As always, up front I want to be clear that I have no direct knowledge of Clint Dempsey’s condition, treatment or prognosis. Two weeks ago, I wrote a couple of columns offering two possible scenarios on Dempsey’s heart condition providing a physician’s perspective based on what we know. (Those links are here and here if you need more background.)
To briefly summarize, I provided Scenario 1 in which he had arrhythmias that were highly amenable to procedures known as ablation in which the source of the electrical abnormality is scarred in such a way that it becomes electrically isolated and cannot spread its abnormal signal. Scenario 2 involved arrhythmias that are less responsive to ablation, and more often require additional medications and/or a procedure known as “DC cardioversion” in which an electrical shock is used to reset the heart.
On Tuesday, the Sounders community was informed that Clint Dempsey was ruled out for the season. Garth Lagerwey also mentioned some “out-of-market” physicians. Seattle is blessed with some of the best experts in all areas of medicine, but even with some of the top physicians locally it would be expected that Dempsey and the team would get a second opinion prior to making such high-stakes decisions.
As I mentioned in my first follow-up column, his earlier return to training was encouraging and suggested that he had undergone an ablation, with gradual increase in activity to see if the arrhythmia returned with increasing exertion over a two- to four-week period. The subsequent announcement that he is out for the season suggests the possibility the arrhythmia did, in fact, return. However, had this been a “Scenario 1” arrhythmia I think it would be premature to rule him out for the season entirely (particularly if the playoffs become a reality), as a prompt repeat ablation would potentially put him back on a two- to four-week recovery timeline. Since Scenario 2 is looking more likely, at least in my opinion, let’s dig into those implications a bit more.
The more complex arrhythmias, such as atrial fibrillation or atrial flutter, can increase the risk for stroke and heart failure when left unchecked. Not everyone with these conditions requires a blood thinner, but most do, and those who do require them for life. The decision to start blood thinners for life is based on the overall risk of forming clots that would lead to stroke, and that risk is determined by the presence of other medical conditions and the patient’s age. As far as we know, Dempsey is otherwise healthy, and at his age the concern would be less for the formation of blood clots, and more for the possibility that with exertion his heart rate might approach 200 beats per minute and not come back down when he rests, which in turn would lead to heart failure.
The fact that Lagerwey suggested he could return next season fortunately points us away from lifelong blood thinners and more toward a recurrence that just failed initial management. I suspect Dempsey underwent cardioversion (whether it occurred spontaneously, with medication, or via electrical shock), was then prescribed a medication to prevent recurrence of the arrhythmia, and was placed on a continuous heart monitor to see if it recurred despite the medication. Implanting this monitor could have been the “procedure” Garth alluded to previously, or perhaps he meant an initial cardioversion. Regardless, Clint’s return to training might mean the medication was initially effective, but as he increased his level of exercise it was proven to be inadequate. When the arrhythmia (presumably) recurred and persisted he was likely informed by the medical team that he would require cardioversion/ablation.
If Clint needs to undergo ablation for a “scenario 2” arrhythmia then he would likely be placed on a blood thinner for three weeks prior to the procedure, then for two months afterward (something that is not required for “scenario 1” ablations). Sometimes these procedures need to be repeated, so by starting the three-week clock now it would mean his earliest ablation could be next month, which would maximize the time for repeat procedures as needed prior to next season. If he is able to remain without symptomatic recurrence then he could be back for 2017.
How likely is that? Unfortunately it is very difficult to say for two reasons. The first is that I don’t know the results of his testing, and medical studies on the effectiveness of these procedures vary greatly depending on those details. The other reason, which is even more important to bear in mind, is that the studies were not done on elite world-class athletes. As a result, the likelihood of effectiveness for Dempsey could be much higher or much lower than that of the average population, but there is no way to know for sure.
My crystal ball is on backorder, but weighing all of the studies and possibilities my best guess is that he has a slightly better than 50 percent chance at returning next season, but a slightly less than 50 percent chance of lasting the entire season. Just like before, as both a physician and a fan I wish him the best of health.
RealDoctorFakeName is obviously not the name on his medical license, but Sounder at Heart can vouch for the fact that he is a working physician at a local hospital. He'll be providing opinions based on his medical knowledge periodically.