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Atrial fibrillation as a athlete.
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Hi all ,hoping get some peoples experiences with Atrial fibrillation occurring during or post exercise. This just happened to me on Thursday ( or the first one I was aware of) after a swim workout. Now I have been pouring over Pub med and a few podcasts on the subject and am coming to a few conclusions with my episode ,but want to hear from others regarding how it happened the lead up and if it was during ,before or post work out. Also if you solved it with diet , medical intervention or training changes.
My story. I have been training for Ironmans on and off since 1990 and have never had any health related issues. I have not always eaten well and thru the early 2000 raised 2 kids ( with my wife) so training was inconsistent. Started back training consistently in 2016 using a polarized model but the last few yrs spent more and more time in the pool while keeping the same bike, run ,gym volume. The month leading up to Thursday were high volume swimming and increasing in Swim ,bike ,run ,gym hours. The A fib started after the swim session when my wife and I were sitting for breakfast and it lasted 12 hrs ,i did see a medical professional and am in line for a ECG but that will probably show little of why it happened. From the what I have been reading and what I have listened too this is what I have come up with. Inflammation is a probable cause ,a large volume of work with little recovery ,high carb diet , too much caffeine , using fish oil supplements are all things I did that I think triggered this event. This below is a 2 part podcast with a person who has gone thru it and researched AF its very interesting.
https://podcasts.apple.com/...9275?i=1000504660749
https://podcasts.apple.com/...9275?i=1000504660748
So if anyone has had it or it’s a ongoing issue I would love to hear your take on your experiences.
All the best.

"Be your best cheerleader , not your worst critic.”
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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I was just in A fib for the first time a week ago Friday

Woke up at 4 AM. Heart beat a big BOOM followed by nothing then regular beat. Over and over

Went to fire Dept at 9 AM. They do free EKGs. At first they said pulse was 80 but EKG showed 175. First thing they said was it looked like I was dehydrated.

Wanted to give me cadizen drug to convert me and take to emergency. I opted to drive 10 mins home and have my wife drive me.

I took the EKG test strip with me.

By the time I got to the hospital I was converted. All sorts of tests Blood pressure high at 152/90.

Blood test showed high BUN and something else high both indicating dehydration.

Thought back over the past few days. Urine was a bit darker. Was wearing a wetsuit while swimming in a pool. Drank a ton of water but obviously not enough. Swimming I was getting my heart rate to 160, I am 60 years old

Biking inside the last few days hours on end. At a Low heart rate 120 max. But swearing more than usual Morning heart rate had been a few beats higher than normal.


I had a followup visits with the cardiologist yesterday
So here I am calcium test scheduled.

Stress test scheduled

Echocardiogram scheduled

Lipids blood test scheduled

Pulse is back to normal but
Have pounding heart feel for hours at a time
Blood pressure ranges from 135/83 to 107/73

I bought Kardia from Amazon for $75 it is a home EKG test for A Fib. Cardiologist said it is reliable

I stopped all caffeine and extra salt hoping it will help. Feel shaky and anxious as the day goes on

Swam 1200 yards yesterday and today kept heart rate below 130. Usually do 4200 4x/week. But it didn’t feel easy doing just 1200

Still leery to go back to biking

Dr says no need to severely limit salt said I can have coffee and can go back to exercising as I was. But I am very hesitant to do that

Sleep has become bad. Waking up every couple hours with pounding heart feeling. Check heart rate, EKG and blood pressure. All are good but still pounding heart

I was diagnosed with sleep apnea years ago but couldn’t figure get mask to stay on.

Now I have disciplined myself to sleep on my side so am getting a cpap machine next week

Getting 5.5 hours of sleep since the incident VS 9 hours before all of this

Emotional and me I feel completely fine for most of the day. But the last few days I was feeling scared, depressed and anxious and shaky. don’t know why as I really have a stress feee life

Retired, financially set for life, great marriage. Great relationship with my grandchildren and children so I don’t know what is causing this

Hope this helps

BTW how do you know you were in Afib?

How did you convert on its own?
Last edited by: MrTri123: Feb 26, 22 13:18
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Re: Atrial fibrillation as a athlete. [MrTri123] [ In reply to ]
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Thanks for the reply and i wish you all the best. Yours sounds scarier than mine but the dehydration rings true ,I was peeing very dark on Wednesday after a 5000m swim and 1.5hr bike high cadence. My wife gave me the gears regarding my pee and i just laughed it off. I did take Friday off as it is my usual day off and did 1 hr light bike as my wife did a 2 hr heart rate was low >90 bpm. My head is still out of sorts Feeling like i dont want to go too hard ,but from what I’ve read and listened too people seem to think it is volume related and not so much intensity.
Good luck.

"Be your best cheerleader , not your worst critic.”
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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Thank you

How do you know you went into A Fib?
Last edited by: MrTri123: Feb 26, 22 15:21
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Re: Atrial fibrillation as a athlete. [MrTri123] [ In reply to ]
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Funny you asked that ,as the more I am reading and from your account of your own Im starting to doubt it. First when I was sitting for breakfast after our swim I started to feel a tightness in my chest and what felt like a elevated heartbeat . I used the app on my Apple Watch and it said I could be having a A-fib episode but I did not have a elevated heart rate. I went about my day all the while i could feel this tightness in my chest every so often. I went to our urgent care center they did not have a ECG but took my vitals ,had high blood pressure 160/89 but HR 60 which they sort of discounted ( my usual blood pressure is 125/75 )The doctor said my heart beat was definitely irregular but said she couldn’t make a for sure diagnosis there. About 1/2hr later i felt it release and that was it.

"Be your best cheerleader , not your worst critic.”
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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Hope you don’t have anything like that again but if you do maybe check and see if your local fire dept will do an EKG (am I saying it wrong is it ECG?) for free

The coupe times I gave gone they were very happy to do it And very nice and friendly
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Re: Atrial fibrillation as a athlete. [MrTri123] [ In reply to ]
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Thanks for the advice I’ll have to check. I dont see a lot of people talking about it but from the literature it seems more common in 50+ age group. I will be waiting for my Dr appointment and my ECG for hopefully a more definitive answer.

