Exercise induced AV Block

Hi. I was diagnosed finally with exercise provoked second degree block with 2:1 conduction. I started having symptoms in October 2017. Caught me off guard. I was running and then all of a sudden I got non stop palpitations. A little about me. I’m 46, active. I love running, golf, hiking and biking. I just like to be on the go and always out doing something. Since this started it has slowed down my activity. I had to learn to back off my intensities during workout in order to have a workout with out triggering a drop.

 

Doc originally thought it was SVT Focal AT based on the kardia band strips I would send him. Went for an ablation, came out with no ablation, no inducible SVT but a heart block. Rate related block. Yes, totally caught him off guard. I did ask a few times before my EP study if it was block. He wasn’t convinced until the EP study. 

After the study, he wanted me to do the stress test again except go as long as I can. By this time, I had been deconditioning myself to not trigger symptoms will working out so by the time I did the stress test again, it took forever to make it happen. I eventually gave up during the test. I did have intermittent 2:1 block but not sustained like I experienced before the study. Before I would drop from 150-75 and it would last about 1.5 minutes before returning to tachy. I can feel it when it starts and stops. 

 

Since then I’ve tried to gradually go back to my preintensity workout routine since I’ve done a great job of making it through workouts with no trigger. It’s not going so well. I’ve already started to notice a decrease in tolerance. I use to run 9:15/mile pace and I’m down to 10:10/mile. I do run: walk method so I use to run 4:1 (4Min run, 1 min walk) now I’m down to 2:1:30. Sometimes I can make the full 2 mins without triggering and others times I can’t. 

 

If anyone has this can tell me if I deconditioned again could this go away? My doctor said I will need a pacemaker but since I didn’t sustain 2:1 block during the stress test, I can hold off for now. I really don’t want a pacemaker. Anyone have experience with this resolving? This condition is so uncommon. I’ve read as many posts on here as I can but haven’t seen any about deconditioning  to see if it will resolve 


7 Comments

deconditioning

by Tracey_E - 2018-05-25 16:42:18

Another way to look at it, why would you choose to decondition when you could fix it and stay in top condition? In the long run, the best thing we can do for ourselves is stay in shape, keep our heart muscle strong. No one wants a pacer, and if you are borderline you can take your time and think about it, but if it's keeping you from doing what you want to do? I'd get it fixed, ymmv.

Heart block does not resolve itself. It's a breakdown in the electrical signal. That signal is not going to come back. It typically stays the same or, more common, gets gradually worse. You may have some success at limiting the triggers, but fixing it is virtually unheard of. Most people try to work around it as long as they can then end up paced. I avoided it as long as I could. Once I was finally paced, I realized it was easier than I expected, I felt better after than I'd ever imagined, so I questioned why I waited so long. My advice now is when it limits what you want to do, just bite the bullet and fix it, then get back to your life.

Tracy.

by PacedNRunning - 2018-05-25 19:07:48

Thanks for replying. I do appreciate your advice. There are some reversible causes of block such as Lyme disease, MI etc. So that’s why I was having thoughts it may resolve. I know I’m past that point if it were one of those causes. I also thought it could be a vagal tone issue. No way to fix that either but I was still curious. It is more work to figure out how to not make it trigger than it would be to just decide on getting a pacemaker. I agree with you, limitations are no fun and why decondition myself just to end up needing a pacemaker and working hard to get back to where I was. 

 

I waa hoping someone else tried it and it worked. I had a theory yesterday with eating food before I work out. I had worked out yesterday with no trigger. Didn’t push too hard but did do the exact same intensity as I’ve been doing and no trigger. The only thing I can think of was I hadn’t eaten for a few hours. Then I thought maybe It’s a vagal nerve stimulating the block. But your response is basically helping me be realistic about curing this and just get a pacemaker. :) 

Ugh, makes me nervous!! I think the hard part for ppl like myself getting this diagnosis is that it doesn’t happen all the time. It’s oniy with activity. Seems silly to get something like this for activity. But your reasons make sense. I appreciate it! 

 

Do you know how long you can go without getting a pacemaker? How bad can it get? Would it eventually cause damage to my heart? I ask because like others I’ve been told it’s not dangerous. But I’m sure that’s true up to a certain point. 

 

 

how to tell when it's time

by Tracey_E - 2018-05-25 22:14:36

Do you have Lyme or MI? Damage from those is not generally reversible. The only time it may resolve itself that I've heard of is when it's a result of surgery. 

The day I got my pacer, my rate plummeted to the low 20's which put me at risk of cardiac arrest. (note, I don't have the exact same thing as you, I have 3rd degree  which means I am always in block, not just on exertion) I think everyone can agree that was waaaaaay too late. I had a doctor who didn't want to do an unnecessary pacer on someone young. What's unnecessary? I got by a good 5 years when in hindsight I think I should have been paced. I was tired a lot, I was dizzy more often than not, I couldn't do any activity whatsoever. Got by, but was not thriving. When I mentioned my purple fingernails one day, he told me to get straight to the hospital. I ended up in emergency surgery, which I can tell you is not the easy way to do it. I wish I'd gotten it as soon as I lost the ability to do what I wanted to do. This was before the internet so there was no way to find others like me or learn more. I thought I had to put it off as long as possible because my life would basically be over after. How wrong I was! It gave me my life back.

