Edited - Atrial Flutter...... Post Covid (or virus) and HR - immediately jumps to a narrow range and stays

Triathlon Forum
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Sorry to hear this Chris, this heart stuff can be a real where’s Waldo in trying to figure out exactly what is going on, and then what to do about it. I think Dan’s guy has done him good, I got to LA cardiology in downtown LA, they are all pretty good there too. Let me know if you need a name there, and of course one to drop…(-;

Your name is good there?? :slight_smile: I’ve got three irons in the fire, a local guy that is in my group that I saw years ago, Dan’s at UCLA and one at Cedars. Could always use another if you want to shoot me the name, increases my odds.

The cardio took one look at the EKG and said “oh you have atrial flutter.” Having gone thru issues before with dx, I was actually quite pleased he was able to ID it so quickly (assuming it’s correct). Much different than my 8 week saga over multiple docs trying to find my pulmonary emboli 14 years ago…

22

the jumps occur because the AV node is the ‘gate keeper’ of the HR for the heart

AV block with atrial arrhythmia occurs in clumps with atrial flutter–2:1, 3:1, 4:1 are most common–so

when the top chamber is going 280-300 bpm, the AV node slows it down inherently *(normally I would impress people with cool words like decremental conduction…but whatever…) and you’ll see actual heart rate (ventricular pumping response) of 140-150 for 2:1, 95-100 for 3:1 and 70-75 for 4:1 block

and there will be jumps in the HR from 70>95>140

and because you were in persistent atrial flutter, you would increase your HR to 95-100…then jump to 140

oh, and please tell me someone did CHADSVASC and decided on whether AC is needed or not…

23

With a couple google searches and a small brain, I think so!

So the “:1” in the ratio is the readout on the HRM as I am understanding it. Atria going at 280-300, ventricle reporting at 140-150…

Actually very interesting and explains a lot

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yes

you are learning Daniel-san
.

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LOL… Well i you stop talking all doctorly this process might go faster

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Interesting….I went in for a pre-op for my shoulder surgery and because I was over 65 they ran an ecg. Thought my resting hr (pulse) was in the 30s the Dr told me I was in flutter at 300 beats. I was cardioverted for the surgery. The following summer I had an ablation to fix the fluttering and keep out of afib. During to surgery I went into afib and several times since. They called it low hr afib where my pulse was 40 to 50 beats. They also discovered wearing a holter monitor that I was avblock 2 heading to total block. I bought and used the Kardia mobile for readings every morning before heading out for a swim, bike or run. One morning this spring, it read that I was in afib with a hr of 30. All I could do was sit in a chair that day because I was so gassed. The next morning I was out of it but it took me two days to feel normal again. I found that when I exercised, especially running, I had to slowly build before I could even reach a pace I considered training. I shutdown any intensity because I was afraid it would send me into afib again and after the last episode decided I didn’t want to go thru that again.

Long story….I am now the owner of a brand new Medtronic pacemaker with a lead in the atrial and one in the ventricles to keep me pacing at 1 to 1. I am only a week into recovery and can’t exercise for another 3 weeks but I am sleeping so much better and not as tired during the day. Pre pacemaker in a 24 hr period my heart would skip beats over 1,100 x for up to 4 seconds.

I did have one extremely rare complication the day following the initial surgery where my right lung was punctured by the screw head from the atrial lead and partially collapsed. I was admitted to the hospital for four days on a rebreather oxygen face mask to stabilize my lungs so they could reposition the lead to an area where it wasn’t going to interfere with my lungs again. But all is good now and I am anxious to test out the new pacing zones they programmed into the pacemaker once the leads have scared into place at the end of my one month recovery.

Good luck with your journey, doctors and research. I did find a forum I thought was helpful if you do face having to go towards a pacemaker. It is the Pacemaker Club.

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Nothing to add beyond what we discussed privately regarding my afib experience but will say again, you are going to be A-ok post ablation. :slight_smile:

28

My experience is different from yours, but there are some similarities. Specifically, the narrowing of my heart rate response to training. My floor is higher and my ceiling is lower. It’s very hard to push toward my max HR anymore.

Background: I’m a 40 year old male and have been doing endurance sports for about 15 years. Prior to that I played soccer in college. Fairly good results over the years.

In June of 2022, I went into a-fib for the first time. I was cardioverted out, but about three weeks later I went back in. Another cardioversion and it seemed to stick. I raced Norseman that August with no issue. In May or so of 2023 I went back into a-fib. The doctor had given me the “pill in the pocket” to try, so I used that and it eventually put me back in rhythm. Over the course of the summer I had 5-6 more episodes, each time using the meds to bring me out, which generally meant taking 2-4 pills and coming out within 24-48 hours.

I didn’t like the idea of lifelong medication and feared for possible other health issues from the frequent episodes of a-fib, so I opted for an ablation. I had the procedure in November of 2023. The procedure went well and has been effective so far, but it was more recovery than I anticipated. They do say it can take 6-12 months to fully recover from, but my performance has definitely seen a bit of an impact. My resting heart rate is in the low 60s now, where it used to be in the low 40s. My top end threshold is harder to find and maintain. No matter what my effort output is, my HR trends between 135 and 160. And easy spin used to be 115 and I could still push beyond 180.

Like I said, my experience is different from yours, but there are some similarities as it deals with the heart. Best of luck as you try to navigate a difficult medical system.

