Two weeks ago Clint Dempsey sat down with Michelle Ludtka and provided some further clues about his heart condition, so while I still have no direct knowledge of his case, what he had to say fills in a few gaps.
In an article on September 28 I speculated that the available information was consistent with arrhythmias such as atrial fibrillation or atrial flutter. Clint described that there “are times when it would flare up and times when it would go away,” which is consistent with these types of arrhythmias. This intermittent nature is particularly suggestive of atrial fibrillation, which is so commonly relapsing and remitting intermittent that it goes by the specific name “paroxysmal atrial fibrillation.” The risks for paroxysmal atrial fibrillation are essentially the same as the persistent version, but can make them harder to catch on monitoring done at one point in time, such as the EKGs he underwent.
This situation is where the loop recorder he mentioned comes into play. These are placed under local anesthesia and can stay in place for years on end, transmitting up to daily reports as needed. Clint said “it’s recording every game,” suggesting that his presumed atrial fibrillation is, to a large extent, exercise induced. While this phenomenon is well documented in medical literature, why one athlete versus another develops this issue, both with otherwise normal hearts, is poorly understood. (Incidentally, articles on this topic include fun phrases such as “…determining which type of physiologic autonomic predominance contributes to destabilization of the arrhythmogenic substrate.” Just a little light reading!)
The good news is that Clint is right when he says the doctors told him that “this is something that can be fixed.” The $3,892,933.50 question is whether that is a permanent fix or not. As described in the September article, he almost certainly underwent an ablation procedure, but when it came to speculating on how likely he’d be to remain in a normal rhythm I wrote, “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.”
Since most recurrences happen early on, based on when he returned to action and the fact that he’s still going hard to goal a couple of months later, I’m not only more willing to speculate now, but increasingly optimistic with each passing game. In studies done back in 2010 and 2013 on a total of about 500 patients, recurrence at nine months in the first trial was 16 percent, and at 12 months in, the second study was seven percent. Why the patients in the second study had less recurrence than the first is unclear, but when talking to patients about the success rates, we typically say that it’s about two-thirds of the time after one ablation treatment, rising to about 90 percent total success rate after a second treatment for those who need it.
So Clint’s loop recorder will keep recording, but my best guess at the likelihood that he plays to his heart’s content? Upwards of 90 percent. As always, as both a physician and a fan I wish him the best of health, and I can’t wait to see him back out there on Saturday!