(Ectopic) Rhythm Nation

Okay all you horny Janet Jackson fans. Just sit the hell down. I’m trying to be clever here. Yes, Rhythm Nation was the name of her album back in 1989 (tell me you didn’t watch MTV at some point in the last two decades) and her naked midriff set the standard for abs everywhere for some time after those videos. But the rhythm I really want to talk about is the cardiac kind. And not just the normal rhythm kind. I’m more interested in, as the title suggests, ectopy. This is the term cardiologists give to heart beats that are generated outside of the normal electrical pathways in our hearts.

Our hearts start banging out a beat long before we are born and don’t stop...ever, until we die. Kind of crazy when you consider it. Most people don’t think twice about what their ticker is doing until they have their first MI (myocardial infarction, aka, heart attack) while plowing through their fourth plateful of General Tso’s chicken at the local Hong Kong Buffet. Then they’re bitch-slapped into a new level of intimacy with this vital organ as they lay on the hospital gurney listening to the beeps emanating from the monitor. Note to self...better take care of this sucker lest I find myself settling down for the premature dirt nap.

On the other hand, folks prone to reading my drivel probably are more like the type that spend a few hours a day being very aware of what their heart is doing. Heart rate monitors, training zones, resting heart rates and lactate threshold are all concerns at some point during training for many of us. We take care of the little bugger, training hard and paying attention to every calorie we stuff into our pie hole, hoping that when crunch time comes, our tachometer will rise to the occasion and get us through to the finish.

This is how it’s been for me over the years. Back in the day, running the Human Performance Lab at Boise State University I spent a lot of time watching athletes’ heart rates, among other parameters. I knew there were pathological states that created unusual cardiac conditions, some of them fatal, but I never saw one in any of the athletes I tortured on the treadmill and bike ergometer. We seem to read about the bad ones from time to time. Sudden cardiac death, it’s called. Happens in high schoolers right on up to professional athletes. Can’t think of any sport where heavy breathing is part of the deal that has been spared casualties from this killer. Problem is, no one ever sees it coming. Occasionally, autopsy reveals some sort of structural cause but often a reason is never determined.

Steve Larson, one of America's most prolific endurance athletes, competing in World Championships in road cycling, track cycling, cyclocross, mountain biking and triathlon, died last May while doing track intervals at the age of 39. A father of five children, he was still competing for fun at a high level. Reportedly, he was having some occasional breathing difficulties in the weeks leading up to his sudden death. Autopsy reports were inconclusive but what they did discover is he did NOT have heart disease or die of a blood clot. A possible viral infection leading to cardiac muscle dysfunction has been suggested as a cause. Either way, he was a battle-tested bad ass not far from his prime who dropped dead while exercising. Crazy!

Less sexy and stuff we rarely read about are the non-fatal rhythm disturbances that are common amongst endurance athletes. These rarely make the news because no one dies. One that did make the news years ago involved Bobby Julich, a recently retired American professional cyclist who almost missed the best years of his career due to one of these problems. When his performance suffered and his condition became known, he was summarily let go by his French team during his first stint racing in Europe. Read about his condition here. Once home, the diagnosis was confirmed and a procedure performed that corrected the abnormality. He slowly worked his way back into the fold and became one of the most successful Americans ever to race in the European peloton.

There are many types of rhythm disturbances in athletes. Many of them are common and benign. Most of us throw a premature atrial contraction or ventricular contraction (PAC or PVC) from time to time and these lead to nothing but a curious, brief sensation in our chests. Less common and potentially more serious are the sustained runs of strange heart beats that can occasionally end careers and lives. Re-entrant supraventricular tachycardia (RSVT) and paroxysmal supraventricular tachycardia (PSVT) are two of the more common rhythms that fall into a survivable sub-set of this category and ventricular tachycardia (V-Tach) which can quickly become fatal if the rhythm is not stopped soon after onset with defibrillation (think...shirt ripped open, paddles on the chest, some dude yelling, "CLEAR!" and the body thrusting off the ground). Atrial fibrillation (A-Fib) is another less serious disturbance that can still alter lifestyle. This particular rhythm disturbance derailed New Zealand's Rob Waddell's distinguished rowing career on a couple of occasions. He took up yacht racing instead. Yawn!

