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Atrial Fibrillation - post ablation
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Hi, I was diagnosed with AF in May 2011 It makes it very hard to train. I will get an episode a day for 2 weeks, then nothing for a few days, then more episodes. I sometime needs a cardioversion to get my heart back in rhythm.

I will get a cryoablation in the next few months, so hopefully that will solve my problem.

I haven't done an Ironman yet, only half Ironman, but I'm planning on doing an Ironman in 2013, if my heart can handle the training...

Those of you who got the ablation/cryoablation, were you able to get back into Ironman shape and compete it one? How long after the ablation were you able to resume training?

Thanks
Eric

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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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I have had 2 ablations and I finally did my 1st Ironman! I am finally an IRONMAN!!
It was 4 years in the making and yes your heart can handle it. Train smart and listen to your body
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Re: Atrial Fibrillation - post ablation [coryalps] [ In reply to ]
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Congratulations! You're an inspiration. You must have good doctors.
Last edited by: TriBeer2: Oct 27, 11 14:29
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Re: Atrial Fibrillation - post ablation [TriBeer2] [ In reply to ]
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A GREAT COACH-DR PHIL SKIBA OF PHYSFARM who listened and trained me right.
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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I had a heart ablation carried out a number of years ago to deal with tachycardia issues (HR hitting 230's during episode's) caused by a tertiary pathway.

funny thing was they sent for me a "stress test" as part of the pre-op investigations which I completed without evening hitting my anaerobic threshold. i guess the idea of a "stress test" for sedentary, and usually older people isn't quite the same as what regualr ST'ers would have in mind!

I think this might be different to atrial fibrillation but the ablation has worked and I have been training away ever since, not for ironmans, but I have done plenty of sprint, oly and duathlon races
Last edited by: shouldbeworking: Oct 28, 11 6:00
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Re: Atrial Fibrillation - post ablation [coryalps] [ In reply to ]
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Congratulation on your Ironman.. this is great. Which one did you do?

How long after the ablation were you able to resume training (long run/ride, high intensity)?

Thanks
Eric
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Re: Atrial Fibrillation - post ablation [shouldbeworking] [ In reply to ]
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Was your tachycardia called Atrial Flutter? I have that also and they will fix it at the same time.

Eric
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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I don't recall it every being given a specific name.

I had always referred to it as palipatations but a doc friend of mine referred to as SVT (supra ventricular tachycardia). however, that wasn't a clinical diagnosis and VT / SVT is potentially quite serious so I don't think that is what I had.

re getting back to training, I don't remember what the instructions were post-op, but there was never any suggestion that I would have to give up competitive sport / training. presumably I took a few months off, but i don't really remember
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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tachycardia generally refers only, if i'm not mistaken, to ventricular beats. a-flutter and a-fib are arrhythmias specific to the two atria, rather than to ventricles.


Dan Empfield
aka Slowman
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Re: Atrial Fibrillation - post ablation [Slowman] [ In reply to ]
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Slowman wrote:
tachycardia generally refers only, if i'm not mistaken, to ventricular beats. a-flutter and a-fib are arrhythmias specific to the two atria, rather than to ventricles.

Incorrect. Tachycardia is a generic term referring to any abnormal increased heart rate regardless of cause. A-fib, v-fib, a-flutter, v-tach, WPW are more specific causes of tachycardia.
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Re: Atrial Fibrillation - post ablation [white wizzard] [ In reply to ]
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"Incorrect."

well, then, there you go. teaches me to keep my mouth shut about stuff i don't know enough about.



Dan Empfield
aka Slowman
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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Since extreme endurance training and racing has a well documented association with atrial arrythmias why would you want to do an Ironman?

Seems rather foolish to me.
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Re: Atrial Fibrillation - post ablation [Slowman] [ In reply to ]
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Slowman wrote:
"Incorrect."

well, then, there you go. teaches me to keep my mouth shut about stuff i don't know enough about.

It's OK. You are a medical lay person. We give fancy names to simple things to make us look smarter than we really are.
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Re: Atrial Fibrillation - post ablation [white wizzard] [ In reply to ]
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I've always wanted to do an Ironman.

If I understand correctly, it's relatively dangerous for anybody to do an Ironman. If my doctor tells me it's not more dangerous for me that it is for anybody else, I'll do it. If he tells me it's more risky for me because of my AFIB, I won't do it.

Thanks for the feedback everybody.
Eric
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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had ablation for a-fib and flutter April 28; have not had any episodes since and have returned to training
MRI showed best example of what they wanted heart to look like after the fact - said they were going to use photos in publication
feel good - but 5 weeks ago they call and say they want me on metoprolol - last monitor reading showed
abnormal beat from lower heart

metoprolol took a couple of weeks to adjust to - headaches, fatigue but seem to have subsided
see doc's in two weeks for another mri and consultation - hope to learn more; sure they'll want me to wear monitor again for a week
at some point - not sure why I'm been so accepting and in no rush to know more - maybe just to bug the wife
"i'm in heart failure leave me alone"
"is your life insurance paid up?"
one body, one mind, one swing through life
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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butcher wrote:
I've always wanted to do an Ironman.

If I understand correctly, it's relatively dangerous for anybody to do an Ironman. If my doctor tells me it's not more dangerous for me that it is for anybody else, I'll do it. If he tells me it's more risky for me because of my AFIB, I won't do it.

Thanks for the feedback everybody.
Eric

You are rolling the dice my friend. But hey, what's the worst that could happen. It's only your heart.
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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Eric,

The question you need to ask your EP cardiologist i.e. the person that ablates your afib focus- is that if post ablation, you are still at risk for recurrent afib with sustained exercise. Typically with those that we cardiovert with afib, we admonish to avoid extreme increases if heart rate. And by definition, training for high performance i.e. triathlons is considered so. Especially for those that are older, the concern is that the increased heart rate of high demand exercise makes you prone to having another bout of afib. The expertise I don't have is what happens post ablation. That is something that you need to ask your EP cardiologist. Oh yeah, also just a warning that finding the afib nidus may take some time so just plan on chillling for a while during the procedure. Best of luck!
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Re: Atrial Fibrillation - post ablation [heyMartin] [ In reply to ]
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They put me on metropolol for a while and I hated it. I was always tired, and it didn't work anyway, so they put me on bisoprolol and another I can't remember the name of.

Good luck..
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Re: Atrial Fibrillation - post ablation [gasman] [ In reply to ]
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gasman wrote:
Eric,

The question you need to ask your EP cardiologist i.e. the person that ablates your afib focus- is that if post ablation, you are still at risk for recurrent afib with sustained exercise. Typically with those that we cardiovert with afib, we admonish to avoid extreme increases if heart rate. And by definition, training for high performance i.e. triathlons is considered so. Especially for those that are older, the concern is that the increased heart rate of high demand exercise makes you prone to having another bout of afib. The expertise I don't have is what happens post ablation. That is something that you need to ask your EP cardiologist. Oh yeah, also just a warning that finding the afib nidus may take some time so just plan on chillling for a while during the procedure. Best of luck!

Cardiovert a-fib? That's a great way to give someone a stroke especially w/ a known hx of a-fib. Thats why they created Cardizem.
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Re: Atrial Fibrillation - post ablation [white wizzard] [ In reply to ]
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Just by curiosity, white wizzard, are you an electrophysiologist or cardiologist? You seem to know enough about AFIB to be convinced that I'll put myself in trouble. Have you ever heard of someone getting an cryoablation and then die in an endurance event later on? I'm only 38, does it change how you think, or is age irrelevant?

Thanks for your concerns,
Eric
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Re: Atrial Fibrillation - post ablation [gasman] [ In reply to ]
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Thanks Gasman, I'll make sure to print this tread to remember exactly what I need to ask.. :)

Thanks
Eric
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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Hi Eric-

I've had three ablations in my life, one in '99 for WPW (wolff-parkinson-white type II) and two for Afib in late 2009. The Afib ablations were pulmonary vein isolation using an RF ablation catheter. As you mentioned, they also did the A-flutter ablation line as a bonus while they were in there. At the time of the Afib ablations I was 35 year old Male with about 18 years of triathlon training, 5 IMs with a fairly consistent 10:30 time.

Recovery from the WPW ablation was fairly immediate - swimming within a couple of weeks, half IM (pretty slow!) at 5 weeks, and my first IM later that summer. Recovery from the afib ablations was an entirely different matter. Leading up to the Afib ablations my fitness was at an all-time low from three years of decreasing exercise due to increasing severity of Afib, with about 6 months totally sedentary prior to the procedures. it's fairly standard to need multiple ablations to fully 'cure' the afib arrythmias. My two were ~4 months apart. Recovery was (and still is) a long long process. post procedure ~ 1 or more months totally sedentary, then walking on a treadmill, working up to slow jogging over a multiple-week time period, etc. Then gradually increasing duration and/or intensity over the last two years. After the first ablation I was still having Afib episodes at 3 months, always associated with exercise (though it was much much better than it was prior to the ablation), so we decided to go ahead with another ablation. The Doctor said he re-burned almost everything the second time, as there had been a lot of healing and return of conductivity to the tissue. The Afib ablations do a lot of damage inside of your heart - it's much different from a single-point ablation for other arrythmias, or the line for A-flutter.

