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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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