"Be your best cheerleader , not your worst critic.”
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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an N=1....i had a bout of Afib in June 2018, in Aug 2018, I had heart surgery to repair torn mitral valve.
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Re: Atrial fibrillation as a athlete. [jeffp] [ In reply to ]
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Sorry for my ignorance ,did the A fib create the tear or the tear created the A fib. Also are you back to racing ,training or relaxing.
Thanks

"Be your best cheerleader , not your worst critic.”
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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Kirch wrote:
Hi all ,hoping get some peoples experiences with Atrial fibrillation occurring during or post exercise. This just happened to me on Thursday ( or the first one I was aware of) after a swim workout. Now I have been pouring over Pub med and a few podcasts on the subject and am coming to a few conclusions with my episode ,but want to hear from others regarding how it happened the lead up and if it was during ,before or post work out. Also if you solved it with diet , medical intervention or training changes.
My story. I have been training for Ironmans on and off since 1990 and have never had any health related issues. I have not always eaten well and thru the early 2000 raised 2 kids ( with my wife) so training was inconsistent. Started back training consistently in 2016 using a polarized model but the last few yrs spent more and more time in the pool while keeping the same bike, run ,gym volume. The month leading up to Thursday were high volume swimming and increasing in Swim ,bike ,run ,gym hours. The A fib started after the swim session when my wife and I were sitting for breakfast and it lasted 12 hrs ,i did see a medical professional and am in line for a ECG but that will probably show little of why it happened. From the what I have been reading and what I have listened too this is what I have come up with. Inflammation is a probable cause ,a large volume of work with little recovery ,high carb diet , too much caffeine , using fish oil supplements are all things I did that I think triggered this event. This below is a 2 part podcast with a person who has gone thru it and researched AF its very interesting.
https://podcasts.apple.com/...9275?i=1000504660749
https://podcasts.apple.com/...9275?i=1000504660748
So if anyone has had it or it’s a ongoing issue I would love to hear your take on your experiences.
All the best.

Kich, sorry to hear about what you have been through.
Without wanting to come across the wrong way, which I know this probably will, as much as you can do your own research into why this may have happened etc, there is a reason that cardiologists like DTOCE (and MDs like myself) spend decades becoming experts in their respective fields. By all means google away, but there is so much more information required from a proper assessment and specialised testing etc before you can even start to put a cause behind all of this (and sometimes, the cause is all but an intellectual process as it may not change any future management).
As I said, this probably comes across the wrong way, which is not my intention, my intention is just to tell you to be cautious and await proper specialised assessment before overthinking too much about what could have caused all of this etc.
Wishing you all the best.
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Re: Atrial fibrillation as a athlete. [Amnesia] [ In reply to ]
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No I appreciate your response . Im not looking for a self diagnoses its just interesting to hear other peoples experiences. I will be getting a ECG and follow ups with my doctor so just going to be taking it easy till then.

"Be your best cheerleader , not your worst critic.”
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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Have you searched through ST about Atrial fibrillation , sometimes mentioned as Afib?
Lots of responses and experiences unfortunately.


Like Amnesia said, go see a good cardiologist, the best would be someone also know about endurance athletes.

-shoki
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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I'm going through this now and would have to echo the sentiments of the cardiologist above. I have a number of friends who have also had issues with a regular heartbeat and in each case the etiology and treatment was vastly different. It seems like the afib could be a standalone electrical problem or a symptom of a larger cardiac problem or heart failure.

The testing process ends up being pretty long because you schedule an individual test at some point in the future and then it seems to cause the cardiologist to order additional test so settle in and find someone you are comfortable with because it is sort of a marathon.

Good luck, most people I know with it are doing fine, seemingly I'm not, alas.
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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Dr. Mandrola has many useful insights and a good website : https://www.drjohnm.org/atrial-fib/
Let us know how things go after your complete cardiac assessment. All the best.
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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was told afib was likely a symptom of the tear. back to racing..............not really, still ride and occasionally try to train, but the mind hasnt come to terms with racing at 75-80% of former level which is all i seem to be able to output. was a cyclist only, TT primarily. LVEF is only 45% these days
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Re: Atrial fibrillation as a athlete. [rosegarden] [ In reply to ]
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Thank you for the recommendation . I have heard of the book ( the haywire heart )he co-wrote, my coach has read it so im sure he has some insights for me.

"Be your best cheerleader , not your worst critic.”
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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I went through something weird with my heart when I was doing high tempo intervals running. Had the ECG in the office with no signs. Wore the monitor for a week and did my best to recreate things to trigger an event. Nothing. Bought a Karida off Amazon and carried that with me. Eventually I was able to record a new event on the Karida. Diagnosed with AVNRT and told not to worry about it.
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Re: Atrial fibrillation as a athlete. [Amnesia] [ In reply to ]
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Amnesia wrote:
Kirch wrote:
a large volume of work with little recovery ,high carb diet , too much caffeine , using fish oil supplements are all things I did that I think triggered this event.

be cautious and await proper specialised assessment before overthinking too much about what could have caused all of this etc.
Wishing you all the best.


So much this.

I've been battling afib the past several years. Got it diagnosed on this forum and then confirmed by cardiologist. I was in persistent afib 24/7 for 1.5 years before getting a cardioversion. No hint of it for 7 months then it came back two days after an intense 100 mile ride with a hard crash at mile 65. Off and on for next 4 months and my EP wants me to have an ablation. But then it subsided and as of today have only been in afib for 8 hours in the past 3 months.

Get some real info. We all speculate on triggers and causes, but we don't really know.

I got off all caffeine, which make sense, but studies have actually shown less afib with caffeine, so who knows.

Meat is supposedly a known trigger, the keto diet specifically has shown correlation to afib, probably because it has been shown to increase inflammation. But who knows if that's significant, there's so much uncertainty. I still eat meat and will until they pry it from my cold, greasy hands.

Have not heard of high carb causing afib. The low-carb people claim carbs cause all the problems in the universe and saturated fat will forgive all your iniquities and heal all your diseases, so I'd check the source of that, but maybe it's true.

At this point all the diet and lifestyle connections to afib are somewhere between weak correlations and speculation.

There's lots of info out there, some of it solid, some of it goofy with an agenda. I have several afib books, but the one I'd recommend is Restart Your Heart by Aseem Desai (https://draseemdesai.com/ ).

Keep pestering your doctors. I went to a cardiologist. He was going to schedule me for a cardioversion but my next visit I was not in afib and he was like "great, you don't need to see me for a year". A week later I went back into afib and was in afib continuously for months and kept contacting him and he told me all was good because it was "well controlled". As I read more about it, it seemed afib begets afib and it's not good to stay in it. Finally he transferred me to an EP who had me get a cardioversion.

A colleague who just walked past my door had an ablation two months ago and is doing great. I think of that as a last resort, but maybe I shouldn't be resistant. But again, I've been in sinus rhythm for all except one night the past 3 months.
Last edited by: HardlyTrying: Feb 28, 22 9:20
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Re: Atrial fibrillation as a athlete. [HardlyTrying] [ In reply to ]
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HardlyTrying wrote:
Amnesia wrote:
Kirch wrote:
a large volume of work with little recovery ,high carb diet , too much caffeine , using fish oil supplements are all things I did that I think triggered this event.

be cautious and await proper specialised assessment before overthinking too much about what could have caused all of this etc.
Wishing you all the best.

