Always good advice on this forum from the heart experts and thru my heart and eventual pacemaker journey I also found the “pacemaker club” forum to be helpful as I investigated options and questions I could discuss with my cardiologist. The only thing with the pacemaker club forum is they are redoing their website so are having login issues but you can search and find many posts that may be of help to you.

The question of weather endurance athletics and heart arythmias can be connected is explored in "The Haywire Heart" by John Mandrola, Lennard Zinn, and Chris Case. My wife developed arythmias in her 20's after completing her first Ironman. She found the book eye opening in terms of how to think about and manage the affects of training on the heart.

I don't understand. Do you have ECG of when the tachycardia actually happens or the 'normal' ECG?

Yes, I have ECG from when the tachycardi actually happens. I got the Holter-ECG on and got on my bike and rode as hard as I could for as long as I could until I got tachyardia and kept on going for 5 minutes. Still, it's not enough information that they can do and ablation with it.

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Then I don't know what to tell you. I basically am one step behind - I need to wait for the tachycardia to happen again so that I could record it first. I was told by the doctors, that only after that we could diagnose fully and decide on the intervention. It's weird to me, that your doctors cannot diagnose you fully.

Also, ablation doesn't always go as planned: worst case scenario you might end-up with a pacemaker, that you didn't need before.

Try to contact Fred Funk and/or Vincent Luis. Vincent's had an operation, Fred not yet.

first, sorry to hear about this. second, join the club. third, we have a lot of posts on this.



but you'll note that most of what we have here is on atrial arrhythmias, not ventricular, as atrial appear to be much more common.

and finally, we have cardiologists here, notably dale toce. as a fellow on your same journey - and not a medical expert in any way - i can only say that it seems to me it will certainly help if/when your doctors are able to distinguish which chamber of the heart is causing you trouble. i hope it is atrial.

the one thing i can tell you from experience is that there are 2 kinds of adhesive holters that are that i have used - zio and epatch. i think zio is the typical first line product but i had much better luck with epatch (by phillips), as the zio fell off during the first zwift ride while epatch remained on for the entire week. here is a thread with a list of products, look at the post by dale.

there are 2 options that kind of make sense to me, as a layman. one is a week with an epatch and just go out and do your workouts, hoping that you can induce this. the second is a semi-permanent implant, i think they're good for 2 or 3 years, and in this case you have 2 options: the best is that you can't induce this arrhythmia over that 3yr period; second best is that you can, and your doctors can then know what your problem is.

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Dan Empfield
aka Slowman

sorry to hear of this-however, it is very problematic with endurance trained athletes...but I won't get into that--

as always, you need to work with your doctors etc etc...


It seems as if you've had svt-in particular avnrt with successful ablation (a procedure, not really surgery) which I'm guessing was successful but you had recurrent symptoms and then repeat EP study did not reveal an inducible arrhythmia?? I'm guessing at this.

And now, you've had recurrent palpitations and tachycardia and the doctors are speculating that it is some kind of svt (avnrt vs other-like automatic atrial tachycardia, atypical atrial flutter etc). SVT is a wastebasket term for top chamber tachycardia-starting in the atria or AV node. These are all narrow complex. The bad one, often more dangerous, is VT. *(except RVOT which is much more treatable) is from the bottom chamber-the ventricle, usually the LV but as noted, the RV ones are sometimes more benign and amenable to ablation. These are all wide complex.

So, where to go now?
The arrhythmia needs to be documented and then treated. And go to an EP that will try multiple meds to induce it, not just isuprel. Because you are right, exercise is not usually an option during an EP.

Dan's suggestion regarding loop monitors is a good one. Then The data can be taken to your doctors for plans for treatment--hopefully. I'd opt for an ILR-a tiny litte chip that will truly allow your to do the activity and document the arrhythmia, multiple times over longer periods of times without having to wear monitors repeatedly.

Good luck.

I missed this-
so if they know that you still have recurrent tachycardia, you must find an EP doc that will find it and ablate it. If not inducible before, it must be brought out with one of various stimulant meds-there are several options, but I am not an EP expert...

The morphology of the tachycardia gives clues but isn't a perfect assessment of what exact type of arrhytmia it is.

Dan, just thought I'd mention something interesting from my doc, using information used from your helpful posts on the topic. Met with my EP last week - as an aside, because my a flutter appears to have an actual cause (a virus) as opposed to "athlete's heart" for lack of a better term, we are giving cardioversion an initial shot to see if it holds- and I was asking about his experience with ablations etc. I asked whether he specialized in atrial arrhythmias or ventricular, he said they as you note they rarely see ventricular and if they do they send them to the specialists at UCLA.

Just to translate one of Dale's (dtoce) comments above, in case it is lost in translation slightly.
Within cardiology there are numerous sub-specialty cardiology areas.
One such area is Cardiac EP, or Cardiac Electrophysiology. These are the cardiologists that specialise in rhythm issues. These are the cardiologists that need to be sorting your issues, which from what I can gather quickly scanning your post, is almost certainly who has been involved at some point in the past.
I just wanted to clarify that in case the term EP was not clear to the OP or other readers!

Thank you (and everybody else contributing) for your reply.

I have obviously consulted my doctor and gotten a procedure twice at Mølholm in Denmark which is a small private hospital doing nothing but heart surgery https://www.molholm.dk/...lties/heart-disease/. After last EP they had nothing more to offer than a third EP with the same tools, isuprel and electric shocks.