I did have frequent PVCs (premature ventricular contractions) immediately after the procedure and continuing with decreasing frequency for a year or more. These are fairly common in many people, but can be extremely disconcerting (a lurching/skipped beat feeling in your heart rate) and were specially worrisome for me as they were a common signal that I was going into Afib prior to the ablations. These PVCs have now decreased to the point where they rarely happen (~1/month or so now) and are almost always associated with increased fatigue or stress (both from work or training loads).

For the first year after the procedures I fatigued easily, had no capability for hard efforts, and recovered poorly. if I did do a longer/harder ride or something I would be exhausted for a week or more recovering from it. that has improved gradually this summer to the point where I feel pretty close recovery-wise to where I was prior to the afib problems (though I'm now 5+ years older). I still do not have the upper-end ability to go hard that I did prior to the ablations. My resting pulse has permanently increased from the high 30's to low 40's up to mid to high 50's BPM now - apparently this is a common side effect of the ablations. My max HR spent a year at 15-20 BPM lower than pre-procedures. This summer my max HR and ability to sustain it has gradually crept back up to close to pre-operation levels.

This summer I've gotten back up to 10+ hrs/week of consistent exercise, done several rides of 5-7 hrs length, swam a 55 min IM split (as a relay), and still can't run worth beans (I sucked prior to the ablations). I'm at the point where I don't think about my heart very much - where last year I was very focused/worried about it every workout). I have hopes of a spring marathon and late summer IM next year... in short, I think I'm back to the point where longer consistent training can be a happy and healthy part of my life.

Other people on this forum have reported faster recovery from afib ablations than I've experienced, but I would argue strongly for taking things slowly and carefully. if you don't have an IM fitness base going into the procedure I would guess it might take a couple of years to get back to the point where you can train consistently enough to get ready for an IM. so... an IM could definitely be in your future, but 2013 may be too early depending on your starting fitness level and how your recovery goes.

The ablations are not without risk and the recovery has been a lengthy process, but having the procedures done was the best thing I could have done. It is hard to explain how much living with consistent Afib sucks to people who haven't experienced it.

If you haven't already, search this forum for Afib, Arrythmia, etc. There are a lot of posts in the archives by me and others about the issues we're gone through. Please send me a PM if there is anything you have questions about. Consistent Afib is a life-altering disease, and the ablation procedure seems to currently be the best way to address it for active people.

Good luck!
J
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Re: Atrial Fibrillation - post ablation [JAM] [ In reply to ]
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Hi Jam, thank you very much for this detailed reply. It's very comforting to know that it can be done, and also it's good to know that it might take me longer to recover than expected. If I have to wait until 2013 to do it, I'll wait.

BTW, I also have PVCs and they often lead to AFIB. I think that the PVCs are caused by the medication, but I might be wrong..

Thanks again.
Eric
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Re: Atrial Fibrillation - post ablation [gasman] [ In reply to ]
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Eric - gasman is correct. Very correct actually. Ablation for a-fib is just a different animal than the other diagnoses discussed above. In some cases, if there's a recurrence (of which you already know is a higher probability in a-fib patients), it can be pretty far down the road following treatment. That said, we are simply internet posters who have your best interests "at heart." You'll get the answer that's correct for you and your specific pathology from the physician who provides your care and knows the details of your case.

We, of course, wish you all the best!

John

John H. Post, III, MD
Medical Advisor, TrainingPeaks
Ironman Certified Coach
Contributor, IRONMAN.com, LAVA digital
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Re: Atrial Fibrillation - post ablation [johnpostmd] [ In reply to ]
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Hi John, thanks for the reply.

When you say far down the road, how far down the road do you mean? 1 year? 2 years?

Thanks
Eric
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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butcher wrote:
Just by curiosity, white wizzard, are you an electrophysiologist or cardiologist? You seem to know enough about AFIB to be convinced that I'll put myself in trouble. Have you ever heard of someone getting an cryoablation and then die in an endurance event later on? I'm only 38, does it change how you think, or is age irrelevant?


Thanks for your concerns,
Eric


I am an MD but not a cardiologist. BUT, I am a former 8 time Ironman finisher including 4 finishes in Hawaii. I have always had an interest in this topic due to my own concerns of the potential dangers of ultra endurance racing and training.

It is important to know that this has not been thoroughly studied. The studies which have been done have shown a link between certain arrythmias as well as potential cardiac damage and chronic cardiac scarring.


Getting an ablation is a BIG DEAL. IF they can fix your problem (it is not always successful and can occasionally make things worse) you should be very grateful and not tempt further problems. Just because some people have successfully finished an Ironman does not mean it is safe or that you will be so lucky. There is a lot about this phenomenon which is simply unknown. There are a lot of well known triathletes who have had significant heart issues. I personally know a few locally as well.


Finishing an Ironman is no big deal. It is kind of a huge waste of time to be honest with you. I have gotten out of the sport and don't miss it.


Having a properly functioning heart is a VERY big deal. Why would you screw around with that just to say "I am an Ironman"? Is it really that important to say you completed some arbitrarily concocted race distance?


Why do you REALLY want to do this?
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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I found out after the bike in Challenge Wanaka that I had SVT. I couldn't afford the operation in Australia so decided to get it back in the UK after 12 months more training, 2 Ironman races and 2 70.3s. Really depends how serious the SVT is to affect how able you are to race or not. I had another episode recently but still training on and off.
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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I found that the doctors I talked to, while being very knowledgable about the disease and their technical surgical skills, were fairly clueless about the interaction of high-end endurance training with Afib and recovery from the ablations. i.e. the Doctor said they usually give you a 3-month waiting procedure post-procedure before proclaiming you 'cured', but after that you were 100%, fully cured, good to go, no issues, do whatever you want. This was most definitely not the case. My personal opinion from my experience is that they do a lot of damage to your heart while they're in there burning away and it takes significant time before things heal up to the point where the heart can be pushed. Essentially like any other muscle in your body that you have a major operation on.

As far as long-term consequences, we don't know if continuing to train seriously post-ablation will contribute to a higher probability of developing additional problems later on. It is fairly clear that serious endurance exercise does contribute to the probability of developing Afib in the first place. But the operation hasn't been around long enough to know what long-term results are, and the vast majority of the people with Afib problems who've undergone the procedure are elderly and relatively sedentary. My understanding is the reoccurrence curve for Afib post-ablation is fairly flat once you get out past 6+ months or so - i.e. for the 10 or so years of data we have for people who have undergone the ablation procedure if you don't have problems immediately you likely won't develop them later.

One of my doctors put it this way 'the positive benefits of exercise are well-documented, the interactions with afib are not. I know what I'd choose.' However, I am approaching my post-ablation exercise with a more relaxed attitude - i.e. if I feel like I need recovery or don't feel like training then I don't.

best of luck!
J
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Re: Atrial Fibrillation - post ablation [white wizzard] [ In reply to ]
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ok.. thank you..

Why do I want to do this?? mmm... I've always wanted to be the best that I could be in everything I've done.. soccer, hockey, school, running, etc... doing an Ironman will be reaching the top in my triathlon career, even though I will never come close to finishing in the top of my AG, it's still would be MY biggest accomplishment in this sport.. It's not to tell everyone that "I'm an Ironman", I couldn't care less if nobody knows about it.

I understand all that you're saying, trust me, I glad everybody is giving their opinions. If I only wanted to hear "no problem, just do it", I'd just ask my tri friends. If I only wanted to hear "are you crazy, don't do it", I'd just ask my wife.. so I'm using this forum to learn everything I can about the risks and rewards, and make my decision once I'm ready...

Thanks
Eric
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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Sadly, one of my classmates from medical school had his second ablation for a-fib a couple years later. But, again, I don't know the post-procedure specifics of his diagnosis nor do I know yours. Just because you have the same diagnosis as the next guy, the specifics of the etiology (cause) can be quite different. Just like you don't lump all 35 - 39 year old triathletes together, (well, I do, even though I can swim faster than a couple of them, all I see is their backs - briefly - as they pedal away from me after T1!) The problem runs across a spectrum and your doc has the best idea of where on that spectrum you specifically fit.