So much this.

I've been battling afib the past several years. Got it diagnosed on this forum and then confirmed by cardiologist. I was in persistent afib 24/7 for 1.5 years before getting a cardioversion. No hint of it for 7 months then it came back two days after an intense 100 mile ride with a hard crash at mile 65. Off and on for next 4 months and my EP wants me to have an ablation. But then it subsided and as of today have only been in afib for 8 hours in the past 3 months.

Get some real info. We all speculate on triggers and causes, but we don't really know.

I got off all caffeine, which make sense, but studies have actually shown less afib with caffeine, so who knows.

Meat is a known trigger, the keto diet specifically has shown correlation to afib, probably because it has been shown to increase inflammation. But who knows if that's significant, there's so much uncertainty. I still eat meat and will until they pry it from my cold, greasy hands.

Have not heard of high carb causing afib. The low-carb people claim carbs cause all the problems in the universe and saturated fat will forgive all your iniquities and heal all your diseases, so I'd check the source of that, but maybe it's true.

At this point all the diet and lifestyle connections to afib are somewhere between weak correlations and speculation.

There's lots of info out there, some of it solid, some of it goofy with an agenda. I have several afib books, but the one I'd recommend is Restart Your Heart by Aseem Desai (https://draseemdesai.com/ ).

Keep pestering your doctors. I went to a cardiologist. He was going to schedule me for a cardioversion but my next visit I was not in afib and he was like "great, you don't need to see me for a year". A week later I went back into afib and was in afib continuously for months and kept contacting him and he told me all was good because it was "well controlled". As I read more about it, it seemed afib begets afib and it's not good to stay in it. Finally he transferred me to an EP who had me get a cardioversion.

A colleague who just walked past my door had an ablation two months ago and is doing great. I think of that as a last resort, but maybe I shouldn't be resistant. But again, I've been in sinus rhythm for all except one night the past 3 months.

Thanks for the details
When you said the dr made you get a cardio version I looked it up there are different kinds

What did you have done?
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Re: Atrial fibrillation as a athlete. [MrTri123] [ In reply to ]
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MrTri123 wrote:

Thanks for the details
When you said the dr made you get a cardio version I looked it up there are different kinds

What did you have done?

I had electrical cardioversion, which is the only kind I'd heard of. Googled it and apparently there's a chemical cardioversion as well.
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Re: Atrial fibrillation as a athlete. [HardlyTrying] [ In reply to ]
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  1. Thanks for the reply , When I was mentioning High Carb a podcast I had listened to had suggested high carb diet leads to increased inflammation which could cause a a-fib episode. It’s interesting to me as I hear about how many different triggers could cause a episode. I am hopeful the doctors appt will shed some more light on it.


"Be your best cheerleader , not your worst critic.”
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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here's the short version of my experience with afib:

went into it one day randomly while sitting at my desk - absolutely no prior symptoms. ER visit yielded a very erratic beat - b/w 30 and 180 while sitting in a bed. They tried every drug to get it under control to no avail, electrically cardioverted the next morning (now I know why Michael Jackson liked propofol so much...). Kept on drugs (forget which one) to keep it in check, but they KILLED my energy levels and I work in consulting so I weaned off within a couple months, at the cardiologists' chagrin. Went back into afib with 4-6 months, again drugs didn't work, cardioverted again and began discussions for an ablation. Did that - they found 30-something spots that were trigger points - and really no ill effects since. Tired for a couple weeks post op but back into training/racing after that and haven't had any confirmed afib since.

Take this with a grain of salt, as my wife also had an ablation for SVT and now has a pacemaker thanks to her surgeon fucking up her AV node, so that's fun. Do your research.
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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Kirch wrote:
  1. Thanks for the reply , When I was mentioning High Carb a podcast I had listened to had suggested high carb diet leads to increased inflammation which could cause a a-fib episode. It’s interesting to me as I hear about how many different triggers could cause a episode. I am hopeful the doctors appt will shed some more light on it.

Just listened to the podcasts you posted. Quite informative. Thanks.
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Re: Atrial fibrillation as a athlete. [mattyboy] [ In reply to ]
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WOW eye opening story and sorry to hear about your wife. Thanks for sharing.

"Be your best cheerleader , not your worst critic.”
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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How does fish oil and high carb diet (for non sedentary person) cause AFib?

http://www.coupleofathletes.com
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Re: Atrial fibrillation as a athlete. [synthetic] [ In reply to ]
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Hi , I want to first say I am not a doctor nor do I play one on TV. I am not seeking medical advice or giving medical advice ,I am just wanting to hear peoples events of A-fib too see if there is some correlation to mine. I am waiting for the medical doctors to run the tests I’ve been scheduled for and they will make my medical diagnosis. The triggers I have found are coming thru the podcasts I’ve listened too and the things I’ve read thru Pub-Med. Sorry but i don't want anybody to be misled by this thread.

"Be your best cheerleader , not your worst critic.”
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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After having my Aortic valve replaced I became a member of the Afib club four years ago. Most common symptom was irregular pulse and fatigue. My doctors put me on the pill in pocket plan with Fecaloid, and warned me that I was likely to need an ablation sooner than later. After quitting caffeine, and alcohol I experience little to no change in the frequency of mu Afib episodes.

That was all over a year ago. That's when I started insuring myself that I would get no less that 8 hours of sleep every night. Since then, I've been Afib free, and am nordic skiing and cycling as much as any 66 year old guy deserves to.

This just one persons experience, and while your results may vary, a little extra sleep is always a good thing.
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Re: Atrial fibrillation as a athlete. [MrB] [ In reply to ]
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Thanks I as well have started to try and get more sleep. I only work part time from 5-9 but I always seem to stay up to 11pm and wake up at 5am. this past weekend after reading about how good sleep aids the reduction of A-fib I am committed to gettting to bed by 10 and up at 6. More sleep never hurt anyone. Thanks

"Be your best cheerleader , not your worst critic.”
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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What has helped me sleep and even rest my eyes as much as possible is looking at the body battery on my watch

If you have a Garmin it may help you
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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Hello,

I was recently diagnosed with a-fib. About three months ago while increasing the distance of my long runs I started having a tightening of the chest, dramatically increased pulse (210+), light headed. I felt better if I stopped and walked a few seconds then I could start running again. Sometime just one episode, sometime several. Outside of these episodes I could feel my pulse quicken periodically. If you look at one of my earlier posts here on Slowtwitch regarding my power on the Tacx Flux 2 you can see my heartrate at 213. I have found that using a chest strap heartrate monitor vs a wrist monitor, the wrist is much less sensitive to the a fib.

