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Cycling experiences with a pacemaker/defibrillator

Old 06-16-20, 05:38 AM
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Pete1wray
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Cycling experiences with a pacemaker/defibrillator

A year ago I had a post-ride cardiac arrest. Luckily friends did CPR until my heart could be restarted with a defibrillator. Long story short, I ended up with an ICD implant in my chest. An ICD is a combination pacemaker/defibrillator. The pacemaker side of it controls my heart electrical signals and the defibrillator side is there to fire in case the pacemaker side loses control and then zaps my heart. The implant is made by Boston Scientific. So...the unit can be programmed to creat min/max heart rates, speed of electrical signals thru my heart and a lot of other things I guess I wouldnít understand unless I was a cardiologist. However getting tall the settings right so that I can return to my old power and speed is proving to be a challenge. If it is set to be too sensitive I get a massive shock. Other settings seem to affect warmup time, acceleration and average power The unit can be reprogrammed relatively easily in a doctors office using a Bluetooth-like method, but the cardiologist and a Bos-Sci engineer say that cycling is too ďsmoothĒ for the unit and itís accelerometers to function at optimal levels (I.e., it works better for runners). I am wondering if any others in the forum have pacemakers or ICDs and what their experience has been.
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Old 06-23-20, 06:38 PM
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I didn't want to be the first to answer, but it looks like I'm the only one.

I do have a ICD. Just a monitor. It was put in last October. I think the only reason was because I have good insurance. A couple months prior to that I'd been on a external cardiac monitor for a few weeks. In the follow up vist the doctor told me I have a very healthy heart. When I told him I'd wrecked a month before and had amnesia for 15 minutes prior to the wreck and to a varying extent till in the hospital room, he thought a minute and then said I was getting an ICD.

My wife was there, so I wouldn't win any arguments against getting one. However it still has just shown that I have a very healthy heart.

It does annoy me some when I lay on my side or try to scrunch up in tight places with my arms out front. Mine is about the size of a stubby pencil that you can't sharpen anymore.

Oh... and it hurts like heck when you get hit by a baseball in the chest or get in the way of an elbow.
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Old 06-29-20, 06:26 AM
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Thanks for your reply. I guess there aren’t many if us that have this problem. My ICD is about the size of a pack of cigarettes and about half as thick. It can be damn uncomfortable when I wear a seatbelt or try to sleep on my left side. One corner is particularly close to the top of my skin and sometimes it gets rubbed and chaffed by my clothing.
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Old 06-29-20, 10:58 AM
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So what do the cardiologist's tell you as far as cycling is concerned? If I'm not being too nosy.

Can you pretty much just go out and ride for as long and as hard as you feel able? Or do you absolutely have to stay below a certain HR level or Zone?

I don't have any restrictions from my cardiologist. So I many times will ride as hard as I can for several hours. Even when I'm going easy, I'm in LTHR Zone three and four for much of my riding time.

The doctors are trying to investigate a few times that I passed out over the years. However all those times were when I was not doing anything at all. Several incidents were when I was in very intense pain from cramps in what felt like every muscle group of both legs, feet and toes.

The cramping was not related to riding and was shortly before bedtime after a day of doing nothing. A medicine I had been prescribed recently was the cause of the severe cramps. Needless to say, I won't take that every again. Years before and after, I still have had some syncope incidents, but all when relaxed not doing anything other than having some episodes of various intense pain.

Personally I don't think I'm seeing the right doctors yet. None I've been to so far can find anything unhealthy about me.

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Old 08-17-21, 01:17 AM
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Hi, I'm also interested in this topic. I'm 65 and have been a keen long distance runner and cyclist (both road and trail for both) for over 25 years. I'm also a doctor, though not a cardiologist. A month ago I was fitted with an ICD (Medtronic) because I developed some dangerous rhythms, mainly ventricular tachycardia. I've also been put on a beta blocker to suppress the arrhythmia but it also has the effect of slowing the heart. I've been gently working my way back to running and cycling over the last 2 weeks, trying to get used to new rates and rhythms, and have found the running reasonably easy but when I'm climbing steeply on the bicycle I cannot always get my heart rate up as high as I would like/need. My assumption is that the accelerometer in the ICD, which detects movement and thereby increases heart rate, responds well to the movement of running but less so to cycling (exactly as you say Pete in your original post). It is even worse when I try cycling on a stationery bike, presumably because there is even less movement as the whole thing is basically nailed to the ground - I struggle to get my rate above 90! - whereas when I'm running, even gently, I can easily get up to 130. I'm going to discuss all this with my cardiologist (who is also a friend) when I next see him. There are all manner of different programs/modes/switches etc that can be chosen/adjusted in the ICD, but I suspect the main issue here is the accelerometer and how it is responding to different kinds of movement. Most people with ICDs are not keen runners or cyclists, so this is probably not a common issue!
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Old 08-17-21, 09:33 AM
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Originally Posted by zachdebeer6@gma View Post
........but I suspect the main issue here is the accelerometer and how it is responding to different kinds of movement. Most people with ICDs are not keen runners or cyclists, so this is probably not a common issue!
You hit the nail squarely on the head there. IMHO!
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Old 08-17-21, 10:21 AM
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I have an ICD. Actually on my second unit. I am not sure how yours is programmed but mine does basically nothing unless there's a really bad arrhythmia. I've got HCM, with arrhythmias and family history of sudden death... at least thankfully not afib that needs to be controlled. I have had no sense that the ICD is inhibiting my heart rate. I don't feel it pacing, anyhow, which is a very distinctive feeling. It basically leaves me alone unless something goes wrong. But I seldom ever leave zone 2. I'm very limited by my heart condition which causes angina (much less so since surgery).

