From The Desk Of Clarence Bass
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.
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.
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.
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.
German Visitor Shares Information
I am an enthusiastic (and silent) reader of you website
since many years.
Magnesium: 0.9 1.1 mmol/l
Arginin: 110 -180 µmol/l
Visitor Shares Experience
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
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.
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!
* * *
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.
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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