I had an appointment with my internist who is even older than me (I am 62). He said I was a-fib and referred me to a cardiologist while starting me on Eliquis, a blood thinner. I had the echo-cardiogram, chemical stress test and a consultation. She stated that 1) I had a prolapsed valve. It seems that this is hereditary and mostly likely have had it since birth. 2) One of the chambers of my heart was enlarged. She feels that this is because I have been in a fib for a long while and the heart has adapted by enlarging the chamber. we discussed options from nothing, staying on Eliquis ($500 a month, not cover by insurance), chemical cardio-conversion, etc. She seemed much more concerned about blood clots over the a-fib. They assign a risk number and she placed me at 0-1 (low). She also said she feels that Ironman is okay for me with my condition.

Back to my internist who stated he feels that I should not do Ironman anymore. He also seems much more concerned with the clotting over the a fib. I am still on the Eliquis as his office gave me a six month supply:) and now considering my future in triathlon.

Sucks as with the changes to the Ironman Legacy policy I am only a few races away from qualifying for Hawaii!

We will be seeking a third opinion soon.



.

Once, I was fast. But I got over it.
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Re: Atrial fibrillation as a athlete. [hblake] [ In reply to ]
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HI thanks for your response. I am going to be set up with a Holter monitor on March 14th to track me for 24hrs to see how the heart rhythm is then they will see what the next step will be. The take home i get with all the stories is this is a marathon not a sprint. Question have you stopped training ? And how cautious are you to start.

"Be your best cheerleader , not your worst critic.”
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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About 8 years ago, going into my mid-50s, I started slowing down and feeling a bit more fatigued all the time. My doctor just attributed it to getting older. I started having minor episodes at the beginning of 2017. I’d be out riding, and suddenly feel like the wind got knocked out of me, and if I looked down at my Garmin I’d see that my heart rate had jumped 50-80bpm higher. This would last for 10-30 seconds, then go back to normal. This started happening once every week or two. The night before I had a stress echo scheduled, I went into a persistent state, so the diagnosis the next day was a no-brainer. I was put on Eliquis, along with a few other drugs to slow my HR and steady the rhythm, but those were only partially effective. During that time, my cardiologist told me that I could continue to exercise as much as I felt comfortable doing. Which wasn’t too hard since the medications limited my HR to about a maximum 115bpm. After 9 months, my insurance finally approved an ablation, and I got that at the end of 2017. Since then, I’ve had no issues and have felt better than I did in the last few years leading up to 2017. At 60, I'm consistently matching or beating Strava PRs that I set back in 2013...

"I'm thinking of a number between 1 and 10, and I don't know why!"
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Re: Atrial fibrillation as a athlete. [Warbird] [ In reply to ]
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I had an episode (idk if this was AFIB) early this morning where my heart beat seems to pause, pound and then rapidly beat for several seconds. This actually occurs often but I have never been concerned about it- I never feel uncomfortable but I can feel when it is about to happen. Now I seem concerned.

USAT Level II- Ironman U Certified Coach
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Re: Atrial fibrillation as a athlete. [Once-a-miler] [ In reply to ]
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Once-a-miler wrote:
I had an episode (idk if this was AFIB) early this morning where my heart beat seems to pause, pound and then rapidly beat for several seconds. This actually occurs often but I have never been concerned about it- I never feel uncomfortable but I can feel when it is about to happen. Now I seem concerned.

Totally benign.
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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Yes, still running (agreed to run only with my wife) and stationary cycling only.

One of the posts above mentions the book: Restart Your Heart by Aseem Desai.

This review of the book is very critical of it: https://a-fib.com/...b-by-dr-aseem-desai/

I have not yet read the book but it is at the local library.

There are a few threads regarding a-fib here on Slowtwitch, use the search.

Lemme know if I can help you with anything.


.

Once, I was fast. But I got over it.
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Re: Atrial fibrillation as a athlete. [hblake] [ In reply to ]
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hblake wrote:


Yes, still running (agreed to run only with my wife) and stationary cycling only.

One of the posts above mentions the book: Restart Your Heart by Aseem Desai.

This review of the book is very critical of it: https://a-fib.com/...b-by-dr-aseem-desai/


Bizarre review. "Doctor" (PhD in communications) Steve claims "By advocating living with A-Fib and by not telling patients of the dangers of living in A-Fib, Dr. Desai may be doing lasting harm to many A-Fib patients."

In fact, my cardiologist wanted me to live with afib and it was Dr. (real MD, cardiac EP) Desai who convinced me that it was really serious and I should get it fixed.

Steve says "Dr. Desai’s description of A-Fib as “electrical cancer” is unfortunate and not really relevant or helpful to patients." Yes, he calls it 'cancer' to get your attention and emphasize it's really bad and needs to be treated or it will get worse.

Dr. Desai does ablations, that's his job. The take that he's not serious enough about it is bizarre. Unlike Steve, Dr. Desai has actual medical qualifications and responsibilities and has to deal with real patients.

Don't want to be so defensive. I'd have my own criticisms of the book but I disagree with Steve's take. I suspect he sees Desai as a competitor.

I've run into Steve's website before. Even though he has no medical background or anything, he has some good stuff there, as well as a fair amount of nonsense. My wife told me BCAAs immediately cure afib because she saw it on Steve's site. But again, there's good information there as well.
Last edited by: HardlyTrying: Mar 2, 22 6:39
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Re: Atrial fibrillation as a athlete. [hblake] [ In reply to ]
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hblake wrote:
He also seems much more concerned with the clotting over the a fib.

afib by itself won't kill you, but a blood clot caused by afib leading to a stroke can.
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Re: Atrial fibrillation as a athlete. [Warbird] [ In reply to ]
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This sort of the post I needed to read. I had a mild tachy event a few weeks ago, but have been having what now seem to be some Afib symptoms (occasional dizziness), irregular heart rate, along with my Apple Watch telling me I had had two sets of 5 events of AFib symptoms. One of these sets came after an "easy" ride that I felt really short of breath and HR sat at 160+ for the best part of an hour for low, low speed.

Before all this, I'd had a consistent decrease in form and some feeling of heart beating out of my chest (which I though was normal), but looking back, it might not be so much.

ECG booked in, and thence to the cardiologist. Family history of tachycardia (father, brother, uncle all have had ablation of a dual AV nerve) and aFib (all the family have had electroversion).

It had to hit at some point, training seems to have held it off.
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Re: Atrial fibrillation as a athlete. [altayloraus] [ In reply to ]
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altayloraus wrote:
This sort of the post I needed to read. I had a mild tachy event a few weeks ago, but have been having what now seem to be some Afib symptoms (occasional dizziness), irregular heart rate, along with my Apple Watch telling me I had had two sets of 5 events of AFib symptoms. One of these sets came after an "easy" ride that I felt really short of breath and HR sat at 160+ for the best part of an hour for low, low speed.

