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I had my introduction to a-fib this weekend at age 44 during the run portion of a hard bike/run workout. I didn't recognize what was going on (just felt...bad), so I didn't get to the ER until the next morning. After a couple of hours of IV treatment, I returned to a normal sinus rhythm without the need to resort to the paddles for an electroshock.
For now, the doctor and I agreed on 81 g of aspirin per day plus 1 dose of metoprolol per day. I just went for my first post a-fib jog, and I have to say the results were a bit depressing. My HR was about 25 beats per minute lower than normal for the pace, and my RPE was a little higher. Some or all of the RPE might have been due to heat and humidity, but I don't think all of it was, especially when you add in that I hadn't exercised in close to 72 hours (in fact, I was in the hospital a lot of that time).
Have I basically just installed a governor on the system that will prevent me from going as fast as I could 3 days ago? My "math" is: I used to need 180 beats per minute to run a 6 minute mile, but now I'm only going to able to get to 160 beats per minute. The volume of blood pushed by my heart in each pump is unchanged, and so fewer beats = less blood = less oxygen = less speed. So, is this what I'm look at with the metoprolol or am reading too much into 1 workout?
Maybe I'm willing to live with that scenario if it's correct, but I want to gather information to figure that out. I have a follow up with my cardiologist in 1 month, and I will solicit his input also, but my guess is that slowtwitch may have more experience with attempting to train with a-fib than the doc.
6 months out post surgery I'm experiencing arrythmia about 2x a month---always after digging a huge hole for myself on training rides/races in the middle of 16-20 hour training weeks. Onset is usually in the middle of the night following a huge training day, and I always convert within 6 hours or so. Totally liveable, but we'll see if it gets worse this summer----if so I'll do a followup surgery this fall. However please keep in mind a few things:
1. I'm destroying myself on the bike---it takes a 4-5 hour ride w/8-10k climbing for me to dig myself a big enough hole to become symptomatic.
2. My diet/recovery program sucks. I drink alot of wine, and 90% of my post-surgery arrythmia episodes are after drinking moderate to heavy amounts of alcohol as part of my own unique personal recovery program. I also eat WAY too much simple cargs/sweets, and the simple sugars + alcohol + electrolyte imbalance/dehydration all combine to create a personal arrythmia tsunami for me.
3. IF I were to cut out two of the three contributing factors listed above I'm sure I would rarely, if every experience it.
Plenty of elite athletes can race/train thru afib using medication to govern the occurrences. Personally I couldn't, but also because I refused to eliminate some of the contributing factors from my lifestyle.
“There are two novels that can change a bookish fourteen-year old’s 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.” John Rogers
and Propafenone 300mg 2 as needed for A Fib
When first treated was on beta blocker(class Atenolol
metoprolol etc) and had a TIA also tried me on coumadin which
I didn't like because of what we do. They couldn't get that regulated
so they gave up (thank god) I can w/o and race in A Fib but performance
suffers. Did Clearwater 07 and noticed I was in A Fib about 6-8 miles in bike
backed off and finished. When I downloaded my HRM at home I actually
started about 5min in the swim.
My cardiologist feels ablation has not developed enough to get consistant
Good Luck in your quest
Well, it would be interesting if this link got you to it. Here's the abstract, cut and paste:
Introduction: Atrial fibrillation (AF) may occasionally affect athletes by impairing their ability to compete, and leading to noneligibility at prequalification screening. The impact of catheter ablation (CA) in restoring full competitive activity of athletes affected by AF is not known. The aim of our study was to investigate the effectiveness of CA of idiopathic AF in athletes with palpitations impairing physical performance and compromising eligibility for competitive activities.
Methods and Results: Twenty consecutive competitive athletes (all males; 44.4 ± 13.0 years) with disabling palpitations on the basis of idiopathic drug-refractory AF underwent 46 procedures (2.3 ± 0.4 per patient) according to a prospectively designed multiprocedural CA approach that consolidates pulmonary veins (PV) isolation through subsequent steps. Preablation, effort-induced AF could be documented in 13 patients (65%) during stress ECG and significantly reduced maximal effort capacity (176 ± 21 W), as compared with patients with no AF during effort (207 ± 43 W, P < 0.05). At the end of CA protocol, which also included ablation of atrial flutter (AFL) in 7 patients, 18 (90.0%) patients were free of AF and two (10.0%) reported short-lasting (minutes) episodes of palpitations during 36.1 ± 12.7 months follow-up. Compared with preablation, postablation maximal exercise capacity significantly improved (from 183 ± 32 to 218 ± 20 W, P < 0.02). All baseline quality of life (QoL) parameters pertinent to physical activity significantly improved (P < 0.05) at the end of CA protocol. All athletes obtained reeligibility and could effectively reinitiate sport activity.
