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Update since ablation

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Re: Update since ablation

Post by twal on Thu Nov 24, 2016 3:11 pm

I can't tell when it started since this was the first EKG since the ablation.

I just bought a new heart rate monitor so I can keep track of my rate. Every piece of data helps me figure out what's going on.

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Re: Update since ablation

Post by jerseyguy on Sat Nov 26, 2016 5:18 am

This has been a long road for you. Hopefully this is just another bump in the road and your rhythm will normalize. When do they want to check your ecg again? Well wishes and I remain optimistic.

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Re: Update since ablation

Post by twal on Sun Nov 27, 2016 9:15 am

I got a new heart rate monitor and it has given me some insights into my problems. I can't seem to get my heart rate above about 115 BPM. That may explain why I feel as if I'm running with a piano on my back.

I have an echocardiogram coming up this week to check for structural problems. My next EP visit and EKG is 12 Dec.

My typical run is 3-4 miles without pushing hard. I went through my records for the past year and found this disturbing data by reviewing my average pace.

Pre-ablation in sinus rhythm - 9:25/mi
In afib/flutter - 10:10/mi
After latest ablation - 10:39/mi

I'm going in the wrong direction pretty fast.

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Re: Update since ablation

Post by jerseyguy on Mon Dec 12, 2016 6:40 am

Good luck with EP appointment today.

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Re: Update since ablation

Post by twal on Thu Dec 22, 2016 9:42 pm

Weird stuff in my recovery. I haven't had any afib/flutter which is good.

However, my heart still isn't working right.

I can't get my heart rate up above 125 bpm even with a heard effort. I'm generally running at about 115 bpm. When I hit a hill, my legs are dying to air, my lungs are gasping but my heart isn't keeping up.

My typical run is 3-4 miles at a comfortable pace. About a year ago I was dong that run in 9:20/mi; when I was in flutter, I was running it in 10:10/mi and after this ablation, I was running it 10:40/mi for a good month. Over the past few weeks, I've been doing them in about 10:10/mi.

However, I've had two periods of about 5 min, where my heart rate went up to around 160 bpm, while running, which I think is where my heart rate should be. I hope that one day, my heart will realize that's where it belongs and reach it every time I lace up my running shoes.

But we'll see.

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Re: Update since ablation

Post by jerseyguy on Mon Dec 26, 2016 7:20 am

Am relieved that you are not in those troublesome arrhythmias. Silver lining is that it seems you are not going further backwards with those times. Keep it up and hopefully they will improve.

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Re: Update since ablation

Post by twal on Sat Jan 14, 2017 5:20 pm

The ablation seems to have stopped my afib/flutter. But my heart rate is still dong weird things. (Max rate for my age shoudl be around 155 bpm.)

After about 5 min of warmup, my heart rate is up around 160 bpm. It says there for about 10-15 min and then drops to 120 bpm. And I can't do much to get it back up again, no matter how hard I run.

It is as if I have two systems controlling my heart rate--one at 160 bpm and the other at 120 bpm. My electrophysiologist is stumped. Any suggestions?

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Re: Update since ablation

Post by Dave Tuttle on Sat Jan 14, 2017 5:55 pm

twal wrote:The ablation seems to have stopped my afib/flutter. But my heart rate is still dong weird things. (Max rate for my age shoudl be around 155 bpm.)

After about 5 min of warmup, my heart rate is up around 160 bpm. It says there for about 10-15 min and then drops to 120 bpm. And I can't do much to get it back up again, no matter how hard I run.

It is as if I have two systems controlling my heart rate--one at 160 bpm and the other at 120 bpm. My electrophysiologist is stumped. Any suggestions?

Might be time for a trip to Cleveland Clinic's Sports Cardiology Department for testing and hopefully some answers?

I think Mike had some similar symptoms a few years back...