Before all this, I'd had a consistent decrease in form and some feeling of heart beating out of my chest (which I though was normal), but looking back, it might not be so much.

ECG booked in, and thence to the cardiologist. Family history of tachycardia (father, brother, uncle all have had ablation of a dual AV nerve) and aFib (all the family have had electroversion).

It had to hit at some point, training seems to have held it off.

Same here, the majority of people on my mom's side of the family have had afib or svt (I actually had both)

I hit peak fitness in 2013/early 2014, then started noticeably sliding back. But no other symptoms or indications of anything being wrong. My doctor just said it was because I was hitting my mid-50s, and that's just what happens. It wasn't until early 2017 that I actually had any real indication that anything was wrong, with periodic episodes of shortness of breath/elevated HR. But on my first easy ride 2 weeks after my ablation, without trying I knocked off a few PRs on one of my regular routes, even though I had only ridden a few hundred miles at Z1 effort over the previous 9 months. So it looks like there was something else besides simply "getting older" going on during the previous 3 years...

"I'm thinking of a number between 1 and 10, and I don't know why!"
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Re: Atrial fibrillation as a athlete. [Warbird] [ In reply to ]
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Warbird wrote:
altayloraus wrote:
This sort of the post I needed to read. I had a mild tachy event a few weeks ago, but have been having what now seem to be some Afib symptoms (occasional dizziness), irregular heart rate, along with my Apple Watch telling me I had had two sets of 5 events of AFib symptoms. One of these sets came after an "easy" ride that I felt really short of breath and HR sat at 160+ for the best part of an hour for low, low speed.

Before all this, I'd had a consistent decrease in form and some feeling of heart beating out of my chest (which I though was normal), but looking back, it might not be so much.

ECG booked in, and thence to the cardiologist. Family history of tachycardia (father, brother, uncle all have had ablation of a dual AV nerve) and aFib (all the family have had electroversion).

It had to hit at some point, training seems to have held it off.

Same here, the majority of people on my mom's side of the family have had afib or svt (I actually had both)

I hit peak fitness in 2013/early 2014, then started noticeably sliding back. But no other symptoms or indications of anything being wrong. My doctor just said it was because I was hitting my mid-50s, and that's just what happens. It wasn't until early 2017 that I actually had any real indication that anything was wrong, with periodic episodes of shortness of breath/elevated HR. But on my first easy ride 2 weeks after my ablation, without trying I knocked off a few PRs on one of my regular routes, even though I had only ridden a few hundred miles at Z1 effort over the previous 9 months. So it looks like there was something else besides simply "getting older" going on during the previous 3 years...

So happy for you

Glad you had it taken care of
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Re: Atrial fibrillation as a athlete. [Warbird] [ In reply to ]
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Wow Warbird great to read your story...as it closely resembles mine...was in peak condition in my mid 50's in 2014 and started noticing slight decline in performance...and also when I am honest with myself the first signs of HR/arrythmias which I kind of ignored as I never was out of breath or dizzy...just HR spikes..and at times my heartbeat feeling disorganized while recovering on the sofa after a long ride/run....this continued on and off so much so that I moved away from Ironman level training after disapponting Lake Placid in 2017...continued uninspired "training" with only minimal HR disruption or at least that impacted me daily...until November of last year..when I went into Afib, Aflutters off & on continuously for a week ...kept me up at night,,,felt panicky during the day...I was supposed go on a business trip and my wife made me see the doctor before going...EKG picked up irregularity..put me into the hospital...Stress Test (with Dye infusion to rule out blockages)...and the Afib/Flutter was revealed....(thankfully no artery issues)....I also followed that up with heartmonitor for 30 days which showed I was in Afib for more often than I realized....lastly a sleep study to rule out any apnea as a trigger (negative)...and I chose right away for an Ablation...I didn't want rate control meds for life....I had the ablation on Wednesday this week...and recovering at home...tired, a little sore...but I love the sound of my heart in normal sinus rythm...I'm hoping for the same return to fitness you experienced...fingers crossed.
Last edited by: Soarfeet: Mar 11, 22 9:15
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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I had bouts of afib back in the late 90's primarily at high end training or racing. It sucked. and had to drop out of a few races or stop for a bit to get back to normal sinus rythm. Once doing a 20 mile run from hotel to US Capitol in DC I went into afib running up the stairs to the capitol and had to run 10 miles back in afib which really was not pleasant. Long story short, meds sucked and didn't work. Ablation procedures were only practiced in a couple locations in the US at the time, Primarily Duke University Hospital and UCSF Medical Center. Traveled from the DFW area to Duke to have RF ablation and it took nearly 10 hours. Pretty fast recovery and no afib for about 10 years which my EP indicated was pretty good for an RF procedure since the scar can leave gaps. Sporadic bouts returned and in 2014 had a cryo catheter ablation which is supposedly better than the RF long term since it makes a more complete scar around the pulmonary veins. Procedure only took about an hour or so. Recovery a bit tougher than previous. it felt like an elephant was sitting on my chest for a couple weeks but was back at it in a week though. Since then no afib.

I did find that dark chocolate, red pasta sauce, and red wine were triggers. That seemed to be a common thread on message boards. Bouts of indigestion also triggered since apparently the vagus nerve has connections to both. I think this is know well known but back in the day EP's would look at you funny when you told them others experience the same issue.

I tried taking Taurine, Asparagine, Magnesium, and Prilosec prior to activity which seemed to help a little. Never

Good luck with whatever course you decide.

Jim

Jim Lukanich
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Re: Atrial fibrillation as a athlete. [Soarfeet] [ In reply to ]
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Soarfeet wrote:
Wow Warbird great to read your story...as it closely resembles mine...was in peak condition in my mid 50's in 2014 and started noticing slight decline in performance...and also when I am honest with myself the first signs of HR/arrythmias which I kind of ignored as I never was out of breath or dizzy...just HR spikes..and at times my heartbeat feeling disorganized while recovering on the sofa after a long ride/run....this continued on and off so much so that I moved away from Ironman level training after disapponting Lake Placid in 2017...continued uninspired "training" with only minimal HR disruption or at least that impacted me daily...until November of last year..when I went into Afib, Aflutters off & on continuously for a week ...kept me up at night,,,felt panicky during the day...I was supposed go on a business trip and my wife made me see the doctor before going...EKG picked up irregularity..put me into the hospital...Stress Test (with Dye infusion to rule out blockages)...and the Afib/Flutter was revealed....(thankfully no artery issues)....I also followed that up with heartmonitor for 30 days which showed I was in Afib for more often than I realized....lastly a sleep study to rule out any apnea as a trigger (negative)...and I chose right away for an Ablation...I didn't want rate control meds for life....I had the ablation on Wednesday this week...and recovering at home...tired, a little sore...but I love the sound of my heart in normal sinus rythm...I'm hoping for the same return to fitness you experienced...fingers crossed.

