i take my hat off to you. i don't know how you train in persistent afib. i have 4 questions:

1. how long have you had afib?
2. have you been cardioverted before? have you tried anti-arrythmia meds?
3. why are we not talking about an ablation?
4. in what region of the country do you live, if you're in the U.S.?

---

Dan Empfield
aka Slowman

I was actually training and didn't know I had AFIB! Only reason I discovered it is that I coudn't work out why my heart rate was so high through the Garmin chest strap yet I would be standing still. I had no physical side effects. I would start walking and my heart rate would be 160 yet I my perceived effort was a 1. It was only when I went for an ECG at the GP that they confirmed I had AFIB.

To answer your questions:
I have no idea how long I had it as I had no physical tells
I am on DIaltizhem and blood thinners and going for 1st cardioversion on 1 Nov
Hoping it works and I don't need any further treatment
I am based in New Zealand.

Thanks,

Max

i will just give you my experience. i was a candidate for an ablation:

1. i commenced a hard target search for my electrophysiologist. it's very specialized, like this: cardiologist => electrophysiologist => electrophysiologist that specializes in atrial ablations (rather than ventricular). it took me a bit of work to find my ideal doctor.

2. mine wanted me to go through a bunch of other testing, under a general cardiologist. imaging. stress test. that's weeks or months and i'm certain of that because they're making you wait weeks for a cardioversion.

afib does not, among my friends, happen once and then you're cardioverted and that's the end of that. so, one way to get in front of this is to start that above process on your own terms.

depending on how you're reading this (desktop, handheld) it's hard or easy to find a blue navbar with white writing that says HOT FORUM TOPICS. turn down that arrow to injury and illness, and under that atrial fibrillation. start reading. i will let the cardiologists take it from here.

---

Dan Empfield
aka Slowman

No personal experiences. From my patients (I am a GP) a fib often does not stay away after a cardioversion. Sometimes people are fortunate that way. An ablation much more likely to be successful that way. Given you are in NZ there are likely only a few docs in the whole country well qualified to do the procedure. Not a knock on NZ healthcare just that it is a small population. I am in Canada. With the a fib your cardiac output should be lower. Did you notice less capacity to train?

---

They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

Highly recommend the book "The Haywire Heart: How Too Much Exercise Can Kill You, And What You Can Do To Protect Your Heart". It's all about endurance sports and links to AFIB.

I read the book while I was awaiting my own diagnosis (mine isn't AFIB, but Wolff Parkinson White syndrome...similar symptoms, different causes). It's really enlightening and has a ton of case studies and stories of people training for Ironman etc. through AFIB...even Elites/Pros.

Might be interesting to follow what's been happening with Richard Murray, a current Pro racing WTS/Superleague circuits.

Good luck and be safe. My personal recommendation is at least to avoid open water swims until you have everything sorted.

I have not completed training for a race with AFIB, however have completed training and racing in two 70.3s post-ablation. Firstly, I'm shocked they are not going to cardiovert you if you are in persistent AFIB - doctors (at least american ones) don't seem to like for you to remain in that state due to increased stroke risk. Mine wanted to do it right away the first time it happened - I made them keep me overnight and try all the drugs first (none of which worked).

Second. I'll second the sentiment that the initial cardioversion might not stick. in my case, cardioverted then stayed on beta blockers for a few months before deciding they had horrible side effects. I convinced the doctor to wean me off them, he warned me it may come back, and within 6 months it did. (cardioverted again, then successful ablation). I see no reason that correcting the problem would prevent you from racing again. I'm 8-ish years removed from the ablation with zero lingering issues or reoccurences, with over a dozen races (all distances) since. Warning: ablations are not without risks. Talk to your doctor, and other doctors, and friends. Mine went off without a hitch, my wife had one for a different arrythmia and hers was botched, resulting in a pacemaker in her early 40s.

Best of luck to you.

I have read that cardioversion is only a short term solution to get you into normal rhythm. The iinteresting thing for me is that even in training and preparing for the next Ironman I had no symptom's. It is only the heart readings that would throw me. The heart rate monitor would say I would be at 150 but I felt like I was in Zone 1 so couldn't work out what was wrong. I figure that I will need ablation as a long term fix but hoping by some miracle I stay out of Afib post cardioversion.

Thank you, I actually am busy reading the book and also been following Richard Murray's journey. The hard thing for me is following Cardiologist advice to only light exercise until after cardioversion as I have had no symptom's such as heart palpitations or shortness of breath at any point. Makes it very frustrating.

Yeah thank you for sharing. I am thinking I will need ablation for a long term fix but the Healthcare system in New Zealand is really slow at the moment and I think they doing cardioversion as I did not have any symptoms. I only went for diagnosis because my heart rate monitor wasn't matching how I felt. It would say I was at 160bpm yet I wasn't even out of breath and felt fine. Once I am in normal rhythms maybe it will stick. Happy for you that you could race post ablation and gives me hope:)

Thank you I will definitely check out the other posts!

Tell me about it. I'm on month 10 of only light jog/spin, no more than 60 mins. I've gained about 10kg... :(

I've read that it can actually be more dangerous if you don't feel symptoms because you might not know when you're having a serious issue, so listen to your doc, be patient and be safe. That's what my wife tells me.