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Re: Update since ablation

Post by mikenall on Sat Jan 14, 2017 6:50 pm

Hi Tom,
This is going to be a long post because this is the first time I’ve read this thread and I have a lot of thoughts and opinions on what you’ve said.  It seems as if the ablations have helped, so that’s definitely a good thing.
In regards to the heart rate monitor, what kind are you using?  Over the years I’ve had a Polar, a Timex, and 2 Garmins.  I’ve found that every one of them gave me a pulse in the 160 range when I first start to run.  After about 10 minutes they start to settle down.  I think you start to sweat and the strap gets a better connection and pulse.
Early in 2015 I bought the Fitbit Surge with GPS and in the wrist heart rate monitor.  I hate the chest strap and hoped the wrist based heart rate would be more comfortable and more accurate.  The fitbit was wildly inaccurate.  I used it at the same time as my Garmin and got rate variation between the two between 40 and 60 bpm.  I returned the Surge.  When the Garmin based wrist monitors came out I bought that one.  It is no more accurate but will work with or without a strap so I have it and use it with a strap.

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Re: Update since ablation

Post by mikenall on Sat Jan 14, 2017 7:00 pm

You’re having trouble getting your heart rate above 125? I have had that same problem for years, and was diagnosed with chronotropic incompetence. Your heart won’t beat faster in response to the increased demand and you get easily fatigued on hills etc. It should show up in a Bruce protocol stress test. Have you had one recently? That is one of the reasons I had a pacemaker implant. The rate response, minute ventilation and closed loop stimulation systems are supposed to help with that. Unfortunately the rate response systems in mine are turned off.

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Re: Update since ablation

Post by mikenall on Sat Jan 14, 2017 7:18 pm

I'm still running but I'm not doing all that well. My cardiologist says I ought to give up strenuous exercise, take my blood thinner and be happy I don't have a stroke. I'm not ready to buy that.

That’s a cardiologist I’d think about losing?

Bad news is that I'm in an ectopic rhythm. My beats are not originating from the correct spot in my atrium. I'm told this is a "normal variant" (a normal abnormality).
Tom, I’m assuming they picked this up on an ekg?  Have you had any type of event or holter monitor since you had the 2nd ablation?

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Re: Update since ablation

Post by Gary E on Sat Jan 14, 2017 8:33 pm

Tom, I wish you could take my place on Wednesday when I see my surgeon/EP since he is really good.  I'll try and see if I can sneak your data into the conversation.  Maybe you will be the focus of one of his clinical trials.

Any desire to run on a treadmill in Columbus this winter?
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Re: Update since ablation

Post by twal on Sun Jan 15, 2017 8:48 am

Thanks for the insights guys.

Mike, so you think that I don't have those high heart rates but it's an inaccurate sensor. I have a Garmin with a chest strap. I want my heart rate to be up near 160 not 120 when I'm running hard.

I've suggested doing a stress test but neither my cardiologist nor EP feel it will show much. It would be cool if I could do it while wearing my heart rate monitor to see if they correlate.

I haven't worm a monitor since my second ablation. After the first, I wore a Cardionet monitor but when I tried to really run hard, I got "excess artifacts" (i.e. no reading). My EP thinks the "ectopic beats" were a red herring and just slightly unusual beats that were misread.

Gary, I'll even go to Columbus to get this figured out (can I sleep on your couch while I'm there?).

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Re: Update since ablation

Post by mikenall on Sun Jan 15, 2017 4:28 pm

Tom,
Are you on a beta blocker?

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Re: Update since ablation

Post by twal on Sun Jan 15, 2017 7:14 pm

No. After the "successful" ablation, the doctor said I didn't need them any more. I was on a low dose anyway.

I really appreciate your insights above.

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Re: Update since ablation

Post by twal on Sun Jan 15, 2017 8:07 pm

Thanks to your tip, I came across a very good article on Chronotropic Incompetence in Circulation magazine.

http://circ.ahajournals.org/content/123/9/1010

However, it didn't say much about how to correct it.

Another good one is

http://www.medscape.org/viewarticle/724498

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Re: Update since ablation

Post by mikenall on Sun Jan 22, 2017 7:26 pm

Do you think chronotopic incompetence might apply to your problem?

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Re: Update since ablation

Post by twal on Tue Jan 24, 2017 9:26 am

My self-diagnosis is Chronotropic Incompetence.

There is not much you can do about it short of a pacemaker. I'm not ready for that yet.