My insurance really pushed for keeping me on the meds, but 9 months showed that they were only partially effective at best. My cardiologist was pushing for an ablation, and told me "You're too young to be on drugs the rest of your life."

The thing that really surprised me going into the hospital for the ablation was that I was not nervous at all. The only thing I was feeling was relief that all this would finally be over...

"I'm thinking of a number between 1 and 10, and I don't know why!"
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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had A-Flutter. "kissing cousin to A-Fib"

in my particular case i had a super cardiac electro guy (at that time) down at HNL Cardio clinic. ran a electrode thing up my thigh and burned the AV node on my heart. Two burns. i could feel them. Every sense then my heart has been in cardiac rythym.


/r

Steve
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Re: Atrial fibrillation as a athlete. [Steve Hawley] [ In reply to ]
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Great thread and lots of good info and thoughts.

My first experience with afib was about a week ago (age 59, a lifetime of endurance sports). I'd done about a one hour moderate nordic (skate) ski workout that day. We were watching a movie that evening on the couch, and I noticed that my heartbeats were irregular. I have a good friend with a similar background who had just been through a couple years of dealing with afib (with episodes lasting weeks at a time) which appears to have finally gone away after a 2nd ablation. So, I immediately suspected that as the cause. I was pretty much asymptomatic other than the irregular heartbeat (which was still in the 60s). I only really noticed because I'm probably somewhat obsessive about checking my pulse at least a couple of times a day just to get a sense of what my resting HR is doing.

The next morning the irregular beats were still happening. I wanted to get an EKG while it was going on, so I went to the nearby urgent care. I ended up with about the perfect doc for my situation. He was an ex ER doc who decided to move to urgent care while he was coasting into retirement; and, he'd had afib which has not recurred after his 2nd ablation. So he was quite familiar with my particular situation and had lots of great things to say. They set up an EKG and it was confirmed. Doc consulted with a cardiologist, and they decided to send me to the ER for a possible cardioversion (if done within 24 hours after onset of afib risk of clots forming in the atria, resulting in possible strokes, is generally considered negligible).

The ER experience was not quite as pleasant. I'm pretty sure they forgot somebody was in my room for a few hours. Eventually the doc wandered back and said it would be best to just send me home because: I was asymptomatic; I couldn't say with 100% certainty when my afib actually started; and, most cases convert back to normal on their own. I really wanted to just be done with it but that all made sense.

Sure enough, that afternoon after I came home from the ER my heart rhythm was back to normal. So my episode lasted probably a bit less that 24 hours.

This all happened on a Friday, and by pure luck I managed to get an appointment with a cardiologist the following Monday due to a cancellation. Another ECG showed everything was normal. She was great, and talked about a lot of things I'd already learned about. One thing she did say is that afib pretty much doesn't happen without arrhythmia, which I didn't realize. Atrial flutter can happen with a regular heartbeat, but that's different than afib. She confirmed that afib unfortunately tends to get progressively worse, but that there is huge individual variation. She believed that if progression seems to point to an ablation, sooner is better than later. With a good electro doc (she really emphasized the 'good doc' part) success rate of 1st ablation (no afib recurrence) is about 75%. She recommended that I just carry on with life as normal, and if this keeps happening we'll reevaluate. She got me scheduled for an echocardiogram in a couple of weeks.

Also got a portable EKG device. The Kardia EKG device seems to be the standard and it what my formerly afib-riddled friend recommended, but I got one from SonoHealth because I liked having the screen. I've tried it out and it seems to work great-pretty amazing device. Like the Kardia you can capture an EKG if you're having issues and mail it to your cardiologist.

It's now Friday a week later, and I've been doing normal workouts. In fact, yesterday I did the exact same nordic ski workout as the day I had the afib, except this time I pushed it a little harder. Have also done a couple runs including a great one today, a surfski paddle, and a bike trainer session. Heart rhythm has been rock solid all week.

Things that were different the day I had the afib were: I had consumed at least 2X my normal amount of caffeine (even though based on studies caffeine does not seem to be a trigger); and, I was quite dehydrated that day (which does appear to have some correlation).

So, that's my story . . .
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Re: Atrial fibrillation as a athlete. [Warbird] [ In reply to ]
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Warbird...Curious about your approach to return to activity/training post ablation. My ablation went really well it seems...(had both for Afib & Aflutter...right and left atriums)...I had little to no soreness or bleeding at the insertion sights...some chest tightness on deep breaths...but no pain....I have had a cough though that seems to be from residual heating from the RF and from the Trach tube for breathing under anesthesia...that is fading now also....Anyway...I'm just over a week out and I took a first walk yesterday...25min...conversational....all good...will probably spin the bike wheels on the trainer today...

My plan was 7-10 little to no activity...then begin back with a couple of weeks easy zone 1 stuff cycling/walk-jog...see how that goes then up-it from there but probably no intensity for a month(?)...

I've read alot of blogs, articles , posts ....that range from ...nothing but zone 1 stuff for 3-6months....to top level triathlete who was told by her cardiologist after the ablation to jump right back in (after a week or two)...that "your heart is the same as everyone elses now"...

So I will continue to be cautious with a steady return...but curious how you approached....or anyone else on this forum who cares to share their thoughts.

FYI...I wasn't nervous about the Ablation either....I was really excited...had a great EP who discussed the procedure as much as I cared too...and he was at least an outdoor person...if not an actual triathlete...so he understood well where I was approaching the procedure.
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Re: Atrial fibrillation as a athlete. [Soarfeet] [ In reply to ]
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I started doing easy walks after a week, and did my first ride after 2 weeks. My cardiologist told me I could go as hard as I felt comfortable with, but with little activity for the previous 9 months and my HR still being regulated by various medications, that wasn’t going to be much. I was told that it takes a few months for everything to completely heal, and until then not to be surprised if I had any episodes.

My first ride was mostly easy on a fairly flat bike path, but about 5 minutes in my HR jumped from 110 to 162 while only putting out 75w, then dropped back down to under 100 after a few minutes, but still continued to be all over the place. The next few rides were similar, but with less HR variation. But there was a tendency for my HR to hit its peak while going easy in the first few minutes and then drop back down.

After a few weeks, I was able to start doing 25-30 mile rides. After 2 months, I was back to riding in the local mountains, and picking up new PRs on Strava on every ride, even with the medication slowing me down.
After 4 months, I had a Linq monitor implanted so they could keep an eye on everything, and except for a few very minor episodes in my sleep, everything was looking like it was back to normal.