First, do your homework from what's presented here, learn all you can about the latest research about the effects (as understood in 2011) of endurance athletics and rhythm disturbances. Write down your specific questions, and you'll get exactly what's the best path forward from your treating physician. You may not get the ideal answer, but you will be taking the uncertainty out of the equation, turning a hand full of unknowns into a known. And that's always a good idea. Good luck.

John

John H. Post, III, MD
Medical Advisor, TrainingPeaks
Ironman Certified Coach
Contributor, IRONMAN.com, LAVA digital
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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butcher wrote:
ok.. thank you..


Why do I want to do this?? mmm... I've always wanted to be the best that I could be in everything I've done.. soccer, hockey, school, running, etc... doing an Ironman will be reaching the top in my triathlon career, even though I will never come close to finishing in the top of my AG, it's still would be MY biggest accomplishment in this sport.. It's not to tell everyone that "I'm an Ironman", I couldn't care less if nobody knows about it.

I understand all that you're saying, trust me, I glad everybody is giving their opinions. If I only wanted to hear "no problem, just do it", I'd just ask my tri friends. If I only wanted to hear "are you crazy, don't do it", I'd just ask my wife.. so I'm using this forum to learn everything I can about the risks and rewards, and make my decision once I'm ready...

Thanks
Eric


I hear you. I was as competitive and driven as they come when I was racing. Now that I've stepped back for a few years I realize that doing an Ironman is somewhat overrated and over hyped. In every one of the Ironman races I competed in at some point in the race I asked myself why the hell I was doing this ridiculous event.


Most triathlons deaths occur during the swim. This makes sense as this is likely when the heart rate is at its max and most prone to an event, and if you are in water, have a cardiac event, and lose consciousness you will likely die. It happens and you are at much higher risk than an average competitor.


If I had a cardiac condition such as yours I can honestly say that I would have ended my Ironman ambitions. Its not worth the risk.
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Re: Atrial Fibrillation - post ablation [white wizzard] [ In reply to ]
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Thanks for your honesty white wizzard.

What do you thing about olympic triathlons and half Ironman?
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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butcher wrote:
Thanks for your honesty white wizzard.

What do you thing about olympic triathlons and half Ironman?

I would stop triathlons because of the SWIM. You could get tachycardia , drop blood pressure, fall by the side of the road and likely survive in a road race. That happens in a swim and its over. You drown.

If I had what you have I would certainly stay fit but use MODERATION. No extreme efforts of either endurance or intensity.

Looking back on my life experiences my hikes in our great national parks were far more enjoyable and rewarding than any of the Ironman races I completed.
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Re: Atrial Fibrillation - post ablation [white wizzard] [ In reply to ]
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Butcher,

Sorry to be late to the conversation. Several thoughts to add....

Agree with Dr. John and gasman above.

Most athletes can return to training or competition pretty quickly after an ablation procedure for AF. The procedure is performed using catheters that are placed into arteries or veins, usually in the groin. Once those vessels have healed after the procedure--usually in a week or so--athletes can return to training.

Several people have made good comments about the success of ablation procedures for AF. The initial success rate is certainly not 100%, and varies depending upon many factors. There is also a chance that AF may return over the long term.

Unfortunately, there are really only 3 options for athletes who are bothered by AF: 1) do nothing and take what comes; 2) medications to limit the frequency or severity of episodes; or 3) an ablation procedure. Many athletes could be well served by an ablation procedure because it offers essentially the only option for a "cure."

I've written an article recently about this topic that might be of interest:

http://www.endurancecorner.com/.../atrial_fibrillation


Larry Creswell

Larry Creswell
http://www.athletesheart.org, @athletesheart
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Re: Atrial Fibrillation - post ablation [lcreswell] [ In reply to ]
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Diagnosed A-Fib in '09. That season was a progression in abyssmal results. Dropped my registration to IMLP for '10 as I couldn't run more than 2 or 3 miles without going into a serious episode. As '10 progressed I eventually started having episodes lasting 12 - 16 hours on a recurring basis. I had been on Sotalol and it didn't do anything. So my cardiologist put me on Motoprolol and Flecanaide. Those two combined in a pretty high dosage at least got it under control. But if I missed a dose or two I would go right back into an episode.

My late wife got suddenly sick and was diagnosed with a very aggressive cancer so spent from Nov. '10 through Feb. '11 taking care of her before she passed away. So zero training and only some thoughts of an ablation (even though we had discussed it). We did agree that I should get one though. So through my cardiologist I got in contact with Dr. Francis Marchlinski at U Penn. He basically writes the book on pulm. cath. ablations. After my wife passed I went up there and had my first ablation in March. I also had a-flutter they found out when they went in to do the ablation. The procedure was supposed to take care of both. Seemed to take well but they kept me on the flecanaide and metoprolol for 6 weeks. Once they took me off the flecanaide and gave me the green light I started running and riding again in small amounts. Then I did a half marathon (on no training) in May. Finished, but not a great time for me.

Within a few weeks after that started having more episodes again. And they weren't PVC's. Monitor even said it was a-fib. Lovely. So went back in in July and had round 2. They said there were a few spots that the signals were getting through and touched them up and hit a few other spots that they hadn't before. Took me off the flecanaide right away and had a little bit harder recovery. But even though I have felt like I was having episodes, the monitor never had me out of rhythm. The doc said they were probably PVC's. Every now and then I may have them (usually after intense exercise) and i'll just pop a flecanaide dose or two and they stop. But I have not done more than 5 or 6 miles at a time running.

I do not see myself doing another long event for years. Considering I've done 2 IM's and 9 marathons (including Boston twice) I am not really giving a rat's ass if I get to go long again. I would just like to be able to train again and stay in some sort of shape. It sucks, but I do not need to risk my heart considering I am the sole parent for my three young boys.

Nothing like dramatic life events to make you realize there are a hell of a lot more important things than endurance sports ......

_____________________________________________
Rick, "Retired" hobbyist athlete
Trying to come back slowly from acute A-Fib
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Re: Atrial Fibrillation - post ablation [Daremo] [ In reply to ]
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Oh, my first one took approx. 6 hours for the procedure. Out of the hospital the next day to go home.

Second one took 4 hours. Also out of the hospital the next day.

Both were under twilight anesthesia, but I was completely out for them, no memory of anything.

The worst part is lying there for 4 hours after the procedure. You can't move your lower body at all so the wound sites in the groin area heal up enough. That absolutely sucked .......

_____________________________________________
Rick, "Retired" hobbyist athlete
Trying to come back slowly from acute A-Fib
Last edited by: Daremo: Nov 10, 11 12:49
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Re: Atrial Fibrillation - post ablation [white wizzard] [ In reply to ]
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white wizzard wrote:
butcher wrote:
Thanks for your honesty white wizzard.

What do you thing about olympic triathlons and half Ironman?


I would stop triathlons because of the SWIM. You could get tachycardia , drop blood pressure, fall by the side of the road and likely survive in a road race. That happens in a swim and its over. You drown.

If I had what you have I would certainly stay fit but use MODERATION. No extreme efforts of either endurance or intensity.

Looking back on my life experiences my hikes in our great national parks were far more enjoyable and rewarding than any of the Ironman races I completed.

Jesus Christ Butcher - I don't think you have enough cotton wool for what this guy is advocating.....
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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     I am a 53 year old surgeon who got a-fib at 40. After 15 cardioversions and numerous ruined races, I had an endocardial ablation (pulmonary vein isolation) at Johns Hopkins Hospital in Baltimore in February of 2009 (Dr Hugh Calkins).
Results were fantastic. I can train and race at full throttle now. The procedure improved my triathlon results. This year I won my age group at St Anthonys, raced three ironmans (Lake Placid, Kona, Florida) and two half ironmans (Buffalo Springs and Las Vegas). I did a 9:43 at Florida to win my age group and get a Kona spot for next year.
I was racing eight weeks after the procedure. I've had only one episode of recurrent a-fib which occured within 6 months of surgery.
There are complications. Not everyone does as well as I did but don't be afraid of having the procedure. Definitely don't be afraid of training and racing hard afterwards.
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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I am extremely happy to have found this thread. I will be 52 years old in just a few days, and I had 2 heart ablations for "atrial flutter" back in June and July of 2010 when I was 50. Basically, my heart went out of rhythm and was beating literally 140+ bpm non-stop 24/7 and the doctors had to give me massive doses of medication to be able to bring it down enough to put me through all of the tests before they could do my ablation. The first ablation procedure failed after 2 weeks, and the second procedure just 3 weeks later healed me completely (I went to a different cardiologist the second time). My second cardiologist told me that because I was an athlete (I was actually less than 3 months away from my first Ironman at the 2010 Ironman Louisville when this happened) that my heart muscle was thicker and he believed the first doctor did not do the burns in the ablation slowly enough and deeply enough to account for my thicker heart muscle. 87 days after my second procedure, I had a PR in my 6th HIM, and less than a year later I completed my first Ironman at IM Texas. Two weeks ago I completed my second at Ironman Florida and dropped my time from 13:13:07 in Texas down to 12:02:44 in Florida. I say all of this to let you know for those who are new to this experience that there is hope to go on and lead an active and healthy lifestyle. For a while there, I was beginning to think there were not that many people who had ablations that went on to do an Ironman, thus the reason I am glad to have found all of your comments. I have been doing motivational speaking for more than 20 years, and up until the last 2 years always told stories about other people and what they have overcome, but this past year I have been sharing my journey to Ironman in a speech I call "From ER to PR". If you are interested in watching it, you can go to YouTube and look up my user name "TriBeyond50", then simply look for the speech. I also have videos from the HIM and IM races I did post-ablation. In addition, I wrote several blog posts on iamtri.com related to what happened to me throughout the experience, and would be happy to share those as well if anyone wants the links.

