Bradycardia and dropped beats

Training Q&A [Moderated]
1

I’ve been getting multiple tests since being diagnosed with hypertension a few years ago and a resulting MRI revealed mild fibrosis (stable upon two subsequent MRIs).

I have been doing holter monitors which revealed wenckebach phenomenon.

Over the past 12 months the dropped beats have increased significantly at night.

Holter monitor 12 months ago: Sinus Rhythm, average HR 104(min 42). 56 dropped beats, 564 episodes of bradycardia

Recent Holter monitor: Sinus Rhythm, average HR 62 (min 26). 278 dropped beats, 564 episodes of bradycardia. First degree AV block. 1 PVC

I’ve been doing quite a bit of running in preparation for a marathon. However, it’s only 25% more. I am fitter than then, but only marginally.

I have no symptoms other than palpitations rarely (correlated with emotional stress/ poor sleep).

EJF rate and everything else including exercise stress test are normal.

Is this athletic heart or potential for concern and pulling back on endurance training.
12 months ago first cardiologist told me never to run a marathon, at which point I consulted with Austin and led to 2nd opinions and further testing.

(see last 6 months vs same period 12 months ago)

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2

Hey Adam,

I appreciate you posting this here and asking us to weigh-in. Unfortunately, we’re a bit limited with what we can do via the forum, and this falls into the consultation territory once again. I’d recommend reaching out if you’d like Dr. Baraki or myself to discuss this with you.

-Jordan

3

Agree with Jordan regarding detailed/individualized advice.

I will say that Wenckebach (Mobitz I) in a highly trained, asymptomatic athlete, is generally not a cause for concern. It is thought to be due to high vagal tone, which is going to be even higher while asleep. So it’s not terribly surprising that you are seeing more of it while asleep. I am not sure why this is continuing to be monitored so closely.