After 5 months, I had a stress echo and everything checked out, so I was taken off all the meds, and everything has been OK ever since.

"I'm thinking of a number between 1 and 10, and I don't know why!"
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Re: Atrial fibrillation as a athlete. [Warbird] [ In reply to ]
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Thanks for Sharing. Slow and steady coming back I think makes sense...at least until my 3month follow up...(they will put me on a monitor for 15 days just prior to that)....I recenlty purchased the Kardiamobile ekg device...kinda nice...
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Re: Atrial fibrillation as a athlete. [Warbird] [ In reply to ]
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Just curious, I had my ablation last Wednesday (4/13) and since then my resting HR has been elevated by about 20-25 bpm. My Dr. warned me that might be the case, but I wanted to see if anyone here had a similar "side effect" and if so, for how long? Thanks!
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Re: Atrial fibrillation as a athlete. [LDF] [ In reply to ]
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It takes about a month. No big deal.
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Re: Atrial fibrillation as a athlete. [NealH] [ In reply to ]
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NealH wrote:
It takes about a month. No big deal.
My experience was about the same, FWIW.
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Re: Atrial fibrillation as a athlete. [Soarfeet] [ In reply to ]
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Soarfeet - I looked through my data but don't have anything in Garmin for just post-ablation. Mine was 10/2014, I do have data from 2015 that I was well into training again by spring and racing by August at the very least. But I highly doubt I was doing anything intense for the first month, given my recollection of general chest tightness and lethargy.
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Re: Atrial fibrillation as a athlete. [LDF] [ In reply to ]
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LDF wrote:
Just curious, I had my ablation last Wednesday (4/13) and since then my resting HR has been elevated by about 20-25 bpm. My Dr. warned me that might be the case, but I wanted to see if anyone here had a similar "side effect" and if so, for how long? Thanks!

Mine actually went down immediately. My resting HR had been a bit higher for a few years just before afib hit, in the upper 40s, then was anywhere from 75-220 for the 8 months until I had the ablation. While in the hospital recovering from the ablation, it was at 42, where it had been until about 5 years earlier...

"I'm thinking of a number between 1 and 10, and I don't know why!"
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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Hello Kirch and All,

My wife has Afib occasionally even though she has had an ablation ... everything fine for 3 or 4 months and then has an episode that may last 2 days ... her age is 86

She has a Biotronik pacemaker and takes some drugs to prevent Afib along with Warfarin to reduce possible clotting.

There is a procedure ... whereby using a device that can externally control the Biotronik pacemaker ... the operator can run her pulse up to 250 and right back down and it will stop the Afib.

The Biotroik tech says the procedure only works on 60% or so of patients .. but is is magic when Afib occurs .. and we can get to the doctor's office.



I also have a Biotronik pacemaker because my heart rate was skipping as I aged at a normal resting pulse of 42 .. a double skip would result in a loss of consciousness. The Biotronik keeps heart rate floor at 50 now.

My age will be 90 next year ... The Biotronic pacemaker has a device like a cell phone next to the bed that (Bluetooth?) collects and sends the downloaded file of heartbeats stored each day in the Biotronik via the bedside device selfcontained cellphone to my cardiologist each day with

anomalies flagged.

Recently, after several years with the Biotronik, I had my first Afib event (I was unaware of it) and was called in for some tests and started Warfarin to prevent blood clots in the future.

Today I discussed getting a Watchman installed in my heart and not taking Warfarin in the future. I was told that the procedure takes about an hour and although I was old, I was otherwise very healthy and it should be possible.

Cheers, Neal

+1 mph Faster
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Re: Atrial fibrillation as a athlete [ In reply to ]
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Hi everyone,
Recently my doctor prescribed a holter monitor which indicates mild arrythmia (something ventricular tachycardia?) that starts and lasts about 5 beats. I thought I just consumed too much caffeine and or had anxiety.......

I am awaiting an echocardiogram. My research indicates that this is common with athletes, especially those who have been endurance athletes for years like me. Does anyone have experience training and or racing with this? My doctor has said no worries exercising as long as I don't exhibit additional symptoms (ie. passing out, etc.). I am anxiously waiting for the eco test and an appointment with a cardiologist. I do not exhibit extremely high heart rate episodes while exercising (or at least not that I know of).....

Thanks!

KK
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Re: Atrial fibrillation as a athlete. [Kirch] [ In reply to ]
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I responded to the afib inquiry in another thread, but it is not linked so I copied most of the important stuff.

As always, discuss your own situation with your MD-the internet is not where you should get your medical information. It is well known and documented that afib is associated with activity/exercise.


When afib is discovered (new), we have to decide if it is a triggered issue or not. Meaning, was the reason the heart rhythm going out of rhythm just trouble with the electrical system or if it was caused by an irritant like: alcohol, hormones-like an overactive thyroid, dehydration, severe anemia, or other systemic disease which may or may not be known-especially heart disease. It can be caused by exercise and emotional stress also. The biggest concern is undiagnosed heart disease.

It may come and go (paroxysmal) or become persistent>permanent. There are ways to put the heart rhythm back to normal-with electricity or medication. Some people will need to be on blood thinners/anti-coagulants (AC). The first decision for new afib is to figure out why it happened. Labs and some cardiac testing is usually needed because cardiac disease is the most common underlying concern. Decisions are made based on a decision to either rate control or rhythm control-put the patient back into sinus rhythm. Most patients have very rapid rates when in new afib and are symptomatic.

Some HR monitors are pretty accurate. A lot of the ones with optical sensors are pretty inaccurate but give some useful information at times.The apple watch isn't too bad either but it's not perfect, for sure. Monitors using a chest strap are much more accurate but still not perfect. Movement can mimic afib by artifact. A Kardia device is a much better and more accurate device for checking for afib. The Kardia is worth the $99 bucks and can be uploaded and delivered to an MD for review. Symptoms have to be occurring long enough to get your fingers on the device, though.

One of the risks of doing exercise with very rapid afib is syncope as the heart is going much too fast to fill and pump efficiently so BP can dive and that can be followed by the patient hitting the deck. Something additionally to think about...

-----------------------------------------------------------------------------------

Up To Date has a nice 'summary' about afib-see some of it below which I cut/pasted/added.


Overview of atrial fibrillation


INTRODUCTION
Atrial fibrillation (AF) is the most commonly treated cardiac arrhythmia.

AF is generally associated with an irregularly irregular ventricular rhythm and absence of distinct P waves.

Complications of AF include risk of thromboembolism (including stroke) and risk of heart failure. In addition, affected patients may be at increased risk for mortality.