Conclusions: AF, alone or in combination with AFL, may significantly impair maximal effort capacity thereby limiting competitive performance. Multiple PV isolation proved very effective in these patients to restore full competitive activity and allow reeligibility.
After training for and completing a marathon in November 07, I had made a pretty sizable jump in my running fitness - I was 50 at the time, and my running prowess was actually pretty laughable, but hey I was finally able to consistently go for runs at < 10:00min/mi pace. I had a routine physical in January 08 and found to be in persistant a-fib. No idea when I went into it, but I had only done endurance training since maybe the previous October, and I was unaware of any symptoms. Was referred to a cardiologist, and we had several discussions about possible treatments. He explained that I didn't want to stay in a-fib even though I felt fine, because one of the things that can happen with persistent a-fib is that the atrium enlarges over time and eventually weakens. Not to mention the blood clot risk from incomplete ejection.
The process of evaluation (Holter monitor, various echocardiograms, EKG under stress, etc.) took a period of months partly due to my reluctance to aggressively deal with it because I still didn't feel any effects, and what I had googled about some of the meds used to chemically control it scared the bejeesus out of me. Then the first group rides of the year started, and I immediately realized that things were amiss. If someone at the front really lifted the pace, or we got into some hills, I was gasping. So I decided on cardioversion. I only stayed sinus for 3 1/2 months, so my cardiologist recommended another cardioversion, but combined with Tikosyn/dofetilide (potassium channel blocker, twice daily), Lisinopril/prinivar and one regular aspirin daily. That was in August 08, and I have been sinus ever since; although I have had at least a couple of episodes that self-corrected and I have had occasional arrythmia that is not fibrillation. So fingers crossed, I am not yet a candidate for ablation.
What I have noticed - I seem to not be able to get my heart rate as high as I used to, say during a climb or at the track. Average heart rate for a given workout also seems to be lower. Although as I continue to train, I am actually faster overall than I was when first diagnosed. Resting heart rate seems to have stayed pretty constant. When I first started the meds, my blood pressure dropped a lot, to the point where I was getting light-headed on occasion. I bought one of those electronic blood pressure things, and would occasionally see as low as 80/50. This seems to have self-adjusted over time. This was from the Lisinopril/prinivar, which was prescribed to help the atrium recover. I was found to have significant enlargement of my atrium right before the first cardioversion, but it has dropped significantly and I am getting tested again this July.
There was a further complication from the aspirin. The aspirin is an insurance policy against clot risk from an occasional bout of a-fib. It's much less risky although less effective than Coumadin/warfarin, which I was on for several months but was insistent on stopping once I was sinus for a few months. But I happened to be one of the 20% or so of the population that develop stomach ulcers from daily aspirin use. Again, I wasn't immediately aware, but as I trained again for the marathon in the fall of 08, I was doing great up until the week before the marathon. I was tapering, but wanted to do some small stretches here and there at faster than marathon pace. These felt terrible. I was still sinus, so that wasn't it, so I figured I just needed to cool it as I had done some really hard training sessions in the build up. Stuff I hadn't done for the first one, like a long easy run but several miles at the end at marathon goal pace. At the marathon, I started off running by feel, and I found that I could only run comfortably at last year's pace. I was disappointed, but figured maybe I'd at least feel stronger at the end and be able to make some improvement. Hahahahaha. At mile 17, I felt really strange, and had the sensation that I was lapsing in and out of conciousness while running. So I walked a mile, and then went to try to run again. No. Walked/thumbed a ride back to the car, didn't do anything for a couple of days. But never recovered, really struggled to run even a couple of miles, and easy bike rides were down to like 14 mph. Back for my annual physical, and I was found to be severely anemic. Family doc thought it had to be bleeding, I didn't believe him. But wasn't getting any better, so finally went for colonoscopy and upper GI, and sure enough the aspirin had caused ulcers. Stopped the aspirin. It took many months to recover my blood count, but by the fall of last year I did a couple of tris and running races, and I'm maybe even a little faster yet now that I've been able to train consistently for the better part of a year. Actually podiumed at JerseyMan a week and a half ago.
