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Cooper Clinic Follow-Up on Cusp of 82nd Birthday

Three Options for Heart Rate Irregularity

"NO" to Ablation

The Cooper Clinic is booming in its 50th year. The main clinic building has been leveled and rebuilt from the ground up. With one exception, my overall results are little changed.

Near the end of my follow-up exam, I stepped in the door of the main building and felt lost. I spun around a few times—and finally sat down to wait for a follow-up ultrasound on my carotid arteries and then see cardiologist John Ho. (He has been very generous with his time in the past, showing me that my coronary arteries are very large and wide open.)

This time around, Dr. Ho spend about 30 minutes explaining that my heart rate irregularity is probably genetic and not life threatening. We went over ways to manage it in considerable detail. The first option is to continue monitoring my heart rate on Fitbit. Stay the course for now.

We’ll discuss the other options, after going over my results.

Cardiovascular Results

The follow-up ultrasound on the arteries in my neck showed only minimal change. A repeat test is planned in four years.

My lipid profile without statin therapy continues to be “overall healthy” with a cholesterol/HDL ratio of 3.5, well under the borderline 4.5. My triglycerides are 92, a fraction of the 149 goal level.

My Omega 3 level is 10%, well over the 8% goal.

The concern is that my bad cholesterol (LDL) is far above the goal level. Likely due to genetics and rebound from decades of statin therapy.

Dr. McFarlin recommends that I continue my balanced whole food diet along with a daily fish oil supplement and every-other-day low dose aspirin.

*  *  *

My resting EKG is unchanged, and I show no sign of ischemic heart disease—blood supply to my heart is good at rest and during exercise. I have no chest pain.

A repeat coronary CT angiogram—showing the blood flow in my heart—is planned for 2021.

What I have going for me is a healthy lifestyle: purpose, diet, and a lifetime of exercise.

Other Findings

My kidney function is normal and I show no signs of developing diabetes.

My hsCRP inflammation level is 1.34, a tiny fraction of the reference high of 4.94.

My prostate is normal and my testosterone level is a very healthy 656, more than twice the level of most men my age.

Once again, I exhibited an irregular heart rate during the stress test on the Airdyne.

Supraventricular Tachycardia (SVT) Ablation

“Even though you have not noted a significant decline in exercise tolerance, today’s Airdyne stress test revealed an SVT near maximum exercise intensity and your blood pressure dropped down to 92/56,” Dr. McFarlin wrote in his report. “I anticipate ablation of the SVT arrhythmia will significantly improve your exercise tolerance.

This was a surprise to me. While my Fitbit shows heart rate spikes from time to time, I’ve had no problem during high-intensity exercise. I’ve done HIIT on the Airdyne many times with no problems.

The spikes recorded on my Fitbit are usually during neighborhood walks or foothill hikes; rarely, if ever, during an all-out effort. I don’t feel anything unusual and wouldn’t know about the spikes without Fitbit.

The latest stress test, however, was different. I could feel that something was wrong. I wasn’t short of breath or having pain or pressure in my chest, but I didn’t feel right. I believe psychological stress was an added factor.

The problem coming to a head up at the Cooper Clinic is fortunate and apparently calls for action of some sort. As noted above the first option is to simply be alert to the anomaly. The other options are more invasive.

The second option—medication—has drawbacks. It would probably put a damper on my training and Dr. Ho tells me that drug therapy would likely become less effective with time.

Ablation, the last option, calls to mind a pithy Woody Allen quip: I don't fear dying, I just don’t want to be there when it happens.

*  *  *

The following information on ablation is pieced together from Google and the Mayo Clinic:

Supraventricular tachycardia (SVT) ablation is a non-surgical procedure to create scar tissue within the heart in order to block abnormal electrical signals and restore a normal heart rhythm. It does not require a general anesthetic or stopping the heart.

What you can expect:

SVT ablation is performed in the hospital. You'll receive a sedative that helps you relax.

Once the sedative takes effect, a small area near a vein in your groin or neck is numbed and catheters are inserted into the vein. Your doctor carefully guides the catheters through the vein and into your heart.

Depending on the type of ablation you have, you may or may not be awake during your procedure. If you are awake, you will be asked to report any symptoms, answer questions, or follow instructions given to you by your doctor.

The catheters are equipped with electrodes that are used to record your heart's electrical activity and to send electrical impulses. Your doctor uses this information to determine the best place to apply the SVT ablation treatment. A tip on the ablation catheter will emit high-frequency electrical energy to destroy the abnormal tissue, resulting in a scar.

SVT ablation typically takes three to six hours. Afterward, you'll be taken to a recovery area where your condition will be closely monitored. You'll likely stay overnight in the hospital.

After SVT ablation, most people see an improvement in their quality of life. But there's a chance your fast heartbeat may return. In these cases, you may need to have SVT ablation again or may need other treatment.

