Wow dude, that's insane! I wonder if being an endurance athlete and heightened stroke volume kept you alive

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IG - @ryanppax
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It certainly didn’t hurt. There was a lot of head scratching that I wasn’t at a minimum getting dizzy at regular intervals. The whole thing is weird.

So weird. Were you able to bring your HR up during exercise? What was your max HR over the last month or so - Garmin Connect can tell you and probably every other training data logging system ... When I'm fir, my resting HR is in the high 40s. Always causes some raised eyebrows at annual checkup time. Tf there is any racing to be done this year, I'll be there as a 60 y/o... which seems *very* weird to me...

Looking back my “high” HR was pretty low for the training I was doing, especially the indoor stuff. Average resting 45 average high 119. I’m pretty sure I’ve had this for at least a year based on HR data from Garmin. Which means I did IM Boulder with this (I guess it wasn’t just the altitude that was slowing me down).

As a former pacemaker/defib med rep I will say that this is rather remarkable. What kind of pacemaker did you get? I would be surprised if you have been in this rhythm (AV block) for a while as there is just no way you would have NOT noticed while riding or doing anything. Not even physiologically possible to have the same cardiac output, given that fluid sequence of blood from the atrium to the ventricles (aka Atrial Kick) is responsible for a substantial part of cardiac output.

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It’s a Medtronic Azure XT DR. Looking at the data it certainly takes a dip in December into the low 40s down from the upper 40s/low 50s. Have been hitting the 30s from time to time since Jan. So who knows if I moved from 1st degree to 3rd degree over the course of the last year/6 months.

Any info/advice you can give based on your experience as a rep?

Glad you are doing well.
5 years ago I was told I had 1st degree av block and they said just keep on.
I have been doing tris/ cycling for 25 yrs+ mostly cycling the past 5 no IM stuff since 2010.
My resting heart rate is never low like yours , mine is 50.

Things have changed a lot since my rep days. I would just make sure you are very vocal with your rep/doctor/nurse about the device regarding how it is programmed. Too many reps, doctors, nurses just don't care as they move your through the line in checkups. Ideally you want the device to pace as little as possible for a variety of reasons, one because it wastes energy and there is a finite supply, but also because if you can get your heart to do the pacing you will likely have a much better QOL down the road. Examples of this could be programming the longest delay possible between the atrium and ventricle to give the signal a chance to conduct. You really don't want to pace the ventricle unless you have to. In your case you probably need that pacing and may be unavoidable. In that case they should have it setup to also pace you atrium as little as possible. You want your SA node (atrium natural pacemaker) to be the driver of things so you heart rate adjusts with activity level and ideally lower chancess of afib-aflutter down the road.

Fwiw, back in the day heart block patients were always the patients I least looked forward to checking for a variety of reason. We would do threshold testing to make sure we were using as little energy as possible to pace the heart (again battery saving). We gradually decrement the energy down over seconds until the heart no longer beats from the stimulus provided. Sometimes, there would be a long delay until your ventricular escape rhythm appears (your low 30s beat). I don't know how checks are still done, my repping days were done in 2009 for me, but I would just make sure you tell the rep, doctor, nurse that you have heart block, especially if they seem green. Hopefully they understand that and pay more attention.

Feel free to DM down the road.

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Thanks! Good info! I’ll be curious how much work my lil guy is getting. I’m afraid it’s doing a lot of pacing. My resting is pretty much locked in at 60 (+/- 2). It’s a straight line. I’ll know more tomorrow after my first check. My device actually has an iPhone app that I can use to transmit data and see the battery life and other info. Pretty cool! Thanks Again!

do they have any idea how the AV block occurred? My wife has it due to an ablation gone wrong, I can't imagine it would just spontaneously occur...

Just guesses, but hereditary is what they think (I have limited info on my parents due to adoption). The other one would be Lyme disease (which I’ve never had). The daily HR data clearly shows something changed toward the end of the year.

Did your wife get a pacemaker?

As TG mentioned, there are any number of ways to 'dial down' your pacing. You might introduce your historical RHR as evidence for a pacing < 60 bpm, if warranted otherwise. I can imagine that there would be some reluctance to go much lower than what is probably the 'normal' assumed value of 60. Longer term, there are a number of reasons to be paced where your 'natural' RHR occurs (forcing your heart to do some of the work, battery conservation...). But convincing your physicians that your RHR should be 50 or 48...well, your would be an outlier and that might make them uncomfortable...

I think once I get back to training I’ll know whether there’s any need to dial it back. I’m curious to see what effect, if any, this has on my overall fitness.

I had to get a pacemaker in 2016 once I finally figured out why I would periodically pass out without warning (malignant vasovagal syncope). My resting heart rate was typically in the low 30s and under some circumstances, we're still not sure what, my blood pressure and heart rate would suddenly drop in unison and I'd go out cold. After 12 years of trying we finally caught an episode using an implanted EKG and measured that my heart stopped for a solid 20s. Now with the pacer my heart rate won't go below 45 and it also keeps track of blood pressure so it can kick in if it noticed any sharp drops. I haven't had an episode since!

