Atrial Fibrillation - post ablation

Triathlon Forum
19

Eric,

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

Cardiovert a-fib? That’s a great way to give someone a stroke especially w/ a known hx of a-fib. Thats why they created Cardizem.

20

Just by curiosity, white wizzard, are you an electrophysiologist or cardiologist? You seem to know enough about AFIB to be convinced that I’ll put myself in trouble. Have you ever heard of someone getting an cryoablation and then die in an endurance event later on? I’m only 38, does it change how you think, or is age irrelevant?

Thanks for your concerns,
Eric

21

Thanks Gasman, I’ll make sure to print this tread to remember exactly what I need to ask… :slight_smile:

Thanks
Eric

22

Hi Eric-

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

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

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

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

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

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

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

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

Good luck!
J

23

Hi Jam, thank you very much for this detailed reply. It’s very comforting to know that it can be done, and also it’s good to know that it might take me longer to recover than expected. If I have to wait until 2013 to do it, I’ll wait.

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

Thanks again.
Eric

24

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

We, of course, wish you all the best!

John

25

Hi John, thanks for the reply.

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

Thanks
Eric

26

Just by curiosity, white wizzard, are you an electrophysiologist or cardiologist? You seem to know enough about AFIB to be convinced that I’ll put myself in trouble. Have you ever heard of someone getting an cryoablation and then die in an endurance event later on? I’m only 38, does it change how you think, or is age irrelevant?

Thanks for your concerns,
Eric

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

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

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

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

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

Why do you REALLY want to do this?

27

I found out after the bike in Challenge Wanaka that I had SVT. I couldn’t afford the operation in Australia so decided to get it back in the UK after 12 months more training, 2 Ironman races and 2 70.3s. Really depends how serious the SVT is to affect how able you are to race or not. I had another episode recently but still training on and off.

28

I found that the doctors I talked to, while being very knowledgable about the disease and their technical surgical skills, were fairly clueless about the interaction of high-end endurance training with Afib and recovery from the ablations. i.e. the Doctor said they usually give you a 3-month waiting procedure post-procedure before proclaiming you ‘cured’, but after that you were 100%, fully cured, good to go, no issues, do whatever you want. This was most definitely not the case. My personal opinion from my experience is that they do a lot of damage to your heart while they’re in there burning away and it takes significant time before things heal up to the point where the heart can be pushed. Essentially like any other muscle in your body that you have a major operation on.

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

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

best of luck!
J

29

ok… thank you…

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

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

Thanks
Eric

30

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

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

John

31

ok… thank you…

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

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

Thanks
Eric

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

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

If I had a cardiac condition such as yours I can honestly say that I would have ended my Ironman ambitions. Its not worth the risk.

32

Thanks for your honesty white wizzard.

What do you thing about olympic triathlons and half Ironman?

33

Thanks for your honesty white wizzard.

What do you thing about olympic triathlons and half Ironman?

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

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

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

34

Butcher,

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

Agree with Dr. John and gasman above.

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

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

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

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

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

Larry Creswell

35

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

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

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

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

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

36

Oh, my first one took approx. 6 hours for the procedure. Out of the hospital the next day to go home.

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

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

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

37

Thanks for your honesty white wizzard.

What do you thing about olympic triathlons and half Ironman?

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

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

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

Jesus Christ Butcher - I don’t think you have enough cotton wool for what this guy is advocating…

38 
 I am a 53 year old surgeon who got a-fib at 40.  After 15 cardioversions and numerous ruined races, I had an endocardial ablation (pulmonary vein isolation) at Johns Hopkins Hospital in Baltimore in February of 2009 (Dr Hugh Calkins). 
  Results were fantastic.  I can train and race at full throttle now.  The procedure improved my triathlon results.  This year I won my age group at St Anthonys, raced three ironmans (Lake Placid, Kona, Florida) and two half ironmans (Buffalo Springs and Las Vegas).  I did a 9:43 at Florida to win my age group and get a Kona spot for next year.
 I was racing eight weeks after the procedure.  I've had only one episode of recurrent a-fib which occured within 6 months of surgery.
 There are complications.  Not everyone does as well as I did but don't be afraid of having the procedure.  Definitely don't be afraid of training and racing hard afterwards.