

Hello everyone.  I am a 45 year old amateur bicycle racer in excellent physical condition, with pSVT, self diagnosed.  I have episodes 3-4x per year.  

My resting HR is about 48 bpm, and my max HR is about 182.  During an SVT episode my HR will go over 200.

The trigger is always the same: a hard physical effort that abruptly transitions to a lesser effort (for example, climbing a hill and reaching the top).  I had an episode today just after climbing a big hill.  The HR monitor recorded an immediate jump from 120 to over 200, and an immediate recovery to 75 when the episode ended.  I have attached an image of the HR recording.

Valsalva has never worked for me, at all.  The only way to stop the episodes is lying flat on my back.  After I lie down the episodes always end within 30 seconds.  The episode today lasted over 5 minutes because it started while I was cycling on a busy road and I had to get to somewhere I could lay down safely.

I have lived with these episodes my whole life and consider them a nuisance, but I do not get anxious or panicked.  I have never considered pharmaceutical treatment or ablation.

My question is specific to HR behavior during vigorous exercise, and is somewhat technical.  Lately I have been comparing my HR recordings to other members of my racing team.  My HR recovers quickly and normally when I stop exercising completely.  But when I transition from a hard effort to a moderate effort, my HR remains much higher than my teammates.  

For example, when compared to a teammate of the same age, if we do a hard effort together (like climbing a hill in a bike race), both of our HRs will hit 175-180.  If we then transition to an easy effort (like coasting down a hill), both of our HRs will quickly recover to 100.  But if we transition from the hard effort to a moderate effort (like maintaining a tempo paceline after the hill), his HR will drop to 130 within a minute or two, but mine remains around 155.  This is a disadvantage for me, because it means I run out of energy sooner.

This difference may be simply a result of individual physiologies, but I was wondering if there could be some correlation between pSVT and the slow HR recovery during moderate exercise.  There is a lot of information online about HR recovery when stopping exercise, but I can't find anything about HR recovery when transitioning from a hard effort to a moderate effort.  

If it did turn out that there was a correlation, ablation would become much more appealing to me, because it would mean a concrete improvement in my athletic performance.

Thank you for any insight!

15 Responses
1807132 tn?1318743597
Gosh you know I never investigated my avnrt that closely.  I do believe that when one has an episode that the heart will likely be a bit agitated afterwards.  I know I have a tendency towards a higher than average heart rate but I am a small woman so this is common for my body type.  I have been exercising more regularly over the past couple of years and it seems my heart rate is lowering but I can't say for sure it is lowering because I had my svt corrected.  It actually kind of seems it is because I exercised for a good year or so before I did the ablation and I don't know that I saw a difference in my heart rate or ever noticed it going into the 60s and now after the ablation it does but again I can't say that with all certainty because I didn't make a conscious effort to evaluate that.  Though I could not at all tell you if there is a difference in my recovery time because that I really didn't pay attention to.  What I will say about the recovery is there is a high probability of one getting ectopic beats during it and ectopic beats, pacs or pvcs, from what I understand is the main trigger for one falling into accessory pathway svts which classically start and stop on a single beat which is sounds, based on your description, happens to you.  Of course you will need to get this verified, get your issue diagnosed by way of a monitor to be sure what exactly you have but it does indeed sound like an accessory pathway svt like avnrt, avrt or wpw.  What I will also say is it won't go away and will likely get worse as you age.  Mine got worse as I got to my forties though you are around my age and in really good health so that may bode well for you as well your pathway may not be as prominent for some anatomical reason.  So if you do know a sure fire way to get it to stop and it doesn't get worse on you then there really isn't a need to correct it.  Your heart should not incur any damage so long as you manage the episodes responsibly which it sounds like you do.  But it also sounds like it does disrupt your cycling so for that fact you may want to do the ablation.  Either way I do think you should be looked at and see if you can at least get it evaluated so you know what you are dealing with is simple svt and not something else.  Chances are that is what you have but it is always best to let a doctor make that call that your health is not in danger.  Then at that point you can decide how to proceed.  Well, I am not sure if I actually answered your question so maybe someone will jump on who is an avid exerciser to give you more info on your question but what I will say though this was not really evaluated scientifically by keeping notes or anything but it does seem as though I am able to push myself harder now that I had the svt corrected if that is worth noting or not.  Ok, take care.  I wish you the best.
1807132 tn?1318743597
I will also add, if you do have pacs or pvcs you will likely not get rid of those if you ever do choose to do an ablation to correct your possible svt.  Just to let you know it is a completely different condition and issue that most people have at some point but they are very benign and even less of on heart then then svts are.
1807132 tn?1318743597
Sorry that should have read "...and even less of a threat on the heart than svts are."
1423357 tn?1511085442
I don't think SVT determines the rate of your recovery.  I also think that when comparing your recovery to your teammate, you're within an acceptable window of variation.  Another, perhaps frank way to explain it is he's just physically better that you.  That's why we can't all be champions.....