Are we at risk of death? No. Are we doing damage to the heart? Some. Any time we are in block, especially on exertion, the heart is out of sync which is hard on it. The atria is pumping the blood through but the ventricles are dropping the ball and not pumping it out. Any time our rate should be higher than it is, our organs need oxygen that they aren't getting. This isn't doing damage you can see day to day, but it takes a toll nonetheless.

How quickly will it deteriorate? Who knows. Some go years and years, some find themselves much worse in a matter of months. 

The other risk is it getting worse and you pass out. Not a big deal if you have a crystal ball to tell you when it's going to happen but most of us do not lol. We've had members pass out on the stairs or driving, then they had to deal with those injuries as well as pacer surgery.

There is no magic time when everyone is going to agree that you need it.  There is a long way between where I was and where you are now. I was getting by without so my doctor wanted to wait. Getting by is the key, I struggled a lot those last two years, was constantly tired and dizzy. Other doctors worry about the damage and want to pace very early even if there are no symptoms. Most are in the middle, gray area. There really is no right or wrong time, it's a judgment call and the answer will vary depending on who you ask. 

I can tell you that it's not at all limiting. Most of us heal and forget it's there for the most part. I got my first one in 1994. I'm healthy and active, there's nothing I want to do that I cannot. I do Crossfit, hike, ski, kayak, run, ride roller coasters, go ziplining every chance I get. I've done a handful of 5k's, a 10k and a Spartan this year, am training for my second half. It's just a tool to keep my heart in sync. I don't let it define me or slow me down. Take it seriously and don't rush into a decison, but don't be afraid of it. 

TracyE

by PacedNRunning - 2018-05-26 00:43:53

I truly appreciate all of your feedback. You make such good points. I don’t think my doctor is all that familiar with this so when you said there is no magic time when it’s time to get a pacemaker is so true. That is the question. It’s not if I need one it’s when. 

While trying to get a diagnosis, I had to Keep cutting back until I could figure what my tolerance was to exercise. I just remember decreasing and decreasing. My tolerance went down quick. I’m just trying to see if I go back to my pre block workout how fast it get worse or stays the same. If it gets worse quick, I will for sure get a pacemaker because continuing to be like this is no fun. It’s actully scary because the symptoms are gawd awful when my heart rate drops. 

 

Im thinking I should wear a zio patch for 2 wks again before commiting or a stress test. I can’t  say how much you have helped me sort thing out and understand what I’m going through. I haven’t gotten much answers from my doctor as far as the extent or that is not curable. He just says the treatment is pacemaker. I do trust him and think he’s really trying to help me understand and being super patient with me.  I wanted to know what extent this is. I hope to sit down with him after some more testing ie sarcoidosis and Lyme and hopefully get a better understanding that this is not going away. 

Thanks again! 

good luck

by Tracey_E - 2018-05-26 09:56:14

What we have is rare. Many cardiologists go an entire career and don't have more than a handful of young paced patients, all causes combined, so I've never held it against my doc when it felt like he was making it up as he went along. Are you seeing a cardiologist or electrophysiologist? Ep's are a better choice, they only deal with electrical problems. 

Do you wear a heartrate monitor when you work out? Stress tests are good to tell you what your heart does on exertion, but you already know what's happening, you just need to know how often it happens so the zio patch or a holter will tell you more. But you can probably tell by how you feel! It's not hard to tell when you are working out and suddenly in block, kinda like hitting a wall. 

Feel free to private message me any time if you have questions or want to chat.

Tracy E

by PacedNRunning - 2018-05-26 14:01:52

That’s the hard part is that it’s rare. I do see an EP doc. He’s the one that found it during the EP study. The first cardiologist I saw when I first had symptoms said I was fine. Told me I was having PVC’s(zio patch) not to worry. Even when I told him my heart rate drops during activity. He didn’t believe me and said it was because I was “fit”. Needless to say I found another cardiologist and he took one look at my kardia band strips and said it was SVT and sent me to the EP doc I see now. 

Lyme disease is reversible once it’s treated but I think that’s only if you have second degree block even without exercise. 

I appreciate your offer. I will be def contacting you. Especially once it’s time for a PM. :( 

I do wear my kardia band

by PacedNRunning - 2018-05-26 14:03:22

One more thing. I do wear my kardia band during workouts. I haven’t recorded much lately since the diagnosis. It will just be a repeat of what he’s seen. 

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I am just now 40 but have had these blackouts all my life. I am thrilled with the pacer and would do it all over again.