I've never heard that they have accelerometers that adjust their settings for activity. I'll have to read up on that.

If you are taking medications like metoprolol consider that they are also inhibiting your heart rate.
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Old 08-17-21, 10:28 AM
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Boston Scientific has another sensor (marketed as RightRate) that measures respiration.

I get the sense this is for people who are paced most of the time. I've had techs tell me I'm on a <1% duty cycle
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Old 09-16-21, 08:34 AM
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Hi everyone. I've had several Medtronics ICD's from 2002 after I survived a VT event following an MS Bike Ride. Also have a family history of sudden death. I've had a-fib episodes that have become more frequent this year and last night got zapped while on a ride after the ICD got confused between a-fib and v-tach. Over the years I've been shocked 3 times while on my bike and thankfully haven't crashed yet. In the beginning, it took the docs and techs a few tries until they got the ICD settings ironed out, but eventually they did. Don't give up if you are struggling with this and don't hesitate to ask them to bring in some help. It was another tech that eventually got mine figured out. I found this group while googling for some more info on cycling and ICD's. Figured I'm not the only one. Thank you all for sharing your experiences, it really helps! No need to stop cycling!
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Old 10-26-21, 10:19 PM
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My experience was like Zach's (I shortened your handle.) I can't get my heart rate over 90 when riding on the road, which makes cycling difficult. After a 15 mile ride I always feel like I have strained something. This make me reluctant to continue. The pacemaker works very well for walking. (My running days are over.) I have a Medtronic micra. I suspect that, if the docs make the pacemaker more sensitive, then my heart rate would go too high when walking normally.
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Old 11-03-21, 08:40 PM
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i have a st jude single chamber ICD implanted to control ventricular tachycardia due to a heart condition called ARVC, which is primarily (but not entirely) an exercise-induced condition that affects the heart's electrical pathways and thus rhythm. it's my second ICD, the first was implanted about 10 years ago and lasted 7 years.

i've been shocked maybe a dozen times over the years, but not for an actual VT event in several years, which makes me fairly confident in riding a road bike fast. i probably wouldn't ride a non-electric bike off road for any great distance where help wasn't relatively close. being shocked over and over again is NOT fun, even if it's (allegedly) saving your life.

i also take flecainide and bisoprolol, the result of which (plus a couple decades of avid swimming, water polo, running, etc) is that my heart rate is more or less impossible to get above 130. doesn't matter because i shouldn't be doing that kind of exercise anyway.

since my ICD is single chamber, it doesn't pace me. it has the accelerometer to help determine when a faster heart rhythm is sinus rhythm vs. a dangerous tachycardia, and it's rarely mistaken sinus tachy caused by exercising for the bad kind.

i second jims63 - the programming of these things is quite nuanced with regard to the various threshold, electrical levels, number of rounds of antitachy pacing and then shocks, etc. if you're not seeing an experienced electrophysiologist, find one!
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Old 09-06-22, 11:27 PM
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Any MTB riders w/ ICD?

Greetings all! I was diagnosed w/ HF reduced ejection fraction (35%) last year. Iíve switched to an ebike only now, but my cardiologist is pushing hard for an ICD to prevent cardiac arrest. Has anyone in this forum been mountain biking w/ an ICD? Iím curious about safety, false triggers due to jarring, etc. Iíve never had a cardiac event, clear on a cardiac cath, but have septal scar at the apex. I still ride, keeping my HR below 120 (on several meds), and donít have issues (other than resting arrhythmias). Iím just debating the install and if it will prevent riding my MTB. This would be a disaster for me as I ride 3-5 times per week, mostly technical single track. Looking forward to any feedback! Thanks!
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Old 09-06-22, 11:39 PM
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Originally Posted by Kirk005 View Post
Greetings all! I was diagnosed w/ HF reduced ejection fraction (35%) last year. Iíve switched to an ebike only now, but my cardiologist is pushing hard for an ICD to prevent cardiac arrest. Has anyone in this forum been mountain biking w/ an ICD? Iím curious about safety, false triggers due to jarring, etc. Iíve never had a cardiac event, clear on a cardiac cath, but have septal scar at the apex. I still ride, keeping my HR below 120 (on several meds), and donít have issues (other than resting arrhythmias). Iím just debating the install and if it will prevent riding my MTB. This would be a disaster for me as I ride 3-5 times per week, mostly technical single track. Looking forward to any feedback! Thanks!
never worried about my ICD going off due to vibrations - itís pretty well insulated in there by the body itself. iíve ridden my rigid gravel bike on some bouncy stuff, but not on a weekly basis. what can be an issue is repeated pressure/abrasion on the chest or repeated hyperextension of the shoulder joint on that side causing the insulation on the lead to fray. happens with weightlifters, some swimmers, contact sports, etc. but iíve never heard of any vibration that your body can tolerate being an issue.