29

Sorry to hear this Chris, this heart stuff can be a real where’s Waldo in trying to figure out exactly what is going on, and then what to do about it. I think Dan’s guy has done him good, I got to LA cardiology in downtown LA, they are all pretty good there too. Let me know if you need a name there, and of course one to drop…(-;

Your name is good there?? :slight_smile: I’ve got three irons in the fire, a local guy that is in my group that I saw years ago, Dan’s at UCLA and one at Cedars. Could always use another if you want to shoot me the name, increases my odds.

The cardio took one look at the EKG and said “oh you have atrial flutter.” Having gone thru issues before with dx, I was actually quite pleased he was able to ID it so quickly (assuming it’s correct). Much different than my 8 week saga over multiple docs trying to find my pulmonary emboli 14 years ago…

my guys at UCLA Health are:

jeffrey hsu: plumber cardiologist
eric buch: electricial cardiologist

electrophysiology at UCLA Health is further bifurcated into (at least) EPs that specialize in atrial versus ventricular arrhythmias. my guy’s speciality is atrial. if you go the EP route you may as well begin by simultaneously setting up appts with a cardiologist who’ll handle all your general heart health modeling: ekg, stress echo, mri etc.

you can see if you can best my 60+ facility record in the bruce protocol :wink:

your EP (well, my EP) wouldn’t even put me on the ablation schedule until i got all the other stuff done, as he wants to know what the condition is of the heart he’s working with.

i don’t know what you need, obviously. i can tell you what what sped up my journey-to-ablation was being ablation-ready way in advance of my own scheduled ablation. when my EP was convinced i needed an ablation it was scheduled 4 months out. they want you on blood thinners a few weeks before your ablation. so, i asked (and was granted) the ability (and the prescription) to go on blood thinners immediately, in case of a cancellation (and of course there are cancellations). i had my ablation 3 weeks later.

i take a lot of care when choosing a doctor. for this reason, there is no way i can be in an HMO and if there is one thing i could tell any and all of you it’s to think hard about whether an HMO is right for you as you enter later life and the need for a specialist, and specialty surgery (like an ablation) is more likely. one of my best childhood runner friends has afib. he’s with kaiser. what a nightmare! not because they don’t have good EPs. it’s because you’ll die of old age before you get to see one of them.

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Your afib article was helpful and my wife wants to read it to better understand what is going on

I’ve been on thinners since 2009 (I’m really just a mess) and have a decent but ultimately expensive PPO, so those are covered. EKG is done. Echo shortly. I presume I’ll be told what else is needed.

As you likely know, it’s very frustrating as basically everything I like to do has to be put on hold until this is handled.

31

Your afib article was helpful and my wife wants to read it to better understand what is going on

I’ve been on thinners since 2009 (I’m really just a mess) and have a decent but ultimately expensive PPO, so those are covered. EKG is done. Echo shortly. I presume I’ll be told what else is needed.

As you likely know, it’s very frustrating as basically everything I like to do has to be put on hold until this is handled.

this is a terrible season in your life, but you’re fixable and it’s temporary.

32

Just replying here to close the loop and in case anyone searches in the future

Doc felt that since my atrial flutter basically turned on like a light switch after the illness, a less invasive cardioversion may be all that was needed to take care of it. They are generally always successful but don’t always hold. If that didn’t hold we’d move to ablation

Had the procedure one week ago today, still in NSR, so far so good.

Even tho it’s less invasive, it’s still a full day off work, no eating, getting knocked out with sedatives in a short stay hospital room. I was asleep for the entire thing but it still is a bit of a procedure.

33

Just replying here to close the loop and in case anyone searches in the future

Doc felt that since my atrial flutter basically turned on like a light switch after the illness, a less invasive cardioversion may be all that was needed to take care of it. They are generally always successful but don’t always hold. If that didn’t hold we’d move to ablation

Had the procedure one week ago today, still in NSR, so far so good.

Even tho it’s less invasive, it’s still a full day off work, no eating, getting knocked out with sedatives in a short stay hospital room. I was asleep for the entire thing but it still is a bit of a procedure.

so far so good. fingers crossed. but if you go back into afib not the end of the world. as i can attest to.

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in a great twist of fate or irony, whatever you want to call it—

I went into atrial flutter a few days ago

–appeared to be in and out of SVT when trying to do Zwift races and workouts-(took me a few days to figure it out)-going from 4:1 block to 2:1 block and my HR would jump from low 70’s to 140 and sustain there, just like you chris.

I drove myself into my office on a Sunday (today) and the EKG is diagnostic…well, who’d have thunk it?

*edited to add-I no longer see my afib article on the ‘new slowtwitch’
:frowning:

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Damn! So knowing everything there is about hearts doesn’t make you immune to heart issues? Wishing you the best in finding a speedy cure for what’s ailing you. These heart threads give me the heebie-jeebies.

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I know there’s this thread: Atrial fibrillation as a athlete

But going back into the ST archives to see if something got missed during the shift…I was positive everything came over from the old site but…

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ha-that’s it!

thanks Ryan–

maybe my brain isn’t getting a good enough blood flow RN…

1 Like
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It took some creative searching on my part.

BUT the search function on Discourse does, in fact, work. So that’s a plus!

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Sorry to hear it doc! I didn’t enjoy my stint with af.

40

Well shit Dale, I guess welcome to the club. Seems like if you do this sport at any sort of higher level, you are bound to get some heart anomaly, sooner rather than later. I have a story I’m going to be writing up soon, just burned through pacemaker #2 and onto #3 now. I will be testing out the limits of wires soon too, coming up on 25 years now…