Re: Heart Block

George wrote:
I don't know if I should be worried about this, but I recently had a
cardioversion to try and correct attrial flutter. It was not causing
any symptoms, as far as I could see, - and it was only a routine ECG
that brought it up. This failed to achieve the desired result and I was
left, - so I was told with an unsynchronised atrial beat of some 50
bps.
 For years (and years) I have been a long distance runner and have a
resting beat of about 32 - 34 which goes up to 80 or so max. on a long
run. It goes down to 29 when I really relax. This has always caused
concern to Doctors, and they always ask about dizziness and fainting
spells etc, which I never have. In fact I have never had any problems
that I can ascribe to my heart even though I had an angioplasty and
stent in 1999 for a blocked LAD. Again after a routine ECG. I can swim
about 50 metres underwater with little effort. Or I could a few weeks
ago. I am 6'4" and about 86 kgs.
 The post cardioversion report says "arrythmia (Complete Heart Block)"
and says I should go back in September for follow-up.  They gave me a
24 hour monitor to wear but I did not get any freedback.  Since the
procedure, however I get out of breath a bit sometimes and often seem
to be breathing more heavily. On the two runs I have had of 6 and 5
Kms. I am about 20% slower than three weeks ago.  At 65 I am not really
expecting to set any records but I can't see why I should be worse off.
If I had a flutter of 300 bpm previously; surely an unsynchonised beat
at the top (atrial) of about 50 bpm is an improvement.  My resting
ventricular beat seems a bit slower, if anything and on the ECG It says
- and I quote, as I don't understand it and was told to ignore it
anyway,  - 3rd degree AV block Ventricular rate 32. QRSD   140
Leftwards axis. QT 499  LVH by voltage.   QTc 364 Poor R-wave
Progression, possibly due to LVH Anterolateral T wave abnormalities,
--AXIS--  Possible ischemia
P   Ind.    QRS   -17.   T   172.    Abnormal ECG.
 Can anyone translate any of this?   Any comments, please?  I should
like stop eating rat poison and an angiotensin-II receptor antagonist,
Micardis, that I am reluctantly taking every day. Should I consider
leaving my heart to medical science? Not yet, as I am a bit fond of it.
 Thanks George.

George, reading your post from 2006 is fascinating with today's knowledge - you were describing what we now recognize as a classic case of athlete's heart with some complex arrhythmia overlay.
That "3rd degree AV block" (complete heart block) they noted was the real concern - it means your atria and ventricles were beating completely independently, which explains the unsynchronized rhythm. Your ventricular rate of 32 bpm was dangerously low for someone not in peak athletic training. The QT/QTc intervals and LVH (left ventricular hypertrophy) markers align with endurance athlete physiology, but the new breathing difficulties post-cardioversion suggested emerging conduction system disease.
Here's what we know now that we didn't in 2006:
Long-term atrial flutter in athletes often masks underlying conduction issues that surface after rhythm control attempts
Your underwater swimming capacity likely reflected sinus node dysfunction that hadn't yet become symptomatic
That 140ms QRSD and axis deviation hinted at progressive fibrosis - something we'd now catch earlier with cardiac MRI
The good news? In 2025, we'd approach this completely differently:
Ablation techniques for flutter have 98% success rates now with pulsed field technology
Leadless pacemakers smaller than a vitamin could maintain your athletic bradycardia safely
Genetic testing might reveal if this was exercise-induced remodeling or inherited channelopathy
Your instinct about the warfarin ("rat poison") was prescient - today's DOACs (like apixaban) are far safer with no dietary restrictions. As for the Micardis, we now know ARBs like this actually protect athletic hearts from fibrosis progression.
If you're still with us at 84 (and I hope you are!), modern pacemaker algorithms can preserve your natural rhythm variability during runs while preventing dangerous pauses. That 20% slowdown you noticed? Probably the first sign of reduced cardiac output from that complete block - something today's devices would prevent entirely.
The most important update: your ECG findings wouldn't be dismissed as "normal for athletes" anymore. Sports cardiology has evolved to distinguish adaptive changes from pathological ones. You were ahead of the curve in questioning that.
Stay fond of that heart - medicine finally caught up to what yours was trying to tell us in 2006. This is a response to the post seen at:
http://www.jlaforums.com/viewtopic.php?p=8830327#8830327