PREVALENCE AND ASSOCIATED CONDITIONS
The prevalence of AF increases with age, and it is estimated to affect over 4 percent of the population above the age of 60. Hypertensive heart disease and coronary heart disease are the most common underlying disorders in patients with AF in developed countries. Rheumatic heart disease is prevalent in certain resource-limited areas and is strongly associated with AF.

●Associated conditions – Hypertensive heart disease and coronary heart disease are the most common underlying disorders associated with AF in developed countries. It also occurs with cardiomyopathy and heart valve disease.

It also occurs in athletes-especially endurance athletes.


CLASSIFICATION
AF is classified according to the following schema described in the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society guidelines on AF management

●Paroxysmal (ie, self-terminating or intermittent) AF – Paroxysmal AF is defined as AF that terminates spontaneously or with intervention within seven days of onset. Episodes may recur with variable frequency. (See "Paroxysmal atrial fibrillation".)

●Persistent AF – Persistent AF is defined as AF that fails to self-terminate within seven days. Episodes often require pharmacologic or electrical cardioversion to restore sinus rhythm. While a patient who has had persistent AF can have later episodes of paroxysmal AF, AF is generally considered a progressive disease.

●Long-standing persistent AF – Long-standing persistent AF refers to AF that has lasted for more than 12 months.

●Permanent AF – Permanent AF is a term used to identify persistent AF for which a joint decision by the patient and clinician has been made to no longer pursue a rhythm control strategy. Acceptance of persistent AF may change as symptoms, therapeutic options, and patient and clinician preferences evolve.

While AF typically progresses from paroxysmal to persistent states, patients can present with both types throughout their lives.

The term "lone AF" is a historical term that is now disfavored as it may be confusing and does not enhance patient care. The term lone AF has been used to describe AF in younger patients (eg, ≤60 years) with paroxysmal, persistent, or permanent AF who have no structural heart disease or cardiovascular risk factors. These characteristics identify a group of individuals with a CHA2DS2-VASc score of "0" and are lowest risk of thromboembolism from AF.

Subclinical AF (SCAF) is defined as episodes of AF detected by intracardiac, implantable, or wearable monitors and confirmed by intracardiac electrogram or review of the recorded rhythm on the electrocardiogram (ECG). SCAF usually occurs in individuals without characteristic symptoms of AF and without a prior diagnosis. Most of these individuals will have paroxysmal AF. A scientific statement from the American Heart Association on subclinical and device-detected AF was published in 2019.

The prevalence of SCAF depends on the population studied as well as the duration, sensitivity, and specificity of screening techniques. The following studies investigated the prevalence of subclinical AF in different populations, using different monitoring techniques:

●In the STROKESTOP observational study of 7173 individuals 75 to 76 years of age in Sweden, previously unknown AF was detected using intermittent ECG recordings over three weeks in 3 percent.

●The ASSERT study monitored (using a dual-chamber pacemaker or implantable cardioverter defibrillator) 2580 patients (65 years or older) with hypertension and no history of AF for the development of AF (defined as episodes of atrial rate >190 beats per minute for more than six minutes). The following findings were noted:

•At three months, subclinical AF was detected in about 10 percent of patients. The median number of episodes was two, and the median time to detection of the first episode was 36 days.

•At 2.5 years, SCAF was detected in about 35 percent of individuals. Clinical AF developed in about 16 percent of patients with SCAF.

●In the ASSERT-II study of 256 patients (mean age of 74 years; mean CHA2DS2-VASc score of 4.1) with an implanted subcutaneous ECG monitor who were followed for about 16 months, one or more episodes of SCAF lasting ≥5 minutes occurred in 34 percent. This was a high-risk population, as 48 percent (of the 256 patients) had prior stroke, transient ischemic attack, or systemic embolism.

●In a study of 590 individuals with stroke risk factors but without AF who underwent screening with an implantable loop recorder for an average of 40 months, 35 percent of participants were found to have AF.


AFib can kill you but most often is just irritating -initially, but over time there is increased risk.



Electrocardiogram — In AF, there are no discrete P waves but rapid, low-amplitude, continuously varying fibrillatory (f) waves are seen. The ventricular rhythm is generally irregularly irregular (lacking a repetitive pattern), although AF is uncommonly associated with a regular ventricular rate. The ECG in patients with AF is described in detail separately. (See "The electrocardiogram in atrial fibrillation".)

There are a number of potential pitfalls in the ECG diagnosis of AF. Errors in the diagnosis of AF are especially common with computerized ECG interpretation and in patients who are continuously or intermittently paced. Hence, it is important that the automated ECG interpretation provided by the machine is confirmed by a skilled reader



MANAGEMENT
A useful framework for the general care of AF patients is the ABC (Atrial Fibrillation Better Care) pathway. The "A" can be considered for anticoagulation, "B" for better symptom management, and "C" for cardiovascular risk factor and comorbid disease assessment and management. Mitigating the risk of stroke is one of the most important management considerations for physicians treating AF patients, and the long-term use of oral anticoagulants is the most effective means of reducing risk of stroke. However, the risk of stroke must be weighed against the risk of bleeding from these anticoagulants with the use of such scores as CHA2DS2-VASc and HAS-BLED. Symptom management starts with rate control of acute AF episodes and then extends to assessment of the benefits of rhythm control over the longer term. Finally, identifying and treating risk factors and comorbidities, such as obesity, sleep apnea, hypertension, and heart failure, may help with AF symptoms and burden. Observational studies, a post-hoc analysis of the AFFIRM trial, and a prospective randomized trial using a mobile application suggest that the implementation of such a framework of care for AF patients may have a salutary impact on adverse cardiovascular events and hospitalizations, while being cost saving for healthcare systems.

Healthcare providers are presented with two broad types of patients with AF: those with newly diagnosed AF and those who have been previously diagnosed and managed. Care of the former includes decisions regarding the need for anticoagulation and the choice between rate or rhythm control strategies. For patients with established diagnosis, periodic assessment of the adequacy of treatment is necessary.

Link to the CHADSVASC and HASBLED scoring calculators.

CHADSVASC, CHA2DS2VASC and HASBLED risk score calculator for atrial fibrillation


Many patients will need cardiac evaluation to look for ischemic heart disease, valve disease or cardiomyopathy. Testing may include a coronary artery calcium score, cardiac echo or stress test.

Cardioversions work to restore sinus rhythm pretty well (~90% success initially), for a time, and can be done repeatedly. With recurrences, ablation is a better long term solution but there are risks also




edited to add Dr. Creswell's blog from long ago as he is more succinct with words than I am

Atrial Fibrillation in Athletes (In a Nutshell) (athletesheart.org)


Also forgot to mention the Watchman Device, which our hospital and many others do put in-if eligible

WATCHMAN Implant for Non-Valvular Afib Stroke Risk



Updated Rx guidelines




Hope this helps.
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