So sorry to be long-winded, but someone out there might recognize similar symptoms and at least know what to ask his/her physician. Bottom line, if you even suspect some sort of heart arrythmia, get it checked as quickly as you can, and by a good cardiologist.
In a way, I can't help but feel responsible, I always knew that you were insane
The doctor said it was quite common to experience ‘healing arrhythmias’ after the procedure. How long does it take for these to go away? It’s been two weeks since the operation and, if anything, my bouts of Afib are getting worse instead of better. I’m having episodes that are as bad or worse than prior to the surgery, with continuous Afib for 10-15 hours. My non-arrhythmic heart rate now is quite elevated from my previous resting rate (it’s 70-80 now, rather than 40-50 BPM), and skipped beats/fluttering is quite common. I’m also experiencing some deep, dull pain in my heart and lungs, I assume from things healing the damage of surgery. I’m quite short of breath, to the point where even talking is difficult – I have to take breaks to breathe.
So, for anyone out there that has gone through this procedure, what was your recovery like? How long did you have post-procedure arrhythmias? What other pain and symptoms did you experience? How long did it take before you were able to live a ‘normal life’ (i.e. function at work, do household chores, etc.)? How long before you were able to exercise again?
I haven’t been able to train consistently or race for about 4 years now, and I haven’t been able to exercise at all for over 6 months. I’ve been dreaming about being able to just go for a walk or an easy bike ride. So far my recovery hasn’t been as smooth as I had hoped…
Someone give me some hope here!
i know 4-5 people who have had it and most were back working out within a couple of weeks and they do not report episodes of A-fib.
Amanda Lavato had it done back in October. read her blog....
here is a video from a guy who had atrial flutter and he talks about his post op.
hope you get better soon. i know how you feel...
After the second one they took me off meds. Two years later I'm back on flecanaide again for mild symptoms. I don't want to go in for a 3rd procedure since the symptoms are not nearly the levels that they were before (I was basically useless when they were going on and it was becoming more and more frequent through '10 and early '11). I'm running 3 - 4 days a week and occassionally getting on the bike. But not racing anymore. I know I'll never be as fast as a I was, nor will I be able to go long again. So I'm resigned to that fact and have accepted it and just try to stay healthy and in somewhat good shape.
Rick, "Retired" hobbyist athlete
Trying to come back slowly from acute A-Fib
So back to your question. After my procedure I did have some flutter and small events for several weeks but they eventually went away. The procedure is now so much better than when I had it done but I would still make sure the doc doing it has done several hundred first.
Also for you afibbers avoid the following leading up to a race: tomato sauce, garlic, peppers of any kind, dark chocolate, red wine, fish oil capsules, too much caffeine, stress, or any foods that give you heart burn especially if your afib might be vagally mediated. Do not slug down cold drinks during your event sip them or store on board and let them warm up a bit. This sets some of us off frequently.
Regards and good luck.
I'm now at a bit less than 4 years after my two ablation surgeries for afib. My resting hear rate increased immediately after the procedure and has remained higher than it was pre-operation. before the ablations I had a resting HR in the low 40s. immediately after the operations it was in the 70s, i'm now down to upper 50s, low 60s, depending on my fatigue levels. One doctor I talked to said it is common to have a permanent increase in resting HR after the ablations.
My maximum HR has also decreased ~10 beats or so (though I am also 5 or 6 years older than when I was last able to really exercise at intensity).
So I haven't made 100% recovery of my fitness after my procedures. But my fitness before them was pretty high. One the positive side, I haven't had any incidence of afib since the second ablation, and I am able to exercise regularly for ~6-15 hours/week. I'm fit, but not quite as lean and fast as I was six or seven years ago (I'm currently 39, so there might be a bit of performance degradation due to age and career and family responsibilities as well...). I also don't have quite the same motivation to pay $500+ a year in advance for the privilege of spending my only vacation either standing in line or being swallowed up by drafting packs. :) I don't really race anymore, but I don't really miss it either. staying fit and healthy is reward enough for me.
