Mardy Fish, who a week ago acknowledged a lingering fear of playing competitive tennis 17 months after an unsettling heart episode, on Wednesday withdrew from next week's U.S. Open, citing his health.

Just two years since he surged to the highest ranking of his career, No. 7 in the world, the 31-year-old Fish conceded on Aug. 12, after losing his first match at the Open tune-up tournament in Mason, Ohio, that he "sort of questioned . . . if there's still that sort of fire and drive that you need" to continue on the professional tour.

He made another attempt at Open preparation in Winston-Salem, winning a first-round match in that event before retiring with heat stroke in the third set of his second match on Tuesday. Since last year's Open, when he pulled out of a fourth-round match against Roger Federer -- also related to his heart issue -- Fish has played only nine matches.

"I've come a very, very long way," he said in Ohio, but admitted that it has "been a very slow process. . . . I think there's going to be some sort of assessment period. With all these problems I've had, healthwise, I left the game in the top 10 in the world; that's pretty hard to deal with. It was very, very hard to get there and to stay there for a while, make the World Tour Finals [in 2011] and do all those cool things.

"So it's been very hard and very challenging to know I had really no control over it. And to sit here 12 months away from playing really good tennis, some of the best tennis of my career" -- with his ranking having plummeted to No. 173 -- "that will challenge you mentally, for sure."

In March 2012, he had experienced a racing heart following a match in Key Biscayne, but was cleared to resume play weeks later. He advanced to the fourth round of both Wimbledon and last year's U.S. Open. But, overnight following his third-round Open victory over Gilles Simon, which set up an anticipated duel with Federer, Fish said, "probably at 3:30 a.m., . . . I knew I had some issues" and sought out psychiatric help.

He said he reached a point where he was afraid to leave his house in Southern California -- "I probably spent three months straight inside my house; I think I went in the backyard maybe a couple of times."

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Last summer "was really the worst times," he said, but even now, "I'll never forget" the heart scare. "I just can't wait to just forget, and years -- five years down the road, whatever I'm doing at that time -- that I can't even remember it."