Sounds like fun!

*  *  *

Dr. Ho has written a letter of referral, and forwarded my records, to a cardiologist in Albuquerque with a special interest in ablation for athletes and others.

After some back and forth with his staff, an appointment has been scheduled in January.

Carol and I look forward to sitting down with him. Very unlikely that we could have found this doctor on our own, or get in to see him without starting from ground zero. Dr. Ho has once again been a big help.

More later.

November 1, 2019

Selected Visitor Comments


Colorado Doctor Responds in Detail

I think sitting down with a cardiologist who specializes in ablation in athletes is critical...seems like every 70 plus athlete in Colorado has an ablation. I don't know the answer but in my view, a detailed risk/benefit analysis is key for you to make the best decision for yourself. I would likely side with your view that meds are not the way to go.

As far as LDL increase...depends a bit on how much...again, I'm not a cardiologist...but there seems to be some controversy about LDL levels...some cardiologists seem to feel its more about the cholesterol/HDL ratio and the triglyceride/HDL ratio....I would say that the fact that you have clean arteries, high ejection fraction and overall good cardiac parameters may be more important than your LDL level which is a proxy indicator of cardiac issues....There seems to be also some feeling that cardiac calcium assessment is a more direct, non surrogate correlation to heart disease.

I do want to emphasize that the devil is in the details and a good doctor should sit with you guys, go over the risk/benefits and options in detail.  If things are unclear, the doctor will not spend the time...get another opinion......every person deserves full info to make the right decision......the process is very important...its excellent that you have the Cooper doctors to advocate and advise you.

Philosophically: cardioversion, stents, statins etc are not "natural" but we live in a time when these assistive interventions can add longevity and quality to life. In many cases, they are used to keep very sick people alive, struggling, with unhealthy lifestyles and problems that are not easily reversed. For those such as yourself who are 98% healthy with one or two risk factors: its well worth considering interventions with good risk/benefit ratios. There are some interesting books and studies about cardiac arrhythmia in older athletes: the book Haywire Heart, the Swedish Vasaloppet study on marathon Nordic skiers (which showed arrhythmia rates were not that increased in 40,000 marathon skiers over 60 over 20 years, but these skiers were much, much healthier than the general population).

I think talking to the doctor is key.

German Visitor Shares Information

I am an enthusiastic (and silent) reader of you website since many years.

Now reading about your upcoming SVT ablation I want to share an information with you that you may find useful.

Heart rate spikes may be due to Kalium [potassium] and Magnesium levels out of balance. Hence I would suggest, that you have checked these blood parameters before you agree to the ablation. Here in Germany there have been success stories about ablations being avoided by replenishing these two minerals.
The prevention doc Dr. Ulrich Strunz whose recommendations I follow, suggests the following values to protect the heart in particular:

Potassium: 3.8 - 5.6 mmol/l

Magnesium: 0.9 1.1 mmol/l

Arginin: 110 -180 µmol/l

Keeping these values in the suggested ranges potentially prevents ablation. It worked for a friend of mine.

Keep up you great work and stay healthy.

Visitor Shares Experience

I was surprised to hear of your irregular heartbeat, but then recognized that some form of atrial fibrillation is not uncommon as you age. As you may recall, we have corresponded before on this as I had an ablation several years ago at age 55.

It was straightforward and recovery was quick. I was back to full exercise within 6 weeks, but did take almost 2 weeks of complete rest after the procedure before I gradually started to exercise other than some short walks.

I did have a repeat episode within one week of the procedure, which is common given all that the heart goes through, but have been fine since. I would do it again with no hesitation if ever needed, and it may be at some point once again.

You may also find information and posts by Dr. John Mandrola MD of interest. He is a cardiac electrophysiolist who often takes a much more conservative or holistic approach to treating afib, though of course most of his practice relates to ablations etc. I found his advice to always be helpful, at least in a general sense.

Wishing you all the best and look forward to some positive news.

Portugal Comments

Thanks for your November articles. Congrats on your impressive Cooper Clinic report. As has happened before, I was worrying about you when the articles appeared a little late this month. I'm always straight in there checking the website on the first day of the month. Having pondered your recent articles, I have a few of bits of feedback for you:

Clearly, it is your job to be an advocate for fitness lifestyle, and, as such, you're overwhelmingly positive about it. I'm not always so positive in so far as any aspect of life can create problems if it gets out of sync with the rest. While most people don't give fitness lifestyle enough prominence, for others hard exercise and focus on diet can result in fatigue, injury or mentally unhealthy ritualistic behaviour.

Anyway, all that to preface the fact that I too have an irregular heartbeat. I'm reminded of your past articles discussing links between extreme exercise (marathons, etc.) and cardiac arrhythmia. While I have not done that kind extremely grueling, very long-duration exercise, in my case I do suspect that my background of hard exercise and HIIT cardio (over decades, at times taken to an excess) almost MUST be a contributing factor in terms of my irregular heartbeat.

