Does running and other high intensity exercise cause heart electrical issues?

As a comparatively unfit male who got his pacemaker as a result of surgical complication, I have been surprised how many runners, cyclists and others whom I would generally consider "fit" are on this forum having had a pacemaker inserted, or told they need one. Do activities that push the heart to high rates end up causing electrical problems? A little Googling suggests that it can: 



by Mad Hatter - 2023-02-11 21:50:34

I fit the moderate exercise category but I remember Jim Fixx, one of the first to promote running as a defense against heart disease, but who unfortunately died of a heart attack.  The below article suggests a connection between running through pain and discomfort, which most runners have learned to do or they wouldn't keep doing it for long periods of time.  Not sure about the connection with electrical problems though.


by Tracey_E - 2023-02-11 22:20:21

It's probable that very high intensity levels for a very long time can cause issues. This applies mostly to elite athletes, not your average Joe weekend runner. The benefits of moderate exercise far outweigh the potential risks.


Exercise vs Electrical issues

by AgentX86 - 2023-02-11 22:58:52

Yes, this isn't the first time the link between electrical issues (primarily Afib) and endurance sporrs has been shown.  The as the artical said, it has  to do with the enlarging of the heart as muscle builds to support the level of exercise.  The enlarged heart causes fibrosis which is the root cause of Afib.

This article goes into far more depth. Good read.

steve triathlete

by stevebne - 2023-02-11 23:33:35

An excellent question!

The way I see it, the PM is simply a tool to increase heart rate albeit through a complex series of sensors and response algorhythms. There are a large number of diseases that result in low or innapropriate HR for which PM is one of a range of treatment options. Many of those with diseases that need a PM to fix are otherwise young and fit and hence want to return to an active lifestyle. 

Personally, my SinoAtrial Node simply stopped working without any apparent reason and my heart is otherwise normal i.e. despite all my athletic activity I don't have any athlete associated structural changes. 


Yes absolutely

by PacedNRunning - 2023-02-12 01:08:13

There is a connection! It's usually attributed to endurance exercise over many years or very intense cardio exercise in a short time say around 10 years.  There is a book called the Haywired Heart. It's all about just this. I have exercise induced 2:1 block. Which means I rate related AV block. Structurally my heart is normal and fine. One theory of my heart block is many years of endurance exercise. It's the only association I can find for my sudden development of this block. I'm no elite athlete, however I've participated in sports since I was 14, played in college and have been active throughout my life. So could be the cause. Or some virus in the past. But endurance exercise can cause fibrosis in the heart which causes a disruption in th electrical signals in the heart. I still exercise but not as long or as intense since my PM


Exercise induced arrhythmias?

by Gemita - 2023-02-12 03:47:21

Hello Andy, are you feeling so well with your replacement pacemaker that you are thinking about doing some serious exercise?  Perhaps you need to think again!

Yes I believe intense exercise can trigger unwanted electrical disturbances, but so is the opposite true - a falling heart rate when we slow down, either due to age or to illness, can certainly spell the start of our electrical disturbances too.  

Exercise induced cardiomyopathy is most definitely a risk factor for electrical disturbances of the heart but there are many other triggers/causes as well.

By the way, both hubby and I were dancers when younger and we both have electrical disturbances, but ageing itself was probably the main factor and none of us can prevent that, can we?  Although my electrical disturbances are mainly triggered by slowing heart rates (according to my medical records), they can clearly worsen during exercise, so it is not in my best interests to push harder and harder at these times.  In any event, I would soon get uncomfortable symptoms to tell me to slow down or even to stop.

I have learned to "pace myself" over the years and not to do too much on one day and suffer the next.  With falling heart rates as my main trigger for electrical disturbances, a pacemaker has been an excellent treatment for me.

Your link was very helpful Andy, especially the suggestions at the end for a safer exercise routine.  Hope you continue to do well

Thank you for the contributions!

by LondonAndy - 2023-02-12 06:34:10

Interesting comments, and yes, though I am fine wit the pacemaker,  Gemita I don't think I will be increasing my exercise regime THAT much!

long term endurance training

by trashcan1 - 2023-02-12 07:13:16

As pacednrunning stated there is a book "the haywire heart" it goes into detail about long term endurance training.After reading the book It got me thinking and I actually cut back on the amount and intenisty of the training that I do. Since Im already wired I don't know if it will help.But it did make for interseting reading.

Endurance training

by Penguin - 2023-02-12 09:59:09

'Although regular physical exercise is beneficial for reducing cardiovascular morbidity and mortality, different exercise activities cause anatomic adaptations in athletes’ heart structure. Those are associated with atrial fibrillation (AF), alterations in the autonomic nervous system inducing early repolarization (ER), chronic systemic inflammation, and fibrosis (Guasch et al., 2013; Wilhelm, 2014; Harada et al., 2015).'


'Large population-based studies confirmed an association between increased cardiac risk for all-cause mortality and the prevalence of ER pattern in middle-aged subjects (Tikkanen et al., 2009; Sinner et al., 2010). The association between the occurrence of heart rhythm abnormalities, such as the occurrence of AF and the peak performance during cardiopulmonary exercise testing (CPET), has been reported in different groups of athletes, mainly focused on endurance sports (Maron and Pelliccia, 2006; Aizer et al., 2009; Sorokin et al., 2011; Guasch et al., 2013; Wilhelm, 2014).'


by doublehorn48 - 2023-02-12 13:13:43

I believe inactivity is much  worse than activity, especially as we age. Seeing as you have been inactive and have had some heart issues it would seem best that you ease into any activities that you may start. I would see my cardiologist about appropriate exercises. 

Agree with doublehorn48

by LondonAndy - 2023-02-13 03:14:19

I am not sure I have been inactive, but nonetheless I agree that exercise is beneficial. It is all about achieving the right balance, as with many things in life.

Endurance Training

by RogerK - 2023-02-19 19:17:25

I have been swimming competitively for over 55 years.  When I had my first rhythm episode, the ambulance attendant said that they see it a lot with long-term athletes.  When I had the PM implanted the electrophysiologist said that he sees it on both ends of the bell-curve - a) people who are 'horrendously' couch-potatoes, and b) in-shape athletes.

A second consideration is that fact that this is a website for PM recipients and you are in an Exercise and Sports forum.  I suspect pretty much everyone in this section of the site a) has a pacemaker, and b) is a very active person just by nature of the Exercise/Sports interest-group.  You are observing questions and comments from a pretty narrow group of people.


Exercise post implant

by BMM262 - 2023-03-02 22:13:05

Hello All. New to the PMC and glad to have found this forum. Came in search of insight from other marathon runners who continue to follow their passion post implant. Encouraged by what I've read here so far, including the concensus that while exercise is a good thing, too much of any good thing is a bad thing. 

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