I wish all of you the best in your recovery and pray for your continued good health and success.
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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Here's some information related to "late" recurrence of a-fib following a successful ablation.

http://www.stopafib.org/...item.cfm/NEWSID/311/
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Re: Atrial Fibrillation - post ablation [ffmedic84] [ In reply to ]
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Cardizem is one of many agents used for chemical cardioversion. However, it may not work. In fact, it likely will not work.

Electrical cardioversion of a fib happens every day. If the patient has been out of rhythm for more than 48 hours, there is a risk of stroke; therefore, steps would be taken to reduce that risk prior the cardioversion--namely either use of anti-coagulation medication for a period of time (days or weeks) or the use of a transesphogal electrocardiogram (TEE) to see if a clot is present in the left atrium.

I'm just posting this because I don't want someone considering a cardioversion to come across this post and freak out.
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Re: Atrial Fibrillation - post ablation [mr. mike] [ In reply to ]
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Two comments here. After my first ablation, in which I was consciously sedated, the doctor leaned over me and said, "We think we got it, but just to make sure we're going to stop your heart and restart it." I realized later after doing more research that was not a good sign and should have been a red flag for me that a recurrence was highly likely in my case.

Second, I had a TEE prior to both my procedures and was probably more scared about having clots than the ablation itself. Thankfully it came back negative both times.
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Re: Atrial Fibrillation - post ablation [tribeyond] [ In reply to ]
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So you had just an ablation for flutter and not an ablation for fib and flutter combined?

If that's the case, I'm a bit surprised you had a TEE prior. I've had 2 ablations for just flutter also, and no TEE or anti-coagulation before. I'm a few years younger than you though.
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Re: Atrial Fibrillation - post ablation [mr. mike] [ In reply to ]
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Mine was flutter only. The first time it happened, it had probably already been going on for a week or more. I had just attributed it to fatigue from training and didn't realize how fast my heart was beating until I took my blood pressure. That's when I finally went in to see the cardiologist. I had never worn a heartrate monitor in my workouts until after my procedure, so I honestly had no idea it was beating that fast. The second ablation, the doctor wanted to do the TEE simply as a precautionary measure.
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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there are several here at ST that have had Afib episodes, Joe Bonness has, he has recently backed off but that was from Back surgery. I had my first Episode in 2001 and realized I needed to change things and that has worked for me. Stress was the big one me, once I could isolate that things returned quickly. My age at the time was 45 and now have done at total of 38 Ironman races. So you can continue. Its listening better to your body and being able to let yourself rest. Good luck .

Push your Passion!
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Re: Atrial Fibrillation - post ablation [dustytri] [ In reply to ]
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I had a TEE before my first one. They had done a CT a few weeks before my second one so didn't need to do a the TEE the second time.

Which was fine because numbing my throat was one of the works parts of the whole experience. They use a swab/applicator to put basically novacaine on your esophagus. The nurse told me that there is a small percentage of people without the gag reflex and it makes it easy for them (mine was in full effect). I remember telling him those people must be talented individuals ...... ;-P

_____________________________________________
Rick, "Retired" hobbyist athlete
Trying to come back slowly from acute A-Fib
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Re: Atrial Fibrillation - post ablation [white wizzard] [ In reply to ]
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HI Wizzard, I'm Todd. I'm scheduled for an Atrial fibrillation Ablation this Monday. I believe that my trigger is stress. I have a few small episodes per month lasting only seconds, none of which are scary. Whoever I have had 2 long episodes one of which required an over night stay in the ER and cardiac ward, the second happened while riding my bicycle on one of my 3X's weekly rides around the reservoir near our home. I'm currently treated with 10 mg of Bystolic once per day which I canít tell if it really works or not. I donít use any other medications, I have never used alcohol or recreational drugs and I try and avoid prescription drugs when ever possible. I donít even take pain killers. I mostly eat well and I'm otherwise in great health for a 50 year old with no restrictions.

In your note to another concerned patient you said that this procedure is not proven having a low success rate and other solutions should be considered before risking his current heart health permanently. Iím thinking that is good advice for me too. Please reply with any additional input to todd@1stopinc.com.

Thanks Todd
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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Just another double ablation 'survivor' checking in.


My a-fib came and went, thus it was a fairly unique case and took close to a year to diagnose. I ran through different medications and the longest one held my a-fib in check was 6 days. Just had an angry ticker apparently and there was no diagnosis of the root cause of the issue.


Had my first ablation to cure 'slow' a-fib in November 2009. Ran a 1/2 marathon 1.5 months later (rather slowly) and my first 1/2 iron 6 months later in May 2010. Upon completing said 1/2 had a run of a-flutter (apparently I have Wolverine like abilities and I had regenerated bridges of heart tissue across the burned regions). Trained and raced through the a-flutter and had a 2nd ablation November 2010. Ran 2 1/2's this year and knocked 45 minutes off my time in each. Going to run cDa next year for grins.


So it can be done without too much difficulty.


Some words of advice:


- Patience is key
- Get an EP with good statistics... nuff said.
- Enjoy the operating room... I did mine in DC and the place looked like the battlestar galactica. Pretty impressive.
- The procedure can hurt. My heart literally burned for a month after the 1st procedure.
- Don't lift weights for a month... there's no need to.
- Take your time, both procedures felt like a cardiovascular reset of a sorts for me.
- Stretch: I could begin practicing yoga and stretching about a 1 week off of the procedure... was a fantastic use of time.
- When you wake up from the procedure give the nurse a big SMILE




Both my cardiologist and EP were former elite level athletes. When I told them what I was hoping to do post op both times they both said take it easy for a while and exercise to feel. Both have been extremely encouraging in returning to training/racing. I am certainly no where near an elite level athlete, however despite all the challenges I have faced with my ticker have moved from about the 50% finisher level to 15 - 25% (depending on the race). All this with tremendous encouragement.


Best of luck to you and hit me up if you need anything.


Mike
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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Looks like some knowledgeable people here. I just finished my Nuclear medicine tests. Dr. said that there was abnormal electrical issues in the heart, he did not elaborate. I have shortness of breath issues, not fast HR.

When I finished the treadmill test, my HR went down pretty quick, so one of the Doctors asked me if I am on Beta Blockers. No, just, SBR

So, now I have to wait 2 weeks till I see the Cardiologist. I ran an hour easy on treadmill on Sunday, HR at 120 or less, so will try to continue SBR till I see the cardio.

I think a few of you will nod your heads when I say it's not death that worries me, but life without being able to train and push myself

Cervelo R3 and Cannondale Synapse, Argon18 Electron Track Bike
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Re: Atrial Fibrillation - post ablation [cervelo-van] [ In reply to ]
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I am not sure whether an increase in A-fib occurrence was ever been positively linked to endurance training. It is very common in the wider population. Athletes may be more likely to be aware of it.

On the other hand, there is mounting evidence that a non-negligible fraction of endurance athletes (few %) may be accumulating scar tissue in their right ventricle, a much more serious issue, and also much more difficult to diagnose:
http://www.medpagetoday.com/...?pfc=101&spc=230

Thierry
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Re: Atrial Fibrillation - post ablation [clownhead] [ In reply to ]
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WOW, I almost have the same story. Had my SECOND ablation last week.

After a three month battle with A-Fib in 2010 I elected to have my first ablation. I could go out and do a hard club ride of 50 to 70 miles on a Saturday, and two days latter I would find my self in complete A-Fib. After several cardio conversions I decided to have the surgery. Overall it was not a bad experience, but the recovery was extremely slow. It also did not help that I pushed myself to get right back to the same level of fitness within the first few months.

Fast forward ten months and I had my first taste of A-Flutter. Once again I discovered it on a ride. It is like a stabilized form of A-Fib. Had it occur a few more times and I did not hesitate to go in for "round two." Although I was not given a good diagnosis, that is they were most likely going to have to ablate my appendage, it turned out one of my pulmonary veins had regenerated. It has now been seven days since the surgery and I feel absolutley 100%. This time I am going to take a slower approach to my recovery, but I would not hesitate to have the procedure done again.

