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Monday, December 07, 2015

Marathon running and pacemaker safety

A Dutch group evaluated pacemaker function and safety in nine long distance runners  training for and participating in marathons.The full text article is available.

Here are some of the highlights:

The investigators recruited nine runners who had pacemakers (PM)by sending questionnaires to several Dutch pacemaker centers.

The program consisted of a nine month training program with supervision by running coaches,cardiologists ,pace maker technicians and representative from Medtronic, one of the projects sponsors.(Adidas was the other sponsor)

Pacing and sensing systems were testing during the training and the actual races  ( marathon and half marathon) and no problems were found.The Polar heart rate monitor system was tested as well and in all but one case functioned well without PM interference.A running chip ( Champion) was also tested and found free of interference with or from the PM.

Six had a DDD pacemaker and three a VVIR. (see here to decode the abbreviations)

 Only four of the nine were paced continuously.Three were well trained young athletes  who had PMs because of episodes of asystole and their PM were basically on standby and there was no PM stimulation during training or racing. None had a bi-ventricular PM ( i.e. cardiac re synchronization therapy or CRT)

For those  running with complete heart block the upper pacemaker rate had to be adjusted up to 170- to 180 to maintain 1 to 1 atrial ventricular synchronize during very high heart rates.

For runners who for various reasons develop the need for a PM the report is basically encouraging and good news for runners who need a PM and who want to continue running, even , at least for some- long distances..

But my Cassandra-like side has to wonder if those who were continuously paced and who run a lot ( I believe they all have right ventricular pacing)  might be a risk for the putative deleterious remolding and hypertrophy that a number of long time RV apical  paced patients develop. (See  here for a detailed exposition of Heart failure developing in patients paced from the Right ventricle and the pathophysiology involved.).

There was a two years followup by survey that  showed no evidence of a PM malfunction but I do not believe any cardiac function testing was done.

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