i have reduced EF, take a couple meds, history of serious arrythmia, and i do about 500 miles/month. a bit more strenuously than my doc recommends but i do keep the HR to an average of 100-110, absolute max 130.

my biggest worry is a shock causing loss of control at high speed on the bike. iíve only been shocked once in the last 5 years, and it was an inappropriate one (cracked lead.) if i was getting frequent therapy from the device (either shocks or ATP) i would not ride.
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Old 09-08-22, 11:31 AM
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Realize that only those that had a good experience with their ICD and cycling are likely around to tell us anything. Those that may have had a bad experience probably aren't here any more! <grin>

So...

Ask your doctor. In fact find as many as you can and ask them specific questions of your concern.
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Old 09-08-22, 02:44 PM
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MTB w/ ICD

Thanks for the feedback guys. I have asked several doctors (cardiologists and non-cardiologists) and none are mountain bikers so say that I probably shouldn't in case I should fall. But one could fall doing almost anything (MTB, road cycling, skiing, etc.) so I was hoping someone here had MTB experience.....Thanks again.

-Kirk
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Old 09-08-22, 03:15 PM
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Well a lot of people are of the opinion that since I ride my bike on two lane country roads with no shoulder that I'll get run over. But if I followed that advice I'll have missed out on 50 years of good riding. However I suppose one day they might eventually be able so shake a finger at me and say I told you so! <grin>

My own doctor told me I should give up cycling after I had my first and so far only bad cycling accident and was in the hospital with a concussion. However after discussing with him why he felt that way, it was pretty much his opinion that cycling in general is too dangerous. So you have to dig a little deeper for their reasoning as you did somewhat.

Did you go deeper and find out why a fall would be bad specifically for your ICD? Or where they like my G.P. just concerned with you getting hurt for other things with the fall in general?

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Old 09-22-22, 11:57 AM
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Hey Iride01, thanks for the reply. Yeah, I believe that any doctor I talk to is going to say "don't MTB" as it's inherently dangerous (like living in our current world :-) ). I did have another chat with a cardiac electrophysiologist and his take was that the major concern for an ICD is skin damage over the device (not the leads pulling out of the heart muscle). This could lead to an infection whitch, apparently, can travel quickly down the leads to the heart, which then becomes quite serious. So in the long run, I think I'll get the ICD (10/11/22), heal for 6-8 weeks and report back here after my first few rides. Wish me luck!

-Kirk
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Old 09-23-22, 10:23 AM
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Originally Posted by Kirk005 View Post
Hey Iride01, thanks for the reply. Yeah, I believe that any doctor I talk to is going to say "don't MTB" as it's inherently dangerous (like living in our current world :-) ). I did have another chat with a cardiac electrophysiologist and his take was that the major concern for an ICD is skin damage over the device (not the leads pulling out of the heart muscle). This could lead to an infection whitch, apparently, can travel quickly down the leads to the heart, which then becomes quite serious. So in the long run, I think I'll get the ICD (10/11/22), heal for 6-8 weeks and report back here after my first few rides. Wish me luck!

-Kirk
Well that at least is a valid consideration I've not heard before. But I'd wonder if it's happened due to cycling and if there is any reporting statistics on that.

Also realize that the ICD I had was just a loop monitor and was completely self contained with no leads. I also had it removed last week as the battery ran out. All it ever told them was that I had a healthy heart. Still think they just put it in because I had good insurance.

One of the things the surgeon that removed it is concerned about is the small incision it was removed through opening up from tension on the skin. So until it's healed completely when I'm riding or doing certain stuff the might work my chest a lot, I'm suppose to put a strip of tape over my chest to help keep that area of skin from being put in tension.

Not certain if that might be a consideration for you with the leads. Though you'd have to keep your chest shaved.

But if you are seeing cardiologist and other heart doctors, then you probably are already doing that since they all want a EKG every time they see you. And those electrode pads can be like the scene in "The 40 Year-Old Virgin" when they rip them off if you have a hairy chest.
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Old 09-23-22, 10:34 AM
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Ha! Haven't seen that movie in a while! I'm sure there are plenty of ways to damage the skin over the device. Maybe time for a chest protector! I would be in a similar scenario where the unit has to be removed for a dead battery. Open me up doc! I guess I just hate the idea of spending any time at the hospital.
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