Sudden cardiac arrest. The absolute last thing you want to hear as a player is hustled off the bench after a collapse. It rarely has a good outcome, but Rich Peverley and the medical staff of the Stars and Blue Jackets have beat the odds.
UPDATE: New information has surfaced in the recent days – it seems that the preseason procedure Peverley chose was an elective cardioversion followed by ongoing medication, so as to minimize his recovery time. Cardioversion is a non-invasive procedure that involves a shock delivered at a certain phase of the cardiac cycle that essentially resets the heart so that it can resume a normal rhythm. After his collapse March 10th and subsequent resuscitation, Peverley was wearing what the NHL calls a “monitoring vest” until he could have a corrective procedure (an ablation – described below), which was done Tuesday at the Cleveland Clinic. There’s been no word about whether he also had an ICD (implantable cardioverter-defibrillator) put in, but that can be done with just an overnight stay.
The monitoring vest is actually a LifeVest – a wearable cardioverter/defibrillator. It’s a vest that continuously monitors the heart rhythm, and delivers a shock if it senses an arrhythmia.
The vest also sounds an alarm first so that if you’re still conscious you can stop it from shocking you. Why? Because if you’re conscious you’re (more or less) okay. You need to call 911 immediately and get to the ER, but you’re okay(ish). You really don’t want to get shocked unless you absolutely need it. While the shock can reset your heart and save your life, more shocks actually increase mortality – so you want to minimize your exposure to those times it’s truly absolutely unavoidable. If you’re unconscious, the vest gives you plenty of chances to deactivate it, and you won’t take any of them (because unconscious people can’t press buttons). It deploys conductive gel onto the pads in the back of the vest, and lights you up. The manufacturer (Zoll) has a pretty graphic demonstration of an EKG that degenerates into a shockable rhythm, the warnings the vest delivers, and what happens when a shock is applied. Turn your volume down a bit for this one, be patient and wait for the arrhythmia. It’s a hell of a process.
Peverley’s season is over, and his ablation will have a four to six week recovery, longer if he also had an ICD placed (and we have no idea if he did at the moment, but no mention was made of it at the Stars’ press conference). There’s been no move on the part of the Stars to commit to Peverley ever playing again after this season. Tincture of time is indicated on this one.
As part of preseason physical testing, Rich Peverley had an EKG that showed a “blip” (a term I apparently wasn’t fond of).
EKGs can have rhythm changes or findings suggesting anatomic changes, but not blips. Quit dumbing it down.
— Jo Innes (@JoNana) September 12, 2013
It turns out the blip was atrial fibrillation (afib) – the most common arrhythmia, present in about 5 million Americans. It happens when the part of the heart responsible for setting the pace doesn’t do its job properly, explained quite eloquently here (Pevs forgive me for the heinous misspelling):
So about Rich Peverly – atrial fibrillation (afib) is when you have a pissy little spot in the heart that gets the rhythm out of whack.
— Jo Innes (@JoNana) September 13, 2013
Afib is exactly what it sounds like – the atria (upper chambers of the heart) don’t squeeze in a nice organized regular manner – they fibrillate (quiver). That increases the likelihood of stroke because blood doesn’t zoom through, it swirls around in the atria. Blood standing still is blood that likes to clot, and clots are things you don’t want in your body. The ventricles are responsible for pumping blood out of the heart to the lungs and the body, and they’ll keep doing their job, just irregularly as they follow the irregular impulses sent down from above by the pissy atria. Afib is something a lot of people live with (on anticoagulation), but in someone like Peverley, it had to be fixed. The odds of sudden cardiac death are already doubled during physical activity, and hockey is a sport with a lot of very intense activity in short bursts, which also increases cardiovascular risk.