NBA Injuries

What’s up with LaMarcus Aldridge’s heart?-Dr. Morse

Photographer: Steve Nurenberg/Zuma Press/Icon Sportswire

Since the All-Star break, the San Antonio Spurs’ LaMarcus Aldridge stats for points, steals, free throw percentage and field goal percentage are all down compared to his pre-break averages. Guys go into slumps, but this time we actually may have a medical explanation for this. Even after getting the previous game off to rest, Aldridge didn’t really have the extra burst that was expected in the Spurs’ March 9th 102-92 loss to the Thunder. On March 11, the Spurs announced that Aldridge would be out an indefinite period due to a recurrence of a minor heart arrhythmia.

Back in 2007, LaMarcus Aldridge, then with the Portland Trailblazers, was experiencing dizziness during a game against the LA Clippers at the Rose Garden on March 31, 2007. After undergoing a series of tests at Providence St. Vincent’s Medical Center in Portland, Aldridge was diagnosed with Wolff-Parkinson-White Syndrome (WPW). Shortly thereafter, he underwent a successful procedure addressing the issue by Dr. Daniel Oseran, which caused Aldridge to miss the final nine games of the season. Then in 2011, Aldridge suffered a recurrence, causing him to miss an additional ten days. If you’re wondering what the heck WPW is, keep reading.

I’m going to try to simplify this as much as possible, so bear with me. Think of the heart as 2 coexisting systems, one electrical/conduction system and one pumping/mechanical system. Structurally, the heart essentially has 4 ‘rooms’ (chambers), and is split into 2 sides –the left and the right. The 2 sides of the heart each have 2 ‘rooms,’ the top part, which is smaller and known as the atrium, and the bottom ‘room’ is typically larger, and commonly referred to as the ventricle. Now imagine that there are doors to enter and exit each ‘room’ or chamber. These doors are called valves, and help pump blood throughout the heart by opening and closing when instructed (electrically) to do so. You may have heard of some of the names of these valves. The two most common are actually both found on the left side of the heart; they are called the aortic valve and the mitral valve. So there are 2 atria, 2 ventricles, and 4 doors/valves. Each side of the heart has one atria, one ventricle, and two valves (for simplification purposes). Got it?

The electrical system sends signals to the pumping system to open and close the doors/valves depending on what the heart wants to do at that time. Typically the electrical signals can only go in one-direction, starting in the upper chambers (atria) going to the lower chambers (ventricles), causing the heart to ‘beat.’ Similar to the electrical system of a car, the electrical system of the heart is vital to the heart’s functionality. Any issues with the electrical system can cause major problems with the heart. How can this electrical system be evaluated? The electrical system is typically evaluated by an electrocardiogram, commonly known as an EKG, which takes a snapshot of a heart’s electrical system, and can help tell if that electrical system is working properly, or if there is an issue. Depending on the different images displayed on the EKG, a medical professional can usually determine the likely causes of these electrical issues.

Okay, so now that you have an understanding of the heart from both a structural point of view as well as an electrical perspective, what happens in Wolff-Parkinson-White Syndrome (WPW)? Remember how I said there was typically only one electrical signal in the heart? Well, in WPW there is an extra electrical pathway, known as the accessory pathway. How big is this pathway? It can be as small as a piece of hair! Basically the extra electrical pathway allows the heart’s muscle to get signals faster than it normally would, so the heart is basically getting two signals instead of just one. Additionally what can happen is that the signal decides to loop back around and continue to send the electrical signal over and over again, creating a repeating loop. Normally the resting heart beats about 60 to 100 times per minute. In WPW, this repeating loop causes the resting heart to be about 140 to 250 times per minute. However this repeating loop kind of has a mind of its own. The extra electrical system does not run continuously, so the elevated heart rate, called tachycardia, can start and stop on its own, lasting for seconds to hours.

What does a person with WPW feel? People with WPW may experience palpitations, dizziness, lightheadedness, and even fainting. Although some people with WPW are asymptomatic and never know they have the issue. LaMarcus Aldridge unfortunately, has this cardiac issue, and this is the reason why in 2007, again in 2011, and just last week, felt dizzy and lightheaded.

Is WPW dangerous? For those people that are symptomatic, especially those that increase their heart rate often, like professional athletes, this rapid heart rhythm can be life threatening. It can result in cardiac arrest, and even sudden death if not corrected. Fortunately, the incidence of sudden death in people diagnosed with WPW is actually quite low, about 0.4% per year, and that risk can be even lower if the person is asymptomatic. In fact Quentin Groves, a former NFL linebacker who played for 7 different NFL teams spanning 8 years was diagnosed with Wolff-Parkinson-White syndrome. Unfortunately Mr. Groves died of a heart attack in October of 2016 at the age of 32, whether his death was due to WPW is unknown.

How is WPW diagnosed? Remember that device that I mentioned earlier about how to monitor the heart’s electrical system, the EKG? Well that’s how you diagnose WPW. A simple, painless EKG, will show the 2 classic findings of WPW, one of which is specific for patients with WPW, called a delta wave. If the person has a normal EKG but the physician is still concerned that the person has WPW, then there is additional testing that can be done at a hospital, called electrophysiologic testing.

How is WPW treated? Most people with WPW who are asymptomatic do not need treatment. For those people who do develop symptoms, like LaMarcus did, especially those who are high-level athletes, there are serious potential risks of because of the tachycardia. These people require treatment, and the treatment focuses on stopping the tachycardia, and preventing it from happening again. For simplification purposes, there are basically 3 ways to correct the WPW (by preventing the recurrence of the tachycardia): radiofrequency ablation, medications and surgery. The choice is typically not up to the patient, but instead the heart doctor that specializes in heart rhythms, called a cardiac electrophysiologist.

It is not exactly clear which treatment LaMarcus Aldridge had in 2007, and if he needed additional treatment after he suffered a flare up in 2011. If I had to guess, I would say he likely underwent radiofrequency ablation. This is a procedure where a wire is advanced into the heart and then high frequency electricity is used to destroy the accessory pathway. Radiofrequency ablation has over a 95% success rate. Unfortunately for Mr. Aldridge, he may fall into that remaining 5%. The best way to ensure that the WPW pathway is completing destroyed, is to undergo surgery, but this is rarely performed with how successful radiofrequency ablation is.

The Spurs announced that Aldridge is scheduled to undergo additional testing on Monday, March 13, 2017. Depending on what the additional testing shows, and which method of treatment he may undergo, his timetable to return to play could be anywhere from a couple days to out the rest of the season (if he were to undergo surgery). I hope this article provided some clarification about this complicated but fascinating topic that is affecting the San Antonio Spurs’ LaMarcus Aldridge, and possibly several other athletes.

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