Ditto on the ALL the advice. I was lucky to have Dr. Andrea Natale both times and would not hesitate to recommend him.
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Re: Atrial Fibrillation - post ablation [The Colonel] [ In reply to ]
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Glad to hear that you are doing well...

(and, yes, a great EP is hard to find and makes all the difference.)
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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Just work with your Cardiologist and your EP.

Had an ablation to cure A-Fib in 2009 and another in 2010 to cure A-Flutter. Ran a 1/2 iron in between the procedures and 2 1/2's (plus numerous sprints and olympics) after. Running IM CDA this year (if this damned Plantar Fasciitis will let go).

Basically the advice you'll get on this board is poo. There are numerous folks who had success with ablations and have raced no problem. There are also numerous folks who will tell you not to participate in tri's anymore.

Unfortunately none of the positive polly's or negative nelly's are you. With that said if your doc's give you the all clear (as mine did, not only did they go all clear but they encourage me, I keep my cardiologist updated with my race results and he comes out to watch the local races and uses me as an example of success from a very bad situation) then you should be good to go. Just listen to your body.

Best of luck to you. With dedication and patience I'm sure you'll be back where you want to be sooner rather then later.
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Re: Atrial Fibrillation - post ablation [clownhead] [ In reply to ]
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Listen to your cardiologist.
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Re: Atrial Fibrillation - post ablation [The Colonel] [ In reply to ]
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Natale is the best. Period. He did my third, after the previous two failed, and knocked it out of the park. Full apendage & everything. If your insurance will cover it, and you can get in, its worth the trip to Scripps Green (or Austin) to see him.

____________
ďThere are two novels that can change a bookish fourteen-year oldís life: The Lord of the Rings and Atlas Shrugged. One is a childish fantasy that often engenders a lifelong obsession with its unbelievable heroes, leading to an emotionally stunted, socially crippled adulthood, unable to deal with the real world. The other, of course, involves orcs.Ē John Rogers
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Re: Atrial Fibrillation - post ablation [mopdahl] [ In reply to ]
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Thanks for all the advice. As for now Dr. Natale wants me to keep my "ticker" under 150 bpm. Although I was back in the gym one week later, and got in a 30 mile ride last weekend, I have kept my heart rate below 130bpm.

I go back in for a check up on the 21st. As for now I am just on two months of Coumadin, and have been sending in daily heart readings via Life Watch. All I want to hear is ďeverything looks great,Ē and those three magic words, "NORMAL SINUS RHYTHM."
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Re: Atrial Fibrillation - post ablation [The Colonel] [ In reply to ]
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Hi, I haven't had a chance to come back to this tread for a while, so here's an update.

I had my first ablation on November 22nd, 2011. It made things even worst than before the ablation. I had episodes almost everyday and needed multiple cardioversions.

I had my second ablation on February 20th, 2012. I had an episode 7 days later and I was cardioverted. I had another one 5 days later that went away on its own 14 hours later. Then everything went well for about 2 weeks. Then, earlier this week, I got 2 episodes in 48 hours.

I wasn't on any medication (except Pradax) for the 1st episode after the 2nd ablation, and I almost passed out 5 or 6 times just walking in the ER. My HR went up to 230bpm. I also almost passed out trying to get up a few hours later in the ER.
I had a good discussion with my electrophysiologist and she convinced me to NOT do any Ironman/Half Ironman/Marathon. She's ok with me training 1 hour a day, and do a 2/2.5 hours race once in a while. So technically, i could do Olympic triathlons. But, after having an episode while not on medication and almost passing out, I decided that I was done with triathlons. If I would get an episode while in the water, there is no way I could get out of the water. I'd drown for sure.

So, I will focus on 10km race and maybe half marathons, depending how things go. I might start playing hockey and/or soccer again, so I will find other ways to get in shape.


Thanks for all the replies to this tread.
Eric


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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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Have there been any studies looking into the incidence of AF in the athlete/triathlete population? Just from the chatter on these boards, it seems that there are many more fit people that develop or suffer from AF than there are in the "real" world. Is this just a case of people on slowtwitch being more open and vocal about this issue?
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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Hi Eric-
I think it's fairly common to have 'healing arrythmias' for the frist 2-3 months after an ablation. The doctors i've spoken with say they don't pronounce a procedure a success or failure until 3 months post-op for this reason.

I was fortunate enough to not have any actual afib episodes after my second ablation, but my heart felt like it was jumping all over the place (likely PVCs) for several months after the operation, and it was easily a year+ until things felt more 'normal'. After my first ablation I had the worst afib episodes I had ever had for the first week, then things calmed down and it was much better than prior to the operation (though I still had some afib episodes with exercise, hence the second procedure 4-5 months later).

In other words, if your last procedure was Feb 20th, it's only been a month. After a month I think I had managed some walk/jog sessions on a treadmill and maybe a little bike trainer time. I think I tried a pushup once too. Get back on the couch, relax, recover, and don't make any conclusions on what you will or will not be able to do until it's been another few months to a year. (my advice based on personal experience, I'm not a doctor, etc. etc.)

Listen to your body, but don't give up hope yet!

keep us updated as to your progress.
Jeff
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Re: Atrial Fibrillation - post ablation [white wizzard] [ In reply to ]
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Some people simply must train and race. Call it addiction, call it atavistic, or even habituation, but it's there... Like most addictions, there are risks and rewards. For the vast majority of triathletes the risks are small and the rewards large, imho.

Having said that, I don't think I'd be racing Ironmans if I had serious heart issues. I'd go back to playing tennis, and probably doubles only. Maybe mixed doubles! ;)

The OP says above that PVCs can lead to afib or tachycardia. Is that right? I have had PVCs for 40 years, but can't get my heart rate above 150. (I'm old as dirt.)

-Robert

"How wonderful it is that nobody need wait a single moment before starting to improve the world." ~Anne Frank
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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butcher wrote:
Hi, I haven't had a chance to come back to this tread for a while, so here's an update.

I had my first ablation on November 22nd, 2011. It made things even worst than before the ablation. I had episodes almost everyday and needed multiple cardioversions.

I had my second ablation on February 20th, 2012. I had an episode 7 days later and I was cardioverted. I had another one 5 days later that went away on its own 14 hours later. Then everything went well for about 2 weeks. Then, earlier this week, I got 2 episodes in 48 hours.

I wasn't on any medication (except Pradax) for the 1st episode after the 2nd ablation, and I almost passed out 5 or 6 times just walking in the ER. My HR went up to 230bpm. I also almost passed out trying to get up a few hours later in the ER.
I had a good discussion with my electrophysiologist and she convinced me to NOT do any Ironman/Half Ironman/Marathon. She's ok with me training 1 hour a day, and do a 2/2.5 hours race once in a while. So technically, i could do Olympic triathlons. But, after having an episode while not on medication and almost passing out, I decided that I was done with triathlons. If I would get an episode while in the water, there is no way I could get out of the water. I'd drown for sure.

So, I will focus on 10km race and maybe half marathons, depending how things go. I might start playing hockey and/or soccer again, so I will find other ways to get in shape.


Thanks for all the replies to this tread.
Eric


Eric, I was hoping to hear more positive news from you, so I am sorry to hear that the issue has not been fully resolved. From someone with no medical background, it sounds like you are doing the right thing. I would defintiely not push it if i were in your position. put hard-core racing out of your head, enjoy some light-to-moderate activity and I am sure you will enjoy that. maybe in 6 months or a year you will find fewer and fewer incidences. Here's hoping
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Re: Atrial Fibrillation - post ablation [JAM] [ In reply to ]
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First, I would like to thank all of you for your dedication to posting and attempting to get the best information our about ablation and triathlon. This is my first post to ST and I only found these threads during multiple web searches.

A quick history of me. Have been doing triathlons since 04. Family history is most likely the main contributor to my afib. I do have reason to believe that running was where it showed up first as my HRM was showing HR of 210 for 5k races and longer. This was about 5 years before the afib was found and was chocked up to a HRM that just did not read well. I was diagnosed with afib in Jan 2011 during a routine physical. Non symptomatic, (which drove my cardiologist nuts). Had a successful cardioversion.

Went back into afib while on vacation in early March of 2012. This time I got hit hard with many symptoms, fatigue being enough to keep me out of work some days.

My question is aimed at those who had afib 24/7/365. My fatigue comes and goes depending on what I do in a given week. The easiest way to explain it is in money terms. When I was not in afib, I had an energy income of $100 per week. Once in afib, the energy levels decreased to about $80 per week. This was livable. The problems came when I continued to use energy like I still had $100 a week coming in. Over a few weeks, my bank account was basically $0. Now, as I get ready for ablation on May 1, if I do much of anything, it is like using a charge card. I must pay back the energy over the next few days.

