DO I need EP Study?

Hello everyone,

First post from a newbie so please be gentle on me, lol.

History

I have been a distance runner for last 12+ years and ran 10+ marathons and numerous half marathons.

Couple of years ago I was diagnosed with CHD and had 3 stents implanted. Subsequently suffered a silent HA which left scarring consequently developed Arrythmia. Couple of months ago during my usual 10K run I suffered syncope out of nowhere and ended up face down first, got some facial scaring as a trophy, lol.

My cardiology team has referred me to an EP consultant, a very nice chap indeed, he has suggested I am a possible candidate for a PM/ICD. He feels that my condition falls into a grey area hence he needs to discuss my case with his team before making a final call, but in his humble opinion I must have the device.

He was asking if I would like to have EP study done to look for evidence (it may or may not be conclusive) or I would rather go for the device directly hence avoiding the ‘risks’ related to EP Study?

Secondly, he was inclined to go for the PM/ICD device rather than S-ICD, naturally later was my preference due to less complications/risks.

I would be grateful for your input.

Cheers


12 Comments

A difficult decision but ....

by IAN MC - 2019-04-23 13:56:55

If it were me , I would want as much info as possible to find out exactly what is going on.

I'm not sure What an  " EP study" means exactly. I assume that you would be fitted with an implantable loop recorder which monitors the electrical signals in your heart.

I assume that you would have ECG's to see what happens when you are exercising

I assume that you would be given a tilt-test to find out what is making you faint . Is it because of heart-rate or blood pressure ?

I can see few downsides to having EP studies done ( other than further delays and the possibility of further faints )

Also if you do end up with a device I would definitely opt for an ICD combined with a pacemaker . I find it very re-assuring to have a PM , knowing that it will never allow bradycardia to cause me to faint ;  but at the end of the day, it is your decision !

Ian  ( another distance runner )

EP Study

by mandm - 2019-04-23 14:17:37

Thanks Ian, glad to hear from another runner, lol.

I hope someone with knowledge can address that better, but from what I understood that the EP study is a test performed to assess heart's electrical system to diagnose source of arrhythmia. The test is performed by inserting catheters/wire electrodes to measure heart’s electrical activity.

The loop recorder was installed after I had the syncope episode and touch wood since then no recording of any unusual activity. No, I have not been given tilt test yet but had to do CPET (stationary bike test, like VO2Max) and they saw unusual activities when I was pushed to maximum. I reached max HR 167; I am 54 years old.

Thanks for the recommending the device, do you think there is a device better suited for distance runners?

EP Study

by IAN MC - 2019-04-23 14:37:55

If that is what an EP study involves I would want a VERY experienced guy doing it. 

I have had  "cardiac mapping ' done where a  catheter was used to identify the source of  my arrythmias . This is routinely done to help position the catheter in the right place before a cardiac ablation.

I had it done prior to having an ablation for atrial flutter BUT I understand that its value as a diagnostic tool is still being assessed.

Sorry, I know that doesn't help you one bit but before embarking on it I would be asking loads of questions re. its likely value

Best of luck

Ian

EP Study

by Czechmate - 2019-04-23 15:55:15

I just went through an EP study prior to an immediate ablation.  Basically, your heart will go off to the races while you lay on a table breathing and sweating.  They have you all hooked up in case something happens.  Think of it as combination of liquid (adrenaline) exercise and electric intervals.  If your heart has issues this test should reveal it.  Mine was SVT.  Afterward, all I can say is the human body is absolutely amazing. 

EP Study

by AgentX86 - 2019-04-23 22:42:57

An "EP Study" is exactly a catheter mapping of the electrical signals in the heart.  It's really not a big deal and is done during an ablation for afib (I've had three).  If your EP thinks he's going to learn something interesting, I'd go for it.

There is no way I'd do an S-ICD, if I could avoid it, though.  A "normal" PM/ICD would be the way I'd go.

Cardiac mapping

by mandm - 2019-04-24 07:26:52

@ IAN MC

Cardiac mapping, guess wont the dissimilar to EP Study or may be we are talking about the same thing with different names, lol.

Ablation was ruled out by the EP instantly and didn’t even mentioned any meds to address the Arrythmia so seems only option left on the table was a device implant.

Would it be possible to know what device you have, guess being a runner you probably are still running so it would be helpful to know about a ‘compatible’ device!

