Check it out...I'm (kind of) mixing it up in the final sprint! Never thought I'd come this far so fast (Follow the arrow...that's my white shoulder and yellow tire, about 10 places back from the winner Lisbon Quintero). Photo: Alvin Poblacion, nyvelocity.com
Lately I've been doing a lot of research on R. Buckminster Fuller, the inventor /designer perhaps best known for his geodesic domes. Fuller was a visionary and an eccentric of a bygone era who sometimes called himself "Guinea Pig B", a reference to his decision to consider his life a constant experiment. Well, this weekend, I put on my Buckminster Fuller hat and checked into my own personal experiment: bike racing with a heavily ablated heart and an Internal Cardioverter-Defibrillator.
Depending on one’s approach the fact of me bike racing again could be considered remarkable or dangerous. At my last follow-up my doctor gave me the go-ahead to compete, but a good many doctors would not. My defibrillator alone is reason enough, the fact that my heart condition is terra incognita is another reason to stay away from racing. The official recommendation of activities for patients with ICDs is as follows (from EP LabDigest.com):
“The Bethesda Guidelines1 on sports participation consider that the risk to compete athletically with an ICD is unacceptably high. The guidelines indicate that individuals with an ICD should not be involved in sports more active than bowling and golf (even though these also have not been shown to be safe either) regardless of the underlying heart disease.”
Clearly this is conservative; these are blanket guidelines, they cannot not take into consideration each individual’s situation. My condition since my last ablation has been utterly stable, and my progress as far as fitness is concerned, counter-indicates any likely negative consequences. There is always the possibility of a run of V-tach coming out of nowhere, but in all my training that has not yet happened. If it did I would surely reconsider. But even then, I tend to be self-cardiovertable. My ICD is set to shock me at 222bpm, a rate I have not seen since last spring, in between ablations. The non-sustained V-tach I’ve experienced since then has only rarely gone above 200bpm. So the likelihood of being shocked while racing is very small.
The other big concern is crashing and damaging my ICD or “pulling out” a lead. This is where things get dicey. Crashing in bike racing is unavoidable. I’ve had very bad wrecks that have landed me in the hospital on multiple occasions. The most common bike related injury is a broken collarbone, and the ICD sits just below the collarbone.
Despite 20+ years of competition, and dozens of crashes, I’ve never broken a collarbone, or any bone. This does not mean it can’t happen at the next race, but I like to think that it is more than just luck that has kept me out of trouble. If I continue to race (the jury is still out) I will pick my events judiciously, avoiding known “crash-fests”, and race only in high category events or master’s races where, we like to imagine, age trumps foolhardiness.
Of course, from the perspective of crashing, the whole enterprise is foolhardy, so I’ve concocted an ICD protector (see previous post). I’m also in the market for a non-homemade pad, so if anyone has any ideas, let me know (I imagine there must be something designed for marksmen, for gun recoil?)
"So," you ask..."how did the race go...?" Stay tuned...
In March of 2008 I began treatment for a potentially fatal heart arrhythmia whose cause was unknown. I was fit and healthy, having spent a good part of my adult life as an elite cyclist, much of it racing in Europe.
After 5 years of fence-sitting on the part of my doctors, I have been given a diagnosis of ARVD/C (Arrhythmogenic Right Ventricular Dysplasia / Cardiomyopathy). I lack the known genetic markers for the disease as well as some of the structural changes that accompany ARVD/C, and my condition has shown no indication of being progressive (yet).
There is a growing population of current and former endurance athletes who end up with acquired arrhythmias, and a diagnosis of ARVD/C. But by placing these athletes in the ARVD/C patient population, we are potentially ignoring the very real likelihood of an acquired condition, similar, but different, from ARVD/C.
This blog is written as a resource for athletes with acquired arrhythmias, as well as anyone about to undergo endo or epi-cardial ablation, or the implantation of a ICD. It is also written to help generate some critical mass of interest in support of further research into acquired arrhythmias in endurance athletes and others. Feel free to contact me through the comments page if you have any questions or wish to make a written contribution to this blog.