I went through exactly what you're experiencing.  I raced back in the "dawn" of organized US cycling competition.  I started out in road racing, but too many episodes of SVT prompted me to switch to track sprint cycling.  In off season, I did short track speed skating.  I have a couple of pictures on my page.  I had excellent recovery times with the SVT.  Ironically, a criterium on city streets ended my racing career when I crashed badly in a corner when someone caught a crank and when down in front of me.  I suffered a badly broken and separated shoulder.  At 30 and with a family, I could no longer risk injury for a trophy.
1423357 tn?1511085442
One other comment I wanted to make:

Consider ablation.  I had serious SVT 3-5 times per month from 6 to nearly 60 years of age.  My rate were anywhere from 200-250 as an adult.  As a kid it was once clocked in the hospital at 312bpm.  I was very good at my chosen sports, and without a doubt it prevented me from attaining my full potential.  Now...you and I are well beyond our core competitive years, but like you I participate in an "old men" skating division they respectively refer to as Grand Masters (ha!),  Cardiac ablation gave me the life that I should have had. I vowed that even at 60, I was going to go full tilt until the end.  You have 15 more years than I had.  Don't wait.  Get it taken care of!
Avatar universal
Thank you so much for the comments.  tom_h, your observations are spot on.  My default assumption has been that my recovery times are slower than my teammates because my fitness is not as high, but I wondered if perhaps the SVT was a contributing factor.  Your experience is that SVT is not correlated with slow HR recovery times, and that's exactly the information I was looking for.  In other words, I have only my fitness to blame.

Your SVT was much worse than mine.  I only have episodes 3-4x per year, and (knock on wood) have never had one during a race, although several times I have had to interrupt group training rides for a lie-down, which is slightly embarrassing but not really a big deal.  At its current frequency I would probably not do ablation, but I will start the process of seeing an electrophysiologist to get properly evaluated, because if the episodes become more frequent that would change my opinion.

In cycling, we just call the old men "masters", because cyclists are not as grand as skaters.  :)

Thanks again, I can't tell you how much I appreciate the infomation.
1423357 tn?1511085442
No problem....  I know what you mean about embarrassment.  In a newspaper article, I was once described as "....and Tom H left his heart in San Fransisco".  How could a nationally ranked cyclist and skater have a heart problem?
Avatar universal
I went to the doctor this week and had blood work done that shows low HCT (the number that endurance athletes want to maximize) and indicates mild anemia.  I see some online references that anemia can be an SVT trigger.  I'll start taking some iron supplements.
1423357 tn?1511085442
Please be careful with the iron supplements!  Males can't get rid their bodies of iron like famales can.  I actually donate blood to keep my iron levels in check, and take a daily aspirin which helps to "leak out" a little blood daily.  Too much iron can lead to premature aging and diseases such as arthritis, cancer, cataracts, diabetes, osteoporosis, and retinal, liver and brain disorders.  I would definitely consult with your physician before taking iron supplements.  Did he speculate why it was low?  There are quite a few factors beside iron levels that could yield low HCT.
Avatar universal
Follow up:  I met today with an electrophysiologist at the Heart Center at Vassar Bros hospital.  The facility was amazingly well-run and professional and the doctor was the best doc I've ever dealt with.  After an EKG and exam, he gave a very forthright, detailed, straightforward explanation of  my likely condition and surgical options.

He said the condition is almost certainly AVNRT.  At the frequency of my episodes (3-4x per year, lasting for a few minutes each), the doctor advised against ablation.  He said plainly, if it meant you would never have a cardiac episode again, would you take a 1 in 500 chance of needing a pacemaker?  My answer is no.

He also said there is no known correlation with athletic performance or heart rate recovery times.

I was interested to learn that although AVNRT can worsen with age, it can also get better or clear up entirely.

If anything changes over time, I'll follow up more, but that seems to be the end of the story for now.
1398166 tn?1358870523
I had the same condition as you... same age. I run - you bike...
Prior to running the freqency for me was 1/month... every other (not much). My Valsalva was to squat and control my breathing. Once I started running, it was twice a week (or more), and the episodes were becoming uncontrollable.

Keep an eye on it. I tend to doubt it will get worse as the condition is congenital, but exascerbated by the maturation process (and activity).

That being said, I think your doc gave you good advice. It's not a problem,  until it's a problem. If it becomes problematic for you then seek a solution. I also agree, HR recovery is generally not affected by SVT. Your graph looks pretty typical to my (SVT) Garmin HRM graphs... immediate spike... and then an immediate recovery to a HR that is typical of what I would expect after a "normal" recovery.

Good luck. Stay safe on the road!!
4760166 tn?1398357313
What heart rate monitor provides you with the spiffy chart?  I don't know if any outcome is concrete with ablations but I wish you luck in whatever you decide!
Avatar universal
The_beat_goes_on, there are several web sites and apps that can graph the recordings of athletic HR monitors.  The specific graph at the top was from Garmin Connect.
1398166 tn?1358870523
I changed my profile picture to one of my worst runs' HRM graph. This is from a Garmin Forerunner with the activities uploaded to Garmin Connect. Love running on a GPS!!
Avatar universal
Holy cow littlegreenman1, I assume you have taken steps to correct those episodes?  3-4x per year is a nuisance, but 4x in 10 minutes must be a very serious detriment to your quality of life.
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