One word of caution based on my experience, which is of course only n=1: ease back in to swimming. I was told not to swim for 6 months after getting the pacemaker, so I deferred some races and stayed out of the pool. After the 6 month mark I got back in the water and within a week noticed my left arm would swell and become painfully engorged. I got it checked out and it was because of blood clots from where the leads entered my veins. I was put on thinners and it took another couple months before I could ease back in to swimming. My electrophysiologist told me that some people develop clots some don't, hopefully you're in the second group.

Another surprising issue I had was that my leads failed within the first year, again because of swimming. Apparently all the freestyle caused one of the sutures that held the leads in place to wear through the insulating coating around the lead and it started to misinterpret normal cell signals as errant heart beats. I sought out a lead replacement specialist who swapped the original leads with different ones, sutured them differently, and I haven't had an issue since.

I'm not trying to freak you out, just suggesting a gradual return to swimming. In fact finding a few other people on this forum who have pacemakers (including one extremely accomplished swimmer and former pro who has had a pacer for decades) really helped allay my fears about whether I'd ever be able to return to swimming, especially after the first doctor I talked to about changing leads told me I should never swim again.

Random side note - I would love for mine to have an iPhone app! But it's a Biotronik rather than your Medtronik. Would be even better if it could Bluetooth to your watch. Ever since getting mine I've lamented that I have one of the most accurate HRMs possible but I can't access the data!

Great! Another reason to hate swimming ;) I will take it very easy when I get back to swimming and be on the lookout for the issues you had.

They just came out with the app last year, but so far haven’t quite opened it up as much as they could. Can’t see live HR or real-time data on pacing. I think most people are older with these things so maybe they don’t think they’ll get anything out of the addt’l data. Still pretty cool though.

Thanks for sharing your story!

In two weeks I will be in the Pacemaker Club, forty years of racing has taken it's toll.

After a number of events where my heart would flutter and my pulse would drop to 30 my heart doc had enough and put me on a monitor for a few weeks. He called part way through the test and said stop running, he was seeing 4-6 second interruptions in my heart beat at random times even while sleeping. So, his recommendation is to implant a pacemaker

At 73 I'm ready to slow down anyway but I would still like to run, bike and swim at a more leisurely pace, I'm just starting to look for other people's experiences with training.

Any thoughts on the new wireless pacemakers.

Ron W.

Wow! It's hard to say you are lucky but . . . really you are lucky.

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Pete Githens
Reading, PA

I could tell you stories of the very many ways people find out they need a pacemaker...

Glad you are now device protected. Make sure you feel well when doing activity. You should have resting heart rates at the device settings of the lower limit (usually) and it should look like a bell curve on the right, going up w activity.

The electrical/conduction system of the heart can fail/falter forlots if different reasons and hopefully your doctors have looked into that-ie Lyme ds, cad, valve ds etc.

Wishing you health and fitness going forward!

Yes indeed. She knew something was wrong within a couple of weeks but held off as long as she could before getting the PM (about 3 months). Imagine an early-40s personal trainer who studied nutrition and eats like a nun being told her heart is wonky. It was quite traumatic for her. That was maybe 4 years ago, and she's had zero issues so far. They've adjusted the settings a few times - she is VERY sensitive to her HR, so she could tell the low setting was too high - she couldn't sleep at night. Then they adjusted the high end to keep up with her workouts. She is 100% paced if I remember correctly. You can barely see the scar on her chest now.

Let me know if you have other questions and I can get her answers.

Good Luck!!!! Other than a few Zwift sessions to complete a challenge I've been taking it easy. I'm almost 4 weeks out and I can absolutely tell a difference with my overall health. Even though I didn't have any real symptoms, but now know I was sluggish, tired, and was feeling the effects of low heart rate for months. The incision is healing well and I should be clear to begin some training next week. I will be interested to see what my heart rate does with my new mechanical assistance.

Let me know if you have any questions after your surgery and I can share what I know.

Thanks! I am also 100% paced and so far the settings haven't been a problem, but I'll see when I actually start training again. I may have other questions if I see some weird things when I get back at it.

Have you been able to get your setting on your device dialed in so you are able to get your HR up on the bike? I have a new Medtronic device and am having trouble getting my HR to stay high on my bike. It fluctuates quite a bit on my rides (lows of 80's to highs of 140')

My issue has been getting used to having a high (normal HR) with my issue being a total heart block (I’m paced 100% of the time). Used to see a HR in the 120-130 with harder efforts (I just thought I was super-fit). Now it gets into the 150 range and it’s tough. Haven’t had them play around with the settings, until I get my fitness used to the robo-HR. The worst is initially the device tried too hard to bring it back to resting (60) so after a hard effort my brain was saying I need a high HR for a while, but the device was saying “ must get it down to 60”. This resulted in pretty rough symptoms of dehydration. As I got used to drinking more water and my fitness got better, this is less of an issue. This doesn’t answer your question, but this has been my experience over the past year.

Wondering how it’s going now after a couple of years with a pacemaker. I was told yesterday that I should get one because I have type 2 av block that progressed from type 1 5 months ago. My resting hr was as low as 36 while wearing a holster monitor during a 24 hr test and I have gone in and out of afib twice in the past 3 weeks. My last afib they caught on a ECG with my hr rate only at a high of 61.

I believe the av block is genetics at play. My grandfather died of a sudden heart attack at the age of 64 in 1958 after shoveling snow….so who knows?