Newly Diagnosed Afib

Triathlon Forum
1

So, I jokingly referred to getting this at Unbound but I now have questions related to other’s experiences

After the ER visit, in Kansas, I was placed on Elliquis and Toprol XL. The Toprol helped control the HR but I remained in Afib (Toprol is a cardioselective Beta blocker that helps to control rate). I have tried very easy runs but get winded if I try any effort.

One week after the ER visit, I got in to see my cardiologist and he tried pharmacological cardioversion…Flecainide 300mg taken in the office. He asked me to come back later in the day to see if I had converted back to NSR (normal sinus rhythm), but I had not. About two hours after I left his office, I did convert to NSR (I have a Kardia device at home and this is nice for a quick evaluation). I have stayed in NSR except when i try to exercise. I can run about 3 miles, very easy, and not feel any symptoms. Between miles 3 to 4, I can feel the “fluttering” in my chest, and back at the car, the Kardia confirms Afib. Within 1-3 hours, I convert back to NSR.

I told my doc about this and he suggested trying a daily dose of Flecainide to see if this could help keep me in NSR better. When I took the Flecainide 300mg, it gave me a very strange sensation when I was running. I would feel like my heart was not able to keep up enough for my breathing. It was actually a little bit scary to feel that way with such an easy effort, and I did not feel a similar sensation when I was on Toprol only. After I mentioned this, he had me set up to see an electrophysiologist about an ablation.

So, I’m curious about other’s experience with Flecainide? I’m worried I’m not giving it a chance and it may not be as bad on a much lower daily dose (50mg twice daily vs the one time 300mg dose I took). My cardiologist was, of course, not sure how I would respond to a lower daily dose. When I search for “Flecainide” on here, the most recent was from 2020, so I am hoping there are others here with more recent or long term experience.

2

I was on Metoprolol, Flecainide, and Eliquis for a bit over a year, back in 2017/18. This kept everything mostly in check prior to my ablation, but also limited my HR to about 105-110bpm. So anything more strenuous than a fast walk/easy spin became a 100% effort. I don’t remember what my dosages were…

3

Saw an electrophysiologist today. He says I appear to be in atrial flutter. I showed him my Kardia readings and even though they read as “normal sinus rhythm”, he says there’s still enough irregularities that it’s flutter (and repeat EKG today confirmed this).

So, he wants to do a cardioversion (electrical) to try and get me back to NSR. Hoping to have that done soon. If that does not allow me to stay in NSR then he said an ablation would be in order. I am to continue on the Elliquis

4

So, I jokingly referred to getting this at Unbound but I now have questions related to other’s experiences

After the ER visit, in Kansas, I was placed on Elliquis and Toprol XL. The Toprol helped control the HR but I remained in Afib (Toprol is a cardioselective Beta blocker that helps to control rate). I have tried very easy runs but get winded if I try any effort.

One week after the ER visit, I got in to see my cardiologist and he tried pharmacological cardioversion…Flecainide 300mg taken in the office. He asked me to come back later in the day to see if I had converted back to NSR (normal sinus rhythm), but I had not. About two hours after I left his office, I did convert to NSR (I have a Kardia device at home and this is nice for a quick evaluation). I have stayed in NSR except when i try to exercise. I can run about 3 miles, very easy, and not feel any symptoms. Between miles 3 to 4, I can feel the “fluttering” in my chest, and back at the car, the Kardia confirms Afib. Within 1-3 hours, I convert back to NSR.

I told my doc about this and he suggested trying a daily dose of Flecainide to see if this could help keep me in NSR better. When I took the Flecainide 300mg, it gave me a very strange sensation when I was running. I would feel like my heart was not able to keep up enough for my breathing. It was actually a little bit scary to feel that way with such an easy effort, and I did not feel a similar sensation when I was on Toprol only. After I mentioned this, he had me set up to see an electrophysiologist about an ablation.