Prior to that I visited Jostein Grimsmo, who is the most experienced doctor on athletes heart. He check my heart and I was able to induce the arrhythmia for 10-15 sec while running on a treadmill with 12-point ECG on me. He noted the following.

Inquiry from professor of physiology regarding Hovda. (No family history of genetic heart disease or sudden death at a young age. Previously healthy). Wanted us. of triathlon-beyond a very high level (won Norseman). For the first time, I noticed an uneven fast heartbeat during the marathon at treadmill on 8 May 2020. This occurred after approx. 1/1/2 hour, when he stopped the treadmill (due to max time) and started at the same speed. Later, the same problem on several occasions, where there was a rapid and uneven heartbeat. Recorded several episodes on a heart rate monitor, where the heart rate rises from an assumed maximum heart rate of just over 180/min to closer to 200/min.

Investigations:
Echocardiography: Left ventricle with dimensions within normal limits for cardio equipment (eccentric hypertrophy). Good contractions. Normal diastolic
function. No valve pathology. Borderline atria (sports heart). Right ventricle also within acceptable limits for sports heart. Normal and good function of the right ventricular free wall.
Normally calculated systolic pulmonary artery pressure and normally dimensioned vena cava inf. with good respiratory variation. No pericardial fluid. EVALUATION: Normal echocardiography.

Resting ECG (standing for start of test: Sinus rhythm. High T waves V3 to V6. No safe delta wave as in pre-excitation. Normal PQ time and QT time.

Cardiopulmonary stress test: He is stressed on a treadmill following a fast running protocol with a rapid rise from 14 km/h to 20 km/h and a 1.5% rise, which he runs 30 sec on and 30 sec off for approx. 20 minutes, for climbing up to 8% and at the same speed, then keeping intervals of approx. 20 seconds. Located at around 180/min hardening frequency at the end of the intervals. Suddenly a faster frequency of 197/min for approx. 10-15 seconds before it again switches to the previous rhythm and frequency around a maximum of 180/min. AKG: We succeeded in capturing the rhythm disturbance on the 12-channel ECG, which showed the narrow QRS complex, regular rhythm, changed from earlier, but it was not possible to define p-waves in front of the QRS complex.

I dont have that ECG, but have an ECG from an arrhythmia measured with a device called ECG247. https://ecg247.com/en/ Its from the picture below.

In addition I have the full Holter-ECG report where I had arrhythmia for 5 minutes, but I dont understand how to read it. It can be downloaded her: https://drive.google.com/...WML/view?usp=sharing

Just to be 100 % certain that I understood it correctly. There is no way to document the issue in a detailed enough degree for treatment without a tube up my groin? Aka, there is no way to detect it while I induce the condition on myself while running/cycling?

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well, I certainly can't read it *(it's in another language-ha)

but what you posted was exactly as it is described: non-sustained, narrow complex, irregular tachycardia at a rate of ~190 bpm then back to sinus tachycardia

it looks like they use a wireless stick on loop monitor which appears to give very accurate tracings

(we use an ILR-last longer, otherwise it seems this one can be repeated...)



Did they say you had nonsustained, paroxysmal afib or was it thought to be something else?

All I can tell you is that you still appear to have nonsustained arrhythmia that needs attention and even though you have the 'best' doctors, they are failing you presently.
Usually there are multiple ways to try to stimulate the arrhythmia other than exercise-various stimulant meds and yes-the only way to ID the arrhythmia is to map it electrically and ablate it.

In the EP lab-it looks like this:




as they map out the heart's electical system and try to find points that cause the arrhythmia and then ablate it

This is way out of my league though. I'm just a regular general cardiologist.

Thank you for sharing this. I have a similar post about an elevated heart rate that I suspect is really some type of arrhythmia. Can you tell us what you are feeling during these episodes? Are there physical symptoms of the arrhythmia? If you wear a Garmin, are these arrhythmias being recorded as elevated heart rates? I'm investigating my issues with the help of a Frontier X2 heart rate strap. (It sounds like an ad, but I promise it isn't.) It provides a continuous EKG during exercises, so it may be easier to provoke an event that whatever your doctor is having you wear. I hope this is helpful and I wish you the best of luck.

My subjective experience is almost certainly coloured by my understanding of what happen. I feel it immediately when it happens, and similar when it normalise (slightly harder to detect after stopping and waiting for the HR to decrease and "resett"). Its not painful, but uncomfortable and a feeling that my heart beats off-beat. I dont get dizzy, clearly feel that my performance is limited. Like my engine goes into safe-mode and stop me from pushing.

I have multiple recordings of the issue, both regular HR-measurement like my H10 Polar chest strap, but also Holter-ECG and the ECG247 device. From my understanding it does not help the doctors diagnose the issue precisely enough to actually do something about it.

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What about medications?

As I dont have any issues from day to day basis (when getting it during hard training session I can just take a 30-60 sec break and get on with it) if there was something I could take that is legal and not performance reducing that could be an option that could work.

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I have a heart arrhythmia.
I have had it since childhood.

I only noticed it because I did endurance sports.

It has gotten better with age and repeated stress (and recovery) from endurance sports.

The heart is a muscle with a lot of "wiring".

The heart is not a Statue.

Neither the muscle, nor the wiring are permanent features- left to slowly decay.
Both are a part of a living organism.

Both the muscle and the wiring respond positively to repeated stress and recovery.

Like all other parts of the body- it's all about the right balance between stress and recovery.