I have a bit of history with Afib. After setting a Marathon PR I took some time off and when I went back to running I was diagnosed persistent Afib. I didn't even know what that was at the time. My first Cadioversion lasted 2 weeks. My 2nd Cadioversion lasted 4 weeks, all while changing up a variety of medications. I had a RF Catheter Ablation in 2009.

Ten years later I was training for an Ironman and went into Afib. Given my history I knew it instantly. While I wasn't persistent, I would go into Afib during every bike/run (captured on holter monitor). My 2nd Ablation (cryo-balloon) was in 2019. No issues since and I take no medications.

Both times it was 10months from diagnosis to ablation due to steps required by insurance. No, I wasn't able to train during these times.

My identical twin brother got into triathlon, completing Ironman California 2022. His cryo-balloon ablation is scheduled 3 weeks from today. I was surprised that it is now scheduled as an out-patient surgery.

Long period of training and racing IM and 70.3 distances over 20+ yr. span. Besides a really bad bike crash day before Vineman in 2016 relatively healthy. Hard push to get back to fitness level by 2018. Life stressors escalated and went unchecked; if anything piled on. Palpatations and racing HR every so often thru 2020. Figured it was part of pushing hard in training, handling work and life challenges, and it would somehow pass; it didn't.

Formal Afib and Aflutter diagnosis late 2020 at age of 59. Multiple cardioversion attempts over 3 month period -- body and mind didn't respond well to any of the medications. Remained on blood thinner, quit alcohol, dropped to 1 cup of coffee/day. Strived to lower outside stress and reduced training levels and intensity significantly. Still had frequent events. No way would I be capable of anything resembling a good outcome at 70.3 or IM distances. Ablation performed in the spring of '21. Dropped all meds within 45 days (and am still off them). Felt stable and gradually began to up training. Had random PAC's and bouts of uneasy feeling but determined to return to some level of fitness and remained confident that I'd be OK. Frequency started to subside and without any noticable Afib or Aflutter events decided to try my hand at training/racing again. Did Oceanside in 2022 with a promise to my wife I would stay within a reasonable level of effort and would drop out if heart started skipping around. Managed to finish; and felt relieved. Did Hawaii 70.3 summer 2022 and felt like I had made it back to pre Ablation level of fitness. Followed up with IM Kona and things were going well on first 2 legs. First few miles into run knew things weren't right and pretty much shut down, swallowed my pride, and limped into the finish line. Volunteers thought something wasn't right and escorted me to the med tent where after some fairly intense dialogue and testing I was taken via ambulance to the local ER. After 24 hours of survelliance, and echo, and stable HR rythm was thankfully released. Followed up with my Cardiologist when I returned state side. Echo's revealed inflammation but otherwise blood work, HR, and overall health was good. Dropped all formal training and committed to listening instead of ignoring body signals and letting go of all un-necessary stress. Follow up echo's reveal subsiding but minor inflammation, likely as a result of years of training, and overall health is excellent. Have spent the last year riding, running and swimming at intensities and duration that feel appropriate. I've got a great group of fellow triathletes that allow me to join on rides and swims. Am starting to itch a bit for racing but have declared IM distance training and racing as off limits. Short distance might also be too intense as I grapple with all that old age brings. Time will tell.

Long story short -- Afib doesn't sentence you to a life without triathlon.

I had an Afib in Germany in early July while I was there on vacation with my family. It actually started the day before with high HR and me feeling a bit dizzy. But it is crazy hot here in Columbia, SC and I was in a high training segment to get ready for a big 100k race, so I thought it was a faulty watch reading and dehydration. And so we flew the next day. When we arrived I did a short and chill shakeout run and my HR raced up to 189 and peaked at 204, but I did not feel bad. And again I blamed my Garmin Fenix 7 watch. The next day to make sure I did a longer power hike and jog but with a Wahoo Tickr X strap and even while hiking it was back up at 189/191 and later stuck at 204. That night I went to a hospital and they confirmed an Afib and after making sure I had no blood clots they gave me a cardioversion the next morning and released me. The head cardiologist said everything looked very good and said that if I were to live there, he would likely not see me again for 10-15 years.

My wife however is a trauma surgeon and we both agreed that I need to see a cardiologist here in the USA once we return. It took a little while because I soon after returned to Europe to run CCC by UTMB (I did not finish, but it had nothing to do with my heart) but eventually I saw a cardiologist and wore a holter for 48 hours. It showed 2 episodes of SVT and one of those was during an easy run, the other while I was just hanging out at home. But I had felt nothing. I had some other episodes of crazy HR data (as high as 231) but now when the numbers go wild I stop and do a manual HR check and each time it was well lower than what my watch showed. But for reference I ran a 100k race in Virginia in September and had no HR issues and won my age group by 75 minutes.

But I sat down with a "heart electrician" and in about 2 weeks I will get an ablation. He said that if I were not an athlete I could use medications to control it, but he said if he were me he would get an ablation. And that is what it is now. He said I could run, swim and bike but should not go all out. As in not full threshold - or racing 5k events etc.

It is easy for me to be chill right now as my next race is not until Mid April (Canyons 100k) and then June Western States