The worst was last Sat. I decided to put a small storage system under my bed, mow the lawn and shop for the parts for the storage system. I took breaks and felt great I finally got something done. It is now Thursday and I have missed 3 days of work and will not go back until after the surgery. I missed the work because I am a laborer/equipment operator with no light duty available. Just walking from my car and into work would get me huffing and puffing. I had no choice but to sit as much as possible. For safety reasons, I decided that since I had the time to stay out sick, I would. My other concern was the fear of pushing too hard, getting sick, and having to wait at least 1 more month for the surgery.

Now to the question. For those who had afib 24/7/265, did you experience these types of extreme fatigue. Also, if you have had the ablation, did you eventually get back to regular training. (JAM if I read correctly, you were a lot like me).

Mind you, I have never been competitive in triathlon except against myself. I do it as a lifestyle choice to try and stay healthy. Right now my main goal is not to feel like I am 85 years old. I will be working with my docs to get me back into training safely with few restrictions over time. In the short term, I will go slow. This I have been able to glean from these threads, so thank you again.
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Re: Atrial Fibrillation - post ablation [Ontherun] [ In reply to ]
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The type of fatigue you're describing is very similar to what I experienced. For the last 6-8 months prior to my ablation it quickly became a choice of if I wanted to try and exercise, or to be able to function in the rest of my life. Even on the days I felt ok if I went for an easy jog or something I'd be laid up for days after, either in afib or just lethargic with extreme fatigue. When I'd come out of a long afib episode I'd be heavily fatigued for several days after - in normal heart rhythm, but just exhausted. Almost like my heart muscle was fatigued from the lengthy afib episode and needed to recover before it could effectively pump blood to my body again.

Iím lucky in that I have a desk job with an understanding boss/company. Even then there were days when I either couldnít go to work or couldnít function at work. It would feel almost like there was a fog over my thoughts Ė I couldnít focus on getting any task done. I canít imagine trying to do any kind of active work while having serious afib problems.

To answer the other half of your question, after two ablations and a lengthy recovery I am exercising consistently again, if not nearly as seriously or as fast as I used to be. My limiting factors for the most part now are the @%#^$ chronic lower back and hip pain, not my heart function. Occasionally Iíll get some double beats or Ďflutteryí feeling if Iím fatigued or pushing harder in training, but so far I just back off and the heart has been fine.

Best of luck with your ablation this next week. Be positive and donít push the recovery!

J
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Re: Atrial Fibrillation - post ablation [JAM] [ In reply to ]
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It has been a week since my surgery, so I figured I would post a quick update. Things went better than expected as far as I am concerned. Other than a good amount of back pain while immobile for the first 6 hours, I have no other complaints.

Now I just need to work on not pushing yet. I am mentally ready to go, but will be taking my time. Thanks for the advice and help.
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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Eric

Not sure where you are located, but I will offer up one tiny piece of advice. Don't be afraid to look at other EP's if you are not getting the results you want. Skill sets in the medical profession vary just as much as they do in a field of triathletes. I know you have heard this one: "What do they call the guy who graduated last in his class in med school? Doctor, just like the guy who graduated first."

If you are in Florida by chance I can recommend an EP who most likely trained your EP on the Medtronic CryoCath system. Before Medtronic bought CryoCath they were a small private company and I called on the EP who was a primary investigator for them. He has trained EP's all over the world on this system and is a prince of a man as well. Skills, bedside manner and cutting edge technology all in one place is a tough find in any specialty. He is the guy patients come to when other docs say 'I'm sorry but you are just going to have to live with ........., it can't be fixed'.
Last edited by: tigerpaws: May 9, 12 5:14
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Re: Atrial Fibrillation - post ablation [butcher] [ In reply to ]
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butcher wrote:
Hi, I was diagnosed with AF in May 2011 It makes it very hard to train. I will get an episode a day for 2 weeks, then nothing for a few days, then more episodes. I sometime needs a cardioversion to get my heart back in rhythm.

I will get a cryoablation in the next few months, so hopefully that will solve my problem.

I haven't done an Ironman yet, only half Ironman, but I'm planning on doing an Ironman in 2013, if my heart can handle the training...

Those of you who got the ablation/cryoablation, were you able to get back into Ironman shape and compete it one? How long after the ablation were you able to resume training?

Thanks
Eric

I was doing light training after a week in all 3 of my cases. Two ablations and one cryoablation. But my condition was supraventricular tachycardia so maybe a bit different...
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Re: Atrial Fibrillation - post ablation [KingJulian] [ In reply to ]
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I want to reply to this thread so badly it hurts, but it seems almost pointless. If you have a heart arrhythmia, High intensity endurance events are probably not something you should do. Look at the number of posters on every one of these threads(do a search) that elude to multiple ablations, and complications. I completely understand the need to workout, and to compete. However, at some point in everyones life they need to objectively look at themselves and make some rational decisions. If you ask multiple cardiologist's to tell you what the best move is, eventually you will find one that will say "go for it". That person is in no way related to you, or the members of your family. Sorry. What you are going to need is one honest cardiologist, and some emotional maturity.
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Re: Atrial Fibrillation - post ablation [white wizzard] [ In reply to ]
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white wizzard wrote:
butcher wrote:
Thanks for your honesty white wizzard.

What do you thing about olympic triathlons and half Ironman?


I would stop triathlons because of the SWIM. You could get tachycardia , drop blood pressure, fall by the side of the road and likely survive in a road race. That happens in a swim and its over. You drown.

If I had what you have I would certainly stay fit but use MODERATION. No extreme efforts of either endurance or intensity.

Looking back on my life experiences my hikes in our great national parks were far more enjoyable and rewarding than any of the Ironman races I completed.

Boy do I agree with many comments here. Might as well offer my 2 cents. :o)

At 55, I have spent the last few years talking with older folks about racing. One common trend I have heard, and seen, is so many blew their bodies apart younger doing long stuff and now can no longer even run. Most say if they could do it over again they would have mellowed out.

I see so many who are into the long stuff, like IM, that I tell folks it is like they are on a drug. No amount of logic has them think about their long term life down the road.

Yes, I am a Type A that wants to be the best I can be, but at the expense of long term medical issues, like just the ability to walk and stand for a day, no way.

I read the studies going on of the Western state 100 folks to see why a number of these longer type runners have died from heart issues.

I have done lots of long stuff, but have basically stopped them all since it just seems to make sense that killing your body will make life down the road not much fun.

And I will add to the comments some have made about doing an IM. Yep, did one. During the entire race I was asking myself why was I doing this. It was painful, and it was in a lot of ways very boring. You swim a long way, bike a long way and run a long way, while eatting a who bunch of food. And that was "fun"? Family is impacted both in training and the race time. No more.

So now I just focus on doing shorter stuff. Allows me to train less. I can red line for 2.5 hours in the race and then go home and do things with the wife in the afternoon. Is it still too much? I just backed out of a race for Sat since I am still feeling the effects of my race Sunday. Balance. Smarts.

Always hard to stop the brain from saying keep pushing. But, I still want to be doing this at 70. Will you make it to my age of 55? Glad I did not even find this sport until my kids were older at 39,
and did not start to go nuts until 50.

Dave Campbell | Facebook | @DaveECampbell | h2ofun@h2ofun.net

Boom Nutrition code 19F4Y3 $5 off 24 pack box | Bionic Runner | PowerCranks | Velotron | Spruzzamist

Lions don't lose sleep worrying about the sheep
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Re: Atrial Fibrillation - post ablation [Raf] [ In reply to ]
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"Have there been any studies looking into the incidence of AF in the athlete/triathlete population? "
----------------------------------------------------

Here's a good starting point.

http://www.wellsphere.com/...-in-endurance/729135

There is definitely evidence that would lead one to conclude that long term participation in endurance sports is one of many variables that contribute to atrial arrhythmias.

To my knowledge, there isn't a comprehensive "study" on the topic. Medical studies generally follow the dollars, and there aren't a whole lot of dollars to be made treating a relatively small group (uber fit middle age and older) with a relatively benign condition.
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Re: Atrial Fibrillation - post ablation [mr. mike] [ In reply to ]
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I spent almost 7 years fighting Afib before finally beating it back (probably only temporarily for the next 10+ years, but we'll see) with my 3rd ablation by Dr. Natale in May 2011. There are a ton of indicators for Afib, and endurance sports are just one of them. In talking with 5-6 of the leading cardiologists & electro cardiologists in the U.S., here was what I concluded seemed to be their shared opinion:

1. Genetics play a huge role. A large % of the population gets Afib as they get older. However a large % does not. If your father/mother had it, you will likely get it as you age, and there isn't much you can do about it.
2. Body morphology: if you are a guy, barrel chested, and tall, you are much, much more likely to get it at some point.
3. Endurance sports, especially when young---they didn't necessarily break down what "young" means, especially as the majority of their patients were north of 50++, but quite a few of them asked me during the diagnosis/background stage what sports I played in high school & college.....they all seemed to believe that an endurance background gave one a larger chance of developing afib at some point.
4. Diet. Smoking, bad. Caffeine, pretty bad. Drinking alot of alcohol consistently, very bad. Sugary/high-carb diet, very, very bad. Combo of any of the above for an extended period of time---yeah, you are basically begging for it.

