Pacemaker safety and long-distance running.

OBJECTIVE: To prove that long-distance running is safe for athletes with pacemaker devices, pacemaker function was evaluated in nine long-distance runners. METHOD: Nine runners participated in a nine-month training programme that involved running for 1000 or 2000 km in preparation for either a full or a half marathon. A professional coach, three cardiologists and a technician - all with running experience - conducted the training and medical checkups. Commercial heart rate monitors were used during training to assess heart rates at rest, and during exercise and long-distance running. Sensing and pacing functions of the pacemaker system were tested during training sessions as well as during the race. In addition, the ChampionChip (a time registration device used in competition) and the Polar heart rate monitor (a widely used self-monitoring device) were tested for possible interference with the pacemaker. RESULTS: All nine athletes completed the Amsterdam 2001 half or full marathon without any pacemaker dysfunction. A short survey after two years showed no pacemaker dysfunction. CONCLUSION: Long-distance running is safe for athletes with pacemaker implants. Overall fitness and sufficient endurance training remain the prerequisites for maintaining the condition necessary for successful completion of a marathon regardless of medical status. In our study, it became clear that for patients who had received a pacemaker because of complete heart block, the upper rate of the pacemaker programme needed to be adjusted to 170 to 180 ppm to insure 1:1 atrio-ventricular synchrony during high atrial rates. It is concluded that there is no a priori reason for cardiologists to advise against long-distance running in athletes with pacemakers. Patients with known or suspected structural heart disease should be screened according the recommendations.

Recommendations and cardiological evaluation of athletes with arrhythmias: Part 1.

Besides the consensus meeting in Amersfoort in 1988 and the Bethesda conference in 1994 recommendations are not available in the Netherlands for screening and evaluation of athletes with cardiac arrhythmias. Guidelines for competitive athletes with cardiac arrhythmias in the United States and Italy were published in 2000. In 1998 Estes et al. published the most important opinions on sudden cardiac death, screening and evaluation of athletes and arrhythmias. This study addresses the physiological and morphological consequences of athletic training, cardiac pathology and risk stratification for sudden cardiac death. Recommendations for competitive athletes with cardiovascular abnormalities, arrhythmias and proposals for specific protocols are given.

Recommendations and cardiological evaluation of athletes with arrhythmias: Part 2.

Confronted with a competitive or recreational athlete, the physician has to discriminate between benign, paraphysiological and pathological arrhythmias. Benign arrhythmias do not represent a risk for SCD, nor do they induce haemodynamic consequences during athletic activities. These arrhythmias are not markers for heart disease. Paraphysiological arrhythmias are related to athletic performance. Long periods of endurance training induce changes in rhythm, conduction and repolarisation. These changes are fully reversible and disappear when the sport is terminated. Pathological arrhythmias have haemodynamic consequences and express disease, such as sick sinus syndrome, cardiomyopathy or inverse consequences of physical training. Arrhythmias can be classified as bradyarrhythmias and tachyarrhythmias. Conduction disorders can be seen in fast as well as in slow arrhythmias.

Incomplete cardiac vagal blockade with atropine in the anesthetized dog.

In dogs in neurolept-anesthesia the successive administration of alpha- and beta-adrenergic blocking agents and atropine, which should cause the functional equivalent of surgical denervation of the heart, always results in a marked tachycardia. The same is observed in conscious dogs, but not during methoxyflurane anesthesia. Bilateral vagotomy and administration of hexamethonium abolish the tachycardia. These observations demonstrate the presence of a vagally mediated chronotropic effect which becomes manifest when the inhibitory vagal effect is eliminated through blockade of the muscarinic receptors with atropine.