Rate Response/Beta Blocker
Background: Had a Medtronic Azure implanted in October with a lower rate of 50 bpm and upper track of 160 bpm. Rate response has been turned off. I'm an endurance runner (I do a few trail ultras a year and have two road marathons planned in 2023) and also do CrossFit a few times a week. The pacemaker was implanted for bradycardia/sick sinus syndrome/marked first degree AV block and a suspected exercise-induced left bundle branch block. There were a lot of AVNRT episodes captured on a Holter monitor prior to implant and there continue to be a lot since implant.
I'm back to running and doing CrossFit, though both are definitely at reduced effort. If I get on an exercise bike at CrossFit, it's awful. I feel like I have no oomph. Ditto a ski machine. I'm easing back into weightlifting and that seems to be going okay.
On runs, I can go long and slow and have plenty of endurance, but I feel draggy for the first couple of miles. I feel MUCH better after the first mile or two. If I get going too fast, especially in the later stages of long runs, OR if I do a double workout (two workouts in one day), the HR jacks up too high. The EP says once it gets over 180, I should assume I'm experiencing an arrhythmia and back off. Fortunately it does come down again when I slow down or stop running.
The EP and I talked it over. To address the oomph problem, we're going to try turning rate response on. At the same time, to lower the number of arrhythmia episodes, we're going to try a beta blocker (slow release propranolol 60mg.) Has anyone who's an avid exerciser tried this? What was your experience like? Suggestions on things to look out for as I experiment with this? I go in to the lab tomorrow to adjust the rate response. Haven't started the beta blocker yet.
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