So, I’m curious about other’s experience with Flecainide? I’m worried I’m not giving it a chance and it may not be as bad on a much lower daily dose (50mg twice daily vs the one time 300mg dose I took). My cardiologist was, of course, not sure how I would respond to a lower daily dose. When I search for “Flecainide” on here, the most recent was from 2020, so I am hoping there are others here with more recent or long term experience.

most of my patients don’t really mind the flec-but most do NOT like beta blockers and how they feel on them…almost all athletic/active patients want to be back in sinus and feel much better.
Getting the heart rhythm right chemically or electrically *(or both) is often needed. Ablation is next level for a more permanent solution.

I’ve written a lot about afib and I think there is additional information in this thread:

Atrial fibrillation as a athlete. (Page 2): Triathlon Forum: Slowtwitch Forums

(my post is on page two third from last)

It’s funny, just recently I was PMing a member here about fib/flutter and the differences etc

When in atrial flutter, the atria are going very fast, fluttering at ~280-300 bpm, but sometimes the actual heart rate is slower because there is slowing through the AV node.

A-FL can go 1:1 on rare occasions and bad things happen–usually fainting, sometimes cardiac arrest–it’s one reason we have the protector AV node which regulates things a bit.

And it is often a ratio like 4/1–top chamber going 280, bottom chamber (ventricle) going like 70 is one example

No one feels the top chamber beating, only if the actual heart is beating fast, which is dependent on the ventricular response-ie how fast the bottom chamber is beating.

Many people go into persistent afib/flutter and most people do feel it as the ventricular rate is USUALLY fast and patients feel palpitations/fluttering from the fast heartbeats.

Atrial flutter usually comes in two flavors-typical and atypical. They are distinct on EKG.

https://assets.radcliffecardiology.com/s3fs-public/article/2020-12/figure-2-ecg-of-a-typical-atrial-flutter.png

In this example, the ventricular response is controlled (60-100 bpm)

https://www.escardio.org/static-file/Escardio/Medias/councils/council-for-cardiology-practice/e-journal/ej-vol11n16-figure1-resized.jpg?mts=1592522679000.jpg

another example-typical ‘sawtooth’ looking atrial flutter waves

Atypical atrial flutter, aka atrial tachycardia-is a bit harder to see

https://www.escardio.org/static-file/Escardio/Medias/councils/council-for-cardiology-practice/e-journal/ej-vol11n16-figure3-resized.jpg?mts=1592522228000.jpg

https://www.researchgate.net/publication/308922146/figure/fig1/AS:871238276771841@1584730800569/lead-electrocardiogram-showing-atypical-atrial-flutter-at-101-bpm-with-positive-flutter.ppm

Saw an electrophysiologist today. He says I appear to be in atrial flutter. I showed him my Kardia readings and even though they read as “normal sinus rhythm”, he says there’s still enough irregularities that it’s flutter (and repeat EKG today confirmed this).

So, he wants to do a cardioversion (electrical) to try and get me back to NSR. Hoping to have that done soon. If that does not allow me to stay in NSR then he said an ablation would be in order. I am to continue on the Elliquis

as you can see, atypical flutter can look an awful lot like regular sinus-and it can look very similar both by ekg and on the Kardia -

5

Thank you so much for the reply/info!

The Kardia is an interesting device, and both the cardiologist and the EP looked back at some of my rhythms detected with the Kardia (I check my heart rhythm a lot). One thing I had noticed is the Kardia would either say “unclassified” or “NSR”, but I would watch the pattern and saw the R-R interval was not consistent. The EP said the pattern can look like NSR on the Kardia but an EKG would detect the true culprit…atrial flutter. Of course, that’s what the EKG demonstrated.

6

I went in for a pre op physical for shoulder surgery where they did an ecg (required since I was 67). I was surprised to find out I was in A-flutter at 300 beats/minute with a resting HR in the mid 30s. Had a cardioversion so I could have the shoulder surgery. Aside from an itchy chest from the paddles, I immediately felt so much better meaning I had more energy and wasn’t falling asleep most days. My resting HR went back up into the low 40s.