I still feel like I'm getting stronger and healthier as time goes on - I think i'm still recovering fitness from the operations. For instance, up until 6-8 months ago, I was still getting PVCs and other 'harder, heavier' heart beats always associated with fatigue and harder exercise sessions. Those seem to have gone away almost entirely now, and I've recently bumped the cycling back up to 6+ hour hard rides on the weekend without issue.
The one thing that really hasn't returned post-ablation is my ability to really really push myself. It feels like my upper end HR has been cut off. I just can't go really hard anymore. But, realistically, I'm old, and going that hard hurts and probably isn't that healthy for you anyway- I'm probably better off with an internal governor.
So, hang in there, recovery can be a long (multiple years) time, but hopefully you'll continue to get stronger and remain free of afib.
If you get the surgery I got one piece of advice for everybody, Pediatric Weenie Cathether!!!
by the secrets of proper diagnosis, do you mean how the diagnosis of afib was finally achieved?
assuming this is the case - if you search for posts by me (JAM) you can dig up pretty much my whole history of heart issues.
The short answer is have your girlfriend leave you, go on a multi-week angst-fueled orgy of excessive endurance exercise and sleep deprivation, wait until you're in afib, then go to the emergency room complaining of heart problems and be hooked up to an ECG faster than you can think. Then you finally have an ECG trace you can show your disbelieving cardiologist demonstrating that there is, in fact, a problem, even though their various tests over the last few years didn't find anything.
In a bit more detail-
I developed a heart arrhythmia at a very early age (like 7 or so) that was mostly controlled via medication until my early 20s. At that point it was frequent enough that I underwent an ablation for what was later called 'Wolfe-Parkinson-White type II syndrome' (spelling might be off). My understanding is this was a single-point ablation to fry a node in my left atrium, a much less complicated procedure than what is used to treat afib. The side effect of this is I was highly sensitized to heart issues, and had confidence in what did and did not feel right with my heart beat.
At this point I was symptom-free and had the best ~6 years of my athletic life filled with excessive ironman racing, getting faster that I ever believed possible. At some point I started getting weird fatigue symptoms and occasional highly elevated 'jumpy' heart rates with excessive intensive endurance exercise. With my history of heart problems I of course went to see a cardiologist and got hooked up to the treadmill stress test, the 24 hour holter monitor, and the month-long event recorder. None of these showed an issue.
After a few more years, a few different cardiologists, and a bunch more testing the afib episodes got a little more frequent (every few months, rather than once a year) and a bit longer duration (10s of minutes, rather than a few minutes). It was during this time that I had an episode trigger after a hard swim on little sleep, and it lasted long enough that I was able to get to an emergency room to get that 'proof' that there was a problem.
I waited another couple of years for things to get worse before I decided the risk of surgery was worth it due to the impact the (now almost daily and hours-long) afib episodes were having on my life.
I'm afraid I'm not much help in how to diagnosis the problem cheaply. The best I can offer there is stress yourself out as much as possible and make sure an emergency room is handy (disclaimer- i am not a medical professional and I don't actually recommend this as a method of diagnosing heart problems!). But I can at least offer some sympathy and my experience - It can take a long time for modern medical science to track down and diagnose intermittent medical problems. In my experience, how I felt was a much more sensitive test than anything the doctors were able to do.
I have heard of a small, implantable monitor that can be used to diagnose heart issues with more confidence. if you're really having issues this might be something that you could discuss with you cardiologist. The one I've heard about is the Medtronic Reveal:
(Disclaimer: I work for Medtronic, but in an unrelated business unit. I don't know anything about this device other than seeing it at a product fair once)
Best of luck, and know that you're not alone.
glad to hear you are doing better. I was wondering how your recovery was going. I am still "waiting" on making my decision. still taking my meds. still get A-fib every couple of weeks....
do not exercise at all. tried running ( even walking) a couple of times but went into A-fib when my heart rate went up to 100+.
I am hoping I wake up one morning and my life and heart are back to normal and this was all a nightmare....( I know, that's not going to happen)
OR they perfect the ablation to be easier, quicker and more successful... I hear of people having 1, 2 or 3 ablations before it stops the a fib.
I would love to be able to train and race again. My life has changed so drastically in the past year and a half.
5 days before the procedure stopped taking my Multaq and haven't been on it since. Off the Coumadin since May, and just on baby aspirin now. A-fib free. Next follow up in 5 months. Procedure was spendy, $74,000. Insurance cut it down to $66,000. My part was $2,000, my out-of-pocket max.