EP Study - pros and cons

by mandm - 2019-04-24 07:31:30

Thanks for your response, Czechmate.

Yeah I kind of have an idea what EP Study is, my question was what are the pros and possibly cons, other than the obvious ‘risk factors’

I assume you are a runner too? If you are than it would be helpful to know if were able to continue with your running? If you could do let me know what device you have?

Cheers

what device

by mandm - 2019-04-24 08:05:44

Thanks for your response, AgentX86.

Pleased to hear that you have suggested a firm option, really appreciate that, did you have any discussion re devices with your EP prior to implant? If you did than what parameters were considered in making the final decision?

cheers

What Device

by IAN MC - 2019-04-24 11:08:48

Hello mandm : You ask if some devices are better than others for running. The answer is " It all depends "  !

There are 4 major makes of pacemaker ... Medtronic, St Jude, Boston Scientific and Biotronik.   The fundamental reason for having any PM is  to stop your heartrate from going too low. All 4 brands do this in pretty identical ways . They all trigger off extra heartbeats if they detect  that your heart is leaving too long an interval between its natural heartbeats.

For example to maintain a heartrate of 60 bpm the PM would kick in if the interval between beats was longer than 1 second.

So far so good.... nothing to choose  between any of them.

A major difference occurs though if your heartrate doesn't increase as it should when you exercise. This is known as " chronotropic Incompetence" and roughly 50 % of PM recipents suffer from this at the time of implant .... It rises to over 70% after a few years.

To counter this, pacemakers have a  " Rate Response" function.  and they are not all the same !

Medtronic and St Jude have sensors which only detect upper body movement  and this has its limitations for athletes. Biotronik as well as detecting  upper body movement also detects electrical changes following heart contractions and claims  to be a very physiological response.  Boston Scientific as well as detecting upper body movement also detects changes in breathing. I believe that the last 2 makes are better for athletes than the previous two but you do need to discuss this with your cardiologist.

I see that you have plumbing problems as well as electrical problems . You are also taking some drugs which may increase the chances of you having chronotropic incompetence. If I were you , I would state loud and clear  at implant time that you want a device which has the most sophisticated Rate Response function available , also that you need a device which gives a physiological response when you do distance running.

When you have said that, say it again !

I was fitted with a Medtronic PM and regret the decision . After lengthy discussions post-implant my cardiologist apologised for his choice of device.   I have no experience of having an ICD. and have no idea if this would impact on your running in any way.

Good luck

Ian

chronotropic incompetence

by mandm - 2019-04-25 03:00:57

Ian thanks for your detailed response so wonderfully explained, much appreciated. I am so glad that I joined this forum at the right time and posts like yours are just music to my ear, not only that I am sure this informative post will be beneficial for the future forum users so well done mate.

I am really sorry to hear about you mishap with device, I guess it’s a prime example of why acquiring prior knowledge is important.

I have asked my EP to arrange a session with a device expert so no doubt we shall be discussing the devices and the famous ‘rate response’ enabled devices. I guess I would not be the first distance runner he would be seeing so perhaps after seeing my history he would know how to address my concern. I will keep you guys posted.

I am not sure which medication would likely to increase the chances of me having chronotropic incompetence?

I guess I can finally conclude that there is no way I could get the device implant and be in a shape to participate comes Berlin 2019!

Rate response

by AgentX86 - 2019-04-25 08:43:38

Hi Mandm, Ian explained things pretty well. What I'd like to add is that the rate response of any of these brands should be good enough for a runner. Your body is moving enough (to, heal strikes) that even the dumbest accelerometer will get the message. Swimmers and bicyclists have a real problem with pacemakers that only use accelerometers to detect activity. There just isn't enough motion (acceleration) to discern the level of exercise over background noise of normal living.

In any case, nothing man made will be better than a normal sinus node for controlling heart rate. It detects the amount of CO2 on the blood, which is a direct indicator of the body's oxygen demand. None of the pacemakers will come close to that, so competitive endurance sports may not be possible. Endurance sports are really hard on the heart, as well.

Rate response

by mandm - 2019-04-26 03:14:26

Thanks AgentX86 for your input and reassurances, I agree that heart is such a complex machine and its a miracle the way it performs without any intervention.

Armed with knowledge gleaned from this thread I feel comfortable that I could have eloquent chat with my device expert, do let me know if there is anything else I must ask to maximise my opportunity.

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