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Re: Update since ablation

Post by jerseyguy on Wed Jan 25, 2017 7:49 pm

This is all a bit above my pay grade, but it seems like everyone has good feedback.
Just a thought, but would you consider seeing an EP at Jefferson, if only for a second opinion?

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Re: Update since ablation

Post by twal on Sun Apr 02, 2017 8:24 am

I ran my first race since ablation surgery in December (and first since 4 July) on Saturday.

I did 28:20 for 5K on a muddy flat trail race (9:00/mi). This was my slowest 5k ever by a huge margin. Here are past times for that race:
2008 - 23:42
2010 – 24:14
2013 – 25:42
2014 – 25:46
2015 – 25:45
2016 – 26:32
2017 – 28:20

Ablation 1 – Jan 2016
Ablation 2 – October 2016

The 2016 time was only 2 ½ months after ablation and I was just getting back into shape. This year I have had good training coming into the race so I have no excuses.

I basically lost 40 sec. per mile and the ablation was the only significant thing that happened in the interim. That’s about how much speed I lost when I had my mitral valve repair 15 years ago. If I had aged at the normal aging rate in 2001, I should be running 5K’s in about 24 or 25 these days.

I finished 4th out of 10 in the 65-69 age group and ironically, I would have won the 60-64 age group (out of 6) (which was pretty weak). I was 76 out of 240 but there were a lot of kids and quite a few walkers in the overall results.

I think part of my problem is chronotropic incompetence which seems to be holding back my heart. In my training, I could almost never get my pulse above 130 bpm. However, in this race I was able to get my pulse up to 150 bpm for the second half of the race. I felt terrible at that time (just wanted to stop) so this must be my max heart rate. I could not go any harder. I should be at about 165 bpm at my age using the standard formulas. So, I was within 10% of my target pulse for my age. I wish I had some heart rate data from before my ablation.

I’m not sure what I can do about this, if anything. In the last year, I’ve aged about 10 years in running performance. I just want to cry (but I’m still running so it isn’t all bad).

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Don't underestimate your capability

Post by Gary E on Sun Apr 02, 2017 10:31 am

My good man, you are too hard on yourself.  If it is of any solace, I'm running much, much, slower (by two minutes/mile...depending on whether the wind is behind me or in my face).  To add insult to injury, that is on a flat surface!!!  I'm considering not even entering the only race I've done in the last few years...and it's a freebie (and you know what a cheapskate I am, so even that may not change my mind).
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Re: Update since ablation

Post by twal on Sun Apr 02, 2017 9:24 pm

Thanks Gary. Yeh I know that I'm lucky to be running at all after all I've been through.

But I don't want to leave any stone unturned in doing my best. I don't want to find out in 2022 that if I had taken pill x or done treatment y or stopped taking pill z in 2017, I would have done so much better.

It's part of my low self esteem that makes me need to do the very best I can in every race.

"Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light."

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Re: Update since ablation

Post by jerseyguy on Mon Apr 03, 2017 7:44 am

I admire your perseverance. It speaks volumes.

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Re: Update since ablation

Post by Dave Tuttle on Mon Apr 03, 2017 1:13 pm

twal wrote:Thanks Gary. Yeh I know that I'm lucky to be running at all after all I've been through.

But I don't want to leave any stone unturned in doing my best. I don't want to find out in 2022 that if I had taken pill x or done treatment y or stopped taking pill z in 2017, I would have done so much better.

It's part of my low self esteem that makes me need to do the very best I can in every race.

"Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light."

Good stuff Tom... You of all people should not have any low self esteem though!

When it comes down to it I think the race is really with ourselves and our personal challenges anyway, not with that other guy.

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Re: Update since ablation

Post by twal on Sun Apr 23, 2017 8:10 pm

Finally had a good race today, 26:06 (8:24/mi) for 5K. Perfect weather. slightly net downhill and about 0.03 mi short (say 10 sec) according to my GPS. Quite a few hills but biggest was in second mile. Splits:
8:20
8:54
8:21
1st out of 2 in 65-69 age group.
25th out of 136 overall.
See my post on the "Statins or Not?" thread for possible explanation.

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