Speaking for myself, I nailed all four (except the smoking part) pretty hard. My father developed it in his late 60s, and he certainly wasn't an endurance athlete, nor a heavy drinker/sugar eater or smoker, though he is barrel chested. I developed it in my mid-30s. 25+ years of high level/effort endurance sports (age group swimmer from 5 thru college, track/cross country in high school, triathlete at 15 doing 1/2 IM's at 16). Did I develop it early b/c I was a pool rat for 15+ years? Or because I drank heavily/ate horribly from college on? Or b/c of some really bad combo of all 4?

I do know this: it is progressive. I went from mild Afib that I could ignore on bike rides & still participate at about 70% effort and be ok to sitting by the side of a road in Australia 4-5x on a long bike ride, fairly sure that I was going to die as I was doing 300+ bpm & fully headed into Vtach, all within a matter of years. However, part of the reason for the escalation was b/c of the drink mixture I was on had a huge amount of simple sugars + caffeine, and during testing back in the states just drinking a small bit while sitting around put me instantly into Afib.

What I'm getting at is that everyone is different. If you are new to endurance sports, and suddenly experiencing Afib, it is possible that the endurance sport was only the final trigger based on your unique biology. Alot of us who have been doing endurance stuff for years are pretty aware of our bodies, and very sensitive to any change......in my experience that isn't the case with the beginner, so blaming endurance sports as the cause, while partially true, certainly isn't the entire story.

Learn to be your own Dr. on this. Learn your triggers, and avoid them if at all possible. Try the medications (they all suck in my opinion as none of them worked for me). However, based on my experience, I really think the only "cure" is a proper ablation, including the sinial node, but an expert.....my first two procedures were done in a minimally invasive way, working on the CAFE method of mapping the various short-circuits & then trying to ablate each circuit. Massive failure, especially the second time when I woke up & absolutely knew they didn't accomplish shit. If you are in Austin, San Fran or SoCal, go see Dr. Natale. He is simply the best (seriously, EVERY Dr. I talked to was in agreement on this). Talk to him about endurance sports & what is important to you. Understand the risks. And then, IMHO, get the procedure done INCLUDING the sinial node. Your life will be 100% better after.

____________
ďThere are two novels that can change a bookish fourteen-year oldís life: The Lord of the Rings and Atlas Shrugged. One is a childish fantasy that often engenders a lifelong obsession with its unbelievable heroes, leading to an emotionally stunted, socially crippled adulthood, unable to deal with the real world. The other, of course, involves orcs.Ē John Rogers
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Re: Atrial Fibrillation - post ablation [mopdahl] [ In reply to ]
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I have to put in another plug for Dr. Natale...absolutely the best. Now three months post my second ablation and feeling great. It is not only that I feel great, but I have had more tests than a lab rat in the last month and everything is normal. As a commercial pilot I had to undergo a pretty extensive "work up" to get my FAA medical back. Although my fitness level is about 50% of what it was before my first ablation, I am not too concerned because I know that it will come back over time. Getting my life and job back were my first goals. I would advise anyone with Afib to see Dr. Natale.
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Re: Atrial Fibrillation - post ablation [white wizzard] [ In reply to ]
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white wizzard wrote:
Since extreme endurance training and racing has a well documented association with atrial arrythmias why would you want to do an Ironman?

Seems rather foolish to me.


I had an ablation for tachy about 10 years ago and saw my surgeon recently, she said I have no exercise limitations i.e. Ironman's pose no risk to my heart.


Edit: I read back to some of your posts, see that you are an MD. I still don't see validity in your claim to stop triathlons because of an ablation. I'm not an expert but it seems once the extra tissue is removed, there is no longer a pathway available to initiate the tachycardia. If it doesn't happen again for ten years, it means it is impossible to have an episode again since the tissue must be gone? Unless the tissue can somehow regrow creating the pathway again? Is that even possible?
Last edited by: cyclops: May 26, 12 11:10
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Re: Atrial Fibrillation - post ablation [Ontherun] [ In reply to ]
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Iím glad I found this thread! I had this thing twice this year and Iím really concerned with the symptoms.

Here is little bit of history and background:

Age 42, Male, drink beer and wine maybe twice a month (lightly), lots of espresso every day (4-5 per day), high cholesterol (!), kidney stones now and then (I learnt later that calcium can play a role here). As mentioned in other threads, Iím in the periodization for IM Austria. Trying to set a PR for my A Race, I was hammering in training (every training) and I guess I didnít give much attention to recovery. To complete the picture, I have various outside stress factors (family, work), so triathlon is a key activity to kill my demons.

Incident #1 Ė Feb/12:
  • - After a stressful day, (which included a nasty discussion with an operator from cell phone call center), I went to the pool for my usual swim practice;
  • - 15 minutes into the training and I couldnít even swim 25m. Fatigued, I decided to call it the day. Just as I did so, I felt my heartbeat hitting the stratosphere. Went to the shower, things didnít improve, call GF and she drove me to hospital;
  • - While en route, I felt an increasing pain in my left shoulder and arm, and I became alarmed it could be a heart attack;
  • - After the initial assessment from the doc, I reverted almost immediately without enough time for an EKG;
  • - Next day, feeling awesome, I went for a 2:30h ride (Z1-2) and felt great as always.


Incident #2 Ė May 16/2012:
  • - I felt a little bit tired this day, but decided to do my swim session (it appears swimming helps trigger this stuff). It was an interval set (3x4x100), did ok the first 2 sets, but barely finished the 3rd. Completed the volume, and hit the treadmill for a tempo run. Feeling exhausted, completed 70% of the run practice;
  • - Showered, went home, had dinner, everything went fine, until I felt the HR going up. This time I put my HR monitor and lay down in bed and took deep breaths. This time the symptoms were worse: heavy pain in shoulder and left arm, pain in my chin, though no sweat or feeling faint. Laying down, my heart beat stood still at 180 bpm for an entire hour. Just by raising to go to the toilet, I had a spike of 215 bpm (not even in training I get that!).
  • - After 1 hour of this and the pain in my left getting worse, I decided it was time to go to the hospital. Again, just as I did so, the thing reverted completely out of the blue.


In both cases, HR did not fluctuate / vary or seemed chaotic. It was more like a steady heart beat at 180+ bpm.

After this last occurrence, I scheduled a cardiologist but kept training @ Z1-2 (stupid!) on the following days, then I stopped all training when I developed an abscess ( http://forum.slowtwitch.com/...w/_pics...)_P3945095)

I saw the MD / Cardio who is specialized in sports on Monday this week and now I have a list of exams (blood test, MRI, scintigraphy w/ stress test) and a advised to stop all training until I get the results.

So now, Iím grounded til further notice. Waiting to get the results next monday an see what awaits me.
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Re: Atrial Fibrillation - post ablation [white wizzard] [ In reply to ]
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thanks for the perspective and time

at the end of the day is ironman just hype and marketing?


In Reply To:
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Re: Atrial Fibrillation - post ablation [clownhead] [ In reply to ]
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Mike -

Who was your EP? I'm in DC and may need an ablasion for WPW soon. I'm finding conservative cardiologists and EPs who tell me to take it easy. That's fine for their elderly and ill patients, but I'm training for my third IM and third Chesapeake Bay Bridge Swim.

Thanks!

Wombat
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Re: Atrial Fibrillation - post ablation [ihaterunning] [ In reply to ]
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Two Doc's worked on me:

The head of the unit Dr. Cynthia Tracy:

http://www.gwhospital.com/...r/cynthia-m-tracy-md

and Dr. Allen Solomon:

http://www.gwdocs.com/...logy/allen-j-solomon

Dr. S was who I was referred to and he was my primary before/after. I think (think being the operative term because I was knocked into orbit) that Dr. T was the primary on both ablation procedures, I think she's the lead EP.