The result of most of these issues is a transient decline in athletic performance. Death, of course, would be a more permanent decline in performance! Treatment for these conditions vary from doing nothing, pharmacologic interventions, and semi-surgical interventions similar to what Bobby Julich had done back in the 90's. Occasional runs of SVT are common and usually benign requiring no treatment. Longer more frequent runs with more sever associated symptoms like light headedness and syncope require electrophysiologic evaluation with a cardiologist and sometimes more aggressive treatment of one sort or another. Implantable cardiac defibrillators (ICD) are a fairly severe form of treatment that can be life saving. Check out this crazy video of a soccer player hitting the deck with a possibly fatal arrhythmia and then getting hit with his ICD. 

That's pretty dramatic stuff and nothing to look forward to. Still, it's better than dying in a bike race or soccer match, right? A more attractive treatment is the one that Julich had done. This is the ablation procedure described here. It's not for everyone and does not always work but when it does it can normalize your athletic experience completely. I actually finished LOTOJA this year with a guy who underwent two such procedures this year, the second being quite successful. Fortunately, it was not successful enough to beat me in the sprint!

On the less invasive front, researchers recently took a group of endurance athletes prone to rhythm disturbances and rested them for 2 to 4 months. During this deconditioning period, the frequency and duration of their ectopic events decreased significantly. The scientists concluded that periods of decreased training volume and intensity may have a protective effect against future, possibly fatal cardiac events. Yahoo! Let's hear it for off-season couch surfing. 

So, what does all this mean? Are we training our asses off only to drop dead at some point or, possibly worse, spend the rest of our lives walking around with some sort of human generator stuck in our chests? Hardly. As I have pointed out previously, there are those in the training community that would have us endurance athletes believe just that. However, more revealing is to simply step back and look at the general population. A certain number of those individuals are going to have fatal cardiac events in spite what they do or don't do. Saying that these unfortunate events are caused by something is a stretch a lot of the time. Hell, remember when we were told that cholesterol caused heart disease and margarine was good for us? Both of those notions are now swimming in the same crock of shit! More likely is that some athletes are genetically prone to these conditions and that certain types of training stimuli trigger their expression. This is similar to the notion that certain environmental toxins may cause cancer is some individuals while other similarly exposed folks will not be afflicted.

The problem often lies in that dedicated athletes are often in denial when it comes to injury or more serious health issues. Heaven forbid if we have to curtail our training or even fail to reach our lofty goals. We tend to train through things rather than go seek medical advice. It's up to each individual to take responsibility for their own well-being and be honest with themselves when things go sideways. We will face the music one way or another. - Brian 

Comments

[Ralph S.]

Responsibility for our own well-being? This is America goddamn it! I will just sue someone...

Kidding aside, do you think a weekend warrior like me should invest the $150 or so to have a LT and fuel efficiency test? I don't really compete, but am curious about training heart rates. I just use general guidelines and a monitor. I am also not worried at all that I am overdoing it! Your opinion is respected and appreciated.

[Maggie Danhakl]

Hello,

Healthline just designed a virtual guide of how atrial fibrillation affects the body. You can see the infographic here: http://www.healthline.com/health/atrial-fibrillation/effects-on-body

This is valuable med-reviewed information that can help a person understand the effects of afib of their body. I thought this would be of interest to your audience, and I’m writing to see if you would include this as a resource on your page: http://getstrongergolonger.squarespace.com/journal/2009/10/12/ectopic-rhythm-nation.html

If you do not believe this would be a good fit for a resource on your site, even sharing this on your social communities would be a great alternative to help get the word out.

Thanks so much for taking the time to review. Please let me know your thoughts and if I can answer any questions for you.

All the best,
Maggie Danhakl • Assistant Marketing Manager
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