Bicycling Blogger Restarts With An ICD: Part 2

EP Cath Lab Label

Last week I brought you up to the point where I was about to have Dr. Lockwood turn me into a cyborg. If you've missed that post, or simply want a re-cap click here.

The implant procedure was out-patient, meaning I was in-and-out in a single day. I was stretched onto an operating table in front of an array of 8 flat-screen monitors. One would display my vital signs. One would display a real-time x-ray image of what was going on in my chest. On another I'm sure I could have checked my e-mail if I wanted to while they were working on me!

Electrophysiology EP Cath Lab

We began with an Electrophysiology (EP) study, where Dr. Lockwood probed my heart through a catheter that had been inserted into a femoral vein (i.e., right near my groin) and pushed through, up, and into my right ventricle. Many cardiac nervous system electrical wiring-type issues are well researched and can be manually triggered through an EP study. From Dr. Lockwood's initial review of my case, he didn't think he'd find any of these typical issues, but to be thorough he looked for them anyway.

Near the end of the EP study, they injected me with epinephrine that made my heart start to race. It was the strangest feeling. Not specifically because my heart was running rapid - I can get it to do that when I train and race, hitting 180bpm and more when I need to. The strange thing was laying perfectly flat, perfectly still, and feeling my breathing rate begin to increase in a rather shallow sense, while my lungs tried to keep up to my swiftly beating heart.

Assimilation Begins!


Just as we thought going into the EP study, Dr. Lockwood found nothing more specific. He then proceeded to prepare my chest for the implant. He administered a general sedative through an IV that had been in place during the entire procedure. But before it fully knocked me out, Dr. Lockwood injected some localized freezing on my chest where he would be making an incision. One injection of freezing and shortly thereafter he began poking.

"Do you feel this?" And I could.

Then a second injection, and a few moments later. "Can you still feel this?" And I could distinctly  feel him draw his scalpel deeper across my skin.

"Ow, yes I still feel that!"

"Goodness, you'll need more here then..."

And that was about all I remembered until waking in the recovery room.

While I was unconscious, Dr. Lockwood used the various monitor screens above me to thread the ICD lead through through my sub-clavicle vein and into the right ventricle of my heart. The lead would serve two functions: monitoring the activities of my heart; and apply electrical stimulation as needed.

With the lead in place, Dr. Lockwood basically screwed it to the ICD. He formed a basic pocket just under my skin on the upper left side of my chest, about an inch below my collar bone, slightly more towards the center line of my chest. In our pre-op consult I had asked Dr. Lockwood to put the ICD a little more to the center of my chest, so when I dropped into the tucked aerobar position on my time trial bike, the device wouldn't get in the way of my shoulders pinching in. He slid the ICD into this pocket, anchored it with a few stitches to some tissues in there, and then closed me up.

Kevin Rokosh post op recovery room
Resistance was futile!

Post-op I couldn't drive for 6 weeks. That was a legal precaution. When they mess around with your heart like this, something could go wrong again and they wouldn't want you to be piloting a hulking beast of metal (i.e., car) down the road when it happens. You might take someone else out, not just yourself. But within a couple of weeks I was at least back to normal training on my bike - and my feet, and my skis, and my snowshoes.

A Quadrathlon?


For you see, that winter I needed to add in some specific run, cross-country skiing and snowshoe training, because in February of 2010, just under 3 months after getting the ICD implanted, I raced in something rather crazy called the Mt. Taylor Winter Quadrathlon, in Grants, NM.

The event began in Grants (elevation 6,500ft) and was a bike-run-cross country ski-snowshoe race to the summit of Mt. Taylor (11,301ft), and then all four events again back down the mountain!  It was about 70 km (44 miles) round-trip.

I placed around 10th out of 18 in my category - not bad I suppose for someone who recently had some hardware added to his heart! (Analyzing my results, not surprisingly I was strong on the bike, being about 5th out of everyone in the entire race coming off the bike going up. From there I was a really lousy runner, where I lost most of my time going up and coming down. Cross country skiing and snowshoeing? I was decent, as these are winter cross-training activities that I do anyway, and they really complement your cycling-specific muscles. If you haven't tried them yourself, do so this winter. Sure beats endless riding your trainer staring at the basement wall!)

Nothing Can Stop Me Now!


In the time that I've lived with my ICD, it has just sat there, monitoring, waiting, until it sees my heart stop beating again. Or rather, it's not that it's looking for my heart to completely stop beating. When it starts to get out of sync it begins to flutter (fibrillate) in a sense that would appear to be a heart rate of over 200bpm. But it's not the kind of heart rate that actually pumps any blood. The ventricles are all out of sync and not sending the blood anywhere. For me, the ICD has been programmed to look for a rate over 206bpm, at which point it would deliver a strong electrical shock and then enter a pacing mode until it detects normal sinus rhythm. If it doesn't see normal rhythm, it would shock me again. A friend of mine, who has an ICD for a heart that's much more messed up than mine, has experienced his ICD firing and says it feels like someone whacking him in the chest with a baseball bat! I'm a cyclist - I don't want to be a baseball player!

I can say that the ICD has not stopped me at all from being an athlete. Sometimes the shoulder straps of my bib cycling shorts bother me a bit in the way they might lay over the ICD - but it's really not all that noticeable. I still train and race competitively on the road and track. I do think twice now about racing cyclocross - if I might fall or get otherwise caught up in a crazy pile up on course where someone could run into and/or over my ICD, it would be more likely in a 'cross race. It all comes down to risk management. I've even been taking tennis lessons, because it's fun and gets my body working in planes of motion that cycling never will. I lift weights, but the only lift I haven't really tried again is the power clean. I could end up hitting the ICD or catching the bar at the top of the lift on my upper chest right in the area of the ICD. Other than that, I have returned to the gym to build strength for cycling.

ICD
How it looks, 3 years later
The only consistent bother is the seat belt shoulder strap when I'm driving. No matter how I adjust it, to keep it properly in place the strap lays right across the ICD. If you've ever sat on an over-stuffed wallet in your back pocket, the feeling is similar. Sometimes you're not quite aware of it, but then it starts bugging you and you pull the wallet from your pocket. Can't do that with the ICD!



For more reading about ICDs, see the wikipedia entry at: Implantable cardioverter-defibrillator

If you're an athlete with your own ICD story, please post a comment and let us all know!