They are fantastic. I live in Charlotte and drove up to DC for both procedures (although I'm a DC native so it was easy). I cannot recommend them enough. Dr. S is a former wrestler and triathlete.
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Re: Atrial Fibrillation - post ablation [mopdahl] [ In reply to ]
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mopdahl wrote:
I spent almost 7 years fighting Afib before finally beating it back (probably only temporarily for the next 10+ years, but we'll see) with my 3rd ablation by Dr. Natale in May 2011. There are a ton of indicators for Afib, and endurance sports are just one of them. In talking with 5-6 of the leading cardiologists & electro cardiologists in the U.S., here was what I concluded seemed to be their shared opinion:

1. Genetics play a huge role. A large % of the population gets Afib as they get older. However a large % does not. If your father/mother had it, you will likely get it as you age, and there isn't much you can do about it.
2. Body morphology: if you are a guy, barrel chested, and tall, you are much, much more likely to get it at some point.
3. Endurance sports, especially when young---they didn't necessarily break down what "young" means, especially as the majority of their patients were north of 50++, but quite a few of them asked me during the diagnosis/background stage what sports I played in high school & college.....they all seemed to believe that an endurance background gave one a larger chance of developing afib at some point.
4. Diet. Smoking, bad. Caffeine, pretty bad. Drinking alot of alcohol consistently, very bad. Sugary/high-carb diet, very, very bad. Combo of any of the above for an extended period of time---yeah, you are basically begging for it.

So glad I stumbled across this thread and so thankful to all who have shared their stories and expertise. As far as the above, I'm 4 for 4, minus the smoking part. I also have mild sleep apnea which I bet many others do as well. My Afib has been sporadic up until this month. I would have very brief episodes that would self-convert within minutes; sometimes during runs. I simply wrote them off as too much caffeine or harmless "flutter".

But on my last three runs, Afib hit almost immediately and I couldn't exert anywhere near the level I'm accustomed to. As soon as my heart rate got into the 150s and tried to come down, it would get stuck and bounce between 90-140bpm. It would self convert only after 8-10 hours, usually with a deep sleep cycle.

The last time this happened, I went to the E.R. so I could get this documented. That was traumatic. They made 3 attempts to convert using shock, all at progressively higher power levels. Put me on the Michael Jackson drug (propofol?). Didn't even offer me candy. Claimed I'd neither feel or remember anything. They lied and all attempts failed. Surprisingly, a drug cocktail of flecainide and a beta blocker finally did the trick.

So now I'm scheduled to see Dr. Thomos Molloy at SW Advent in Oregon. He does a robotic "miniMaze" procedure which is proclaimed to have a better chance at being a one-shot fix vs. the catheter ablations. If anyone has any experience with this type of technique, please share.
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Re: Atrial Fibrillation - post ablation [Czechvar] [ In reply to ]
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I got afib after 10 min during an half marathon, just thought that my garmin isn't working correctly but didn't feel powerful at all and had to walk even some parts. Anyhow I finished that thing with an average hr of 116% of max, and hoped that it normalized itself. Did not. Went to er and after meds didn't work either I had cardio version the other day. After that and a couple of tests there was nothing anymore within the last two years, knock on wood.
Have to take blood thinner, beta blocker, and one to set hr lower cause of a TIA I had 6 years ago.

-shoki
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Re: Atrial Fibrillation - post ablation [shoki] [ In reply to ]
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I had/have afib. Had ablation procedure in 2002 back when it was only available at a couple locations. I went to Duke University Hospital and at the time Dr. Wharton was there who was one of the pioneers in the procedure here in the US. It was 99.9% effective for many years. It started to degrade back late in 2012 and got a consult for a touch up. I was informed that they are finding these procedures last 5 - 10 years and then people tend to degrade back somewhat. Good news is the newer procedures using cryoablation are a bit less risky than the high frequency radio waves I had. In the meantime I did some searching and found a protocol using taurine, magnesium, and l-arginine. So I started on 2,000 mg of taurine, 1,000 magnesium oxide, and 500 l-arginine daily. Protocol allows for higher but started conservative. The effects were almost immediate like turning on a switch. I was having episodes every ride and two days after starting, nothing. It was pretty amazing. So after 4 months only 1 brief (3 minutes) episode on a ride. So my advice would be to give it a try. Inexpensive, easy and no inherent risks. If it doesn't work get the ablation. You will find other positive results on the web. Dont fall for buying the more expensive forms of magnesium just get the cheap version.

Jim
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Re: Atrial Fibrillation - post ablation [clownhead] [ In reply to ]
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Hi Clownhead,

I'm not sure how old this thread is, but I'm a 34 year old crossfit athlete and runner contemplating an ablation with Dr. Solomon as well - your experience is encouraging but if you'd be open to it I'd love to talk more about it. My afib is pretty intermittent, the described it as "lone" as it occurs 1 or 2 times per year - but that frequency is growing a bit with age and it creates tremendous anxiety not knowing when it may happen. I currently take the "pill in the pocket" approach but am contemplating ablation to just rid myself of this. Solomon is my current doc.

Thank you!
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Re: Atrial Fibrillation - post ablation [Crossfit1] [ In reply to ]
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Pretty old thread... so many things since then.

1 Ironman... multiple halves... 3 total ablations (unfortunately they've all failed and I'm back to my 1 pill a day... I guess I'm just lucky). Solomon and Tracy (@ GW) are amazing and you could not be in better hands.

Send me your email address if you'd like and I'll be happy to discuss with you my experiences and hopefully help you make an informed decision.
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Re: Atrial Fibrillation - post ablation [clownhead] [ In reply to ]
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Thank you very much, I'll look forward to it.

dc6crossfit@gmail.com
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Re: Atrial Fibrillation - post ablation [Crossfit1] [ In reply to ]
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I'd be remiss if I didn't point out to anyone reading this a very real potential side effect of ablations. For ablations involving the right atria, there is a risk of developing heart block, which generally requires the implantation of a pacemaker (and definitely does if you're an athlete). Your doctor will likely tell you the chance is .5 - 1%, unfortunately for my wife it happened. She's a very fit 42 year old with on-again, off-again SVT which recurred last year quite badly. She can't tolerate the drugs, decided for the ablation, low and behold 3 months later she has a pacemaker. Apparently this can happen when the ablation affects the AV node and/or surrounding tissue, which prevents the electrical impulses from your SA node from making it to the AV node resulting in an extremely low heart rate, which cannot be raised to normal levels under any circumstances (drugs, exercise, etc). Just wanted everyone to be very aware of the risks since some doctors tend to downplay them.

To answer the original posters question, by experience (ablation for afib - came out of nowhere at 41 with no prior history - unreactive to drugs - cardioversion x2 in ER) was pretty good. Definitely sore and tired for about 4 days, had to wait I think 2 weeks before getting on the bike. About 10 days of some weird palpitations, but was told to expect that. 100% good ever since, currently training for a half ironman with no ill effects.

My advice to anyone is if you can't solve your arrythmia using non-medical intervention. Try the drugs, you might have to experiment with some different ones. Personally they turned me into a zombie and I couldn't imagine being like that for 50 more years, nor could I imagine having to go to the ER to get shocked every 6 months or so.
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Re: Atrial Fibrillation - post ablation [Crossfit1] [ In reply to ]
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FWIW, I had A fib/A Flutter symptoms a few times a year for a while (5-6 years?) but didn't know what it was and the episodes would usually resolve quickly. After a prolonged episode, I went to my Dr and was diagnosed. I had the less invasive right side ablation done in summer 2012 to correct the flutter and the more invasive left side ablation done that fall to correct the Fib. Since then, I have had the occasional "skipped bead" but only a beat or two and only a few times. I got the "all clear" to train in early 2013 and started the comeback. Since then, I've done 3x IM an probably 8x HIM. No issues, other than it took some time to get my fitness back to where I wanted.

I'd say that A Fib is a correctable issue, but you need to follow your doctor's advice closely.

Good luck.
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Re: Atrial Fibrillation - post ablation [jlukanich] [ In reply to ]
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Hey- I hope you're still on ST and posting....

I've got afib/some aflutter. Did a month of cardio monitoring, had a few episodes, good some good data. As a result, my MD is recommending ablation, and tells me i'm in the top 1% of ideal candidates for the procedure. That's all well and good, haven't decided yet; but in continuing my research, found your post, read the protocol you mentioned (George Eby) and started it today. We'll see....

As your post was two years ago, I'm very curious as to how things are going for you now? Still good results? Changes over time? Appreciate whatever info you have to share...

Thanks!
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Re: Atrial Fibrillation - post ablation [mblocher] [ In reply to ]
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Just wanted everyone to be very aware of the risks since some doctors tend to downplay them. //

Well if it is .5 to 1%, then pretty hard to down play those odds. Sucks you wife was the 1 in 100/200, but I would advise anyone to not get the procedure if it is indicated on the very slim chance they will fall into this very small %.

By the way, I have/had 3rd degree heart block, and have come mostly out of it. Have the pacemaker, but there are a ton of other factors that can bring this about, and just temporarily. I have had to learn the hard way, but better to have my battery back up i guess than not..
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