It's good to hear that your irregular heartbeat is likely benign; also good that you're looking into it further. You don't need me to tell you not to worry (stress being very unhealthy).


Sharing Information

Hey Clarence, I read with great interest about your annual visit to the Cooper Clinic. Let me say first, as a word of encouragement, my cousin, now 70, had the ablation procedure for SVT a few years back. It took two procedures to get it just right, but his comment: "after the successful second ablation, I felt like I had a new engine!" He continues to be active with regular training and no recurrence of the issue thus far. With your lifestyle, I'd say your chances for a good outcome are stellar!

I look forward to the update on your decision about the ablation procedure...we're pulling for you!

*  *  *

Clarence, just one thought on tracking the heart rate with the Fitbit. I too wear a Fitbit, and I find it is a good indicator of my general activity, sleep patterns and average heart rate. But if I want to get an accurate peak reading on my heart in real time I use a chest strap transmitter. When doing my sprint intervals, my chest strap will give me a consistently accurate peak reading of 152-155 max (about 90% of my estimated 172 max heart rate). I verify that by my perceived exertion, breathing, etc.

When I wear my Fitbit in conjunction with the chest strap for the same interval session and it will be off by as much as 20 bpm in either direction for a max. Same is true of walking...at the end of a walking session the Fitbit will show that I've had peaks of 162 bpm when my actual max may be around 120. At 162 bpm I would be gasping for air...it's just not that accurate. I've read many reviews from avid exercisers and they complain of the same issue...the optical heart rate sensors that read the pulse by blood flow just aren't that accurate. The chest strap monitor on the other hand sits close to the heart and reads electrical impulse in similar fashion as the electrical leads used in the standard stress test.

I know the chest strap monitors aren't as convenient, but it may benefit you to pick up a good one by Polar or another high quality manufacturer, and see what it shows on your walks. Couldn't hurt to verify those Fitbit numbers, and it may give you some valuable information that will help in your discussions with the ablation physician.

Best regards

December 1, 2019

*  *  *

"NO" to Ablation


Dr. Ho's referral bore fruit and Carol and I sat down with highly regarded Albuquerque cardiologist Sean Mazer early in January. He had my records in hand and we brought him current on new developments.

Following up on the suggestion of the German visitor (see above), we reviewed the Cooper Clinic report and found that my potassium is above the normal reference range and listed as "abnormal."

Carol found a list of high potassium foods and reduced our use by diluting some of them with other foods (sweet potatoes with teff for example), reducing the frequency of use (avocadoes, mushrooms, and regular potatoes), eliminating some of them outright (bananas), and cutting down on others (milk).

This allowed us to continue eating a wide variety of foods and eliminating very few. The difference was barely noticeable.

Voila, my heart rate spikes disappeared almost immediately. A follow-up blood test showed that my potassium is now in the middle of the reference range.

A Google search revealed that the body needs a delicate balance of potassium to help the heart and other muscles work properly. Too much potassium in your blood can lead to troublesome changes in heart rhythm. Many heart arrhythmias are harmless; however, if particularly abnormal they can cause serious problems, even death.

I had discussed this with Dr. McFarlin beforehand and he questioned whether my potassium was high enough to cause problems. Dr. Mazer voiced the same doubt.

Neither one of them offered an explanation for the disappearance of my heart rate spikes. Dr. Mazer did say that the heart sometimes corrects itself and that the spikes may return in the future.

As noted above, Dr. Ho my cardiologist at the Cooper Clinic had spent about 30 minutes explaining that my heart rate irregularity is probably genetic and not life threatening. We went over ways to manage it in considerable detail. The first option being to continue monitoring my heart rate on Fitbit. Stay the course for now.

On this Dr. Mazer agreed. Doing nothing is a viable option.

I asked Dr. Mazer whether he would have ablation if he was in my shoes. Without a moment's hesitation he said "NO." That my situation is not life threatening and if I'm happy the way things are staying the course is the way to go.

If the heart rate spikes again become a concern he invited us to come back to see him.

Tellingly, he sees ablation as akin to plastic surgery. If heart spikes become burdensome and interfere with workouts it is a simple solution with relatively little risk.

*  *  *

Finally, we discussed the benefits of exercise on heart health. While he sees genetics as a more powerful factor than we do, he finds my example--a lifetime of exercise and photos to show the results from ages 15 to 82--extremely interesting and vowed to check out our website ASAP.

*  *  *

A follow-up talk with Dr. Ho found him surprised by Dr. Mazer's assessment, but in agreement that doing nothing unless the heart-rate spikes return and interfere with workouts is a rational approach.

February 1, 2020

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