After recovering from the shoulder surgery, I had an ablation to permanently fix the flutter. Unfortunately during the surgery I went into A-Fib which led to wearing a holter monitor for a month where it was discovered I also had an AV block which led to a pacemaker implant this past April.

That being said, my heart is now beating as it should and I am back to training and feeling great. Other than a scare across my chest, I really don’t notice I have a pacemaker.

Good luck with your journey…darn electrical problems!

7

Diagnosed with Persistant Afib last August. I was already on 60mg/day Propranolol for Tremors, but they added Xarelto to prevent stroke.

I had NO symptoms, felt fine, with the exception that I could do over 180bpm - which I knew was impossible since I’m 77 yeras old.

Had Cardioversion 2/13/2024, which put me back on Normal Sinus Rythm, plus added 25mg Metoprolol to the mix.

With the 60mg Propranolol/25mg Metoprolol/20mg Xarelto daily mix, I can still do over 130bpm, but I limit myself to 110-120bpm while training.

This mornings Kardia reading -

Kardia.jpg

8

Diagnosed with a flutter 4/22, cardioversion 5/8, holding strong so far (knock wood). I know of a few people that had a flutter and CV and no further issues so hoping I’m one of them Doc said ablation if this does not hold but he thinks it will as mine was tied to a virus (not covid apparently) and not an underlying condition

My Kardia would show either “possible a fib, “ “unclassified” or rarely NSR. My understanding is that the non subscription model would not diagnose flutter (and maybe not even the paid version)

After the CV I was pretty shocked (haha ) at how good I felt. No more afternoon crushing fatigue. My HR was always one of the ratios so beating at 100 bpm a lot and RHR went up from 45 to mid 50s

Dale and Dan were great assets working thru this process

Good luck, hoping it works out

9

Diagnosed with a flutter 4/22, cardioversion 5/8, holding strong so far (knock wood). I know of a few people that had a flutter and CV and no further issues so hoping I’m one of them Doc said ablation if this does not hold but he thinks it will as mine was tied to a virus (not covid apparently) and not an underlying condition

My Kardia would show either “possible a fib, “ “unclassified” or rarely NSR. My understanding is that the non subscription model would not diagnose flutter (and maybe not even the paid version)

After the CV I was pretty shocked (haha ) at how good I felt. No more afternoon crushing fatigue. My HR was always one of the ratios so beating at 100 bpm a lot and RHR went up from 45 to mid 50s

Dale and Dan were great assets working thru this process

Good luck, hoping it works out

Yeah I get a lot of “unclassified” readings on my Kardia as well. Since it did not have the “irregularly irregular” appearance of Afib, but was not exactly “regular” either, I knew something was going on strange. I share the afternoon fatigue problem with ya and wish I’d have a good result like you

10

Have you changed your coffee or caffeine intake because of this? I still have to have that one cup in the morning.

I also have the afternoon fatigue problem, but I am old at 77 years, so who knows?

11

First off, hope you and the others you have posted with this diagnosis get it resolved or under control quickly. Second, is there anything proven that brings this condition on? I’m sure I’m a likely candidate for it based upon what I have read in these threads, and I would like to avoid it if at all possible.

12

Long story short. My 14 year old son in October had an ectopic atrial fibulation. He is an extremely healthy swimmer. He had an elevated HR after prac and we took him to the doc. They checked him in and put him on a beta blocker (metopropyl). After a few days he was back in the water.

I’m his HS swim coach and he started his freshman season in dec. He was doing very well even though his hr was limited to prob 140. It really surprised me. After a few meets the next day he thought his hr was a little high so back to doc. They gave him one of those monitors that transmits data via cell signal. He was wearing it 24 hours except for in the water. After Prac one day he thought it was elevated so he pushed the button and within five mins the doc was calling me. Back to the hospital and they switched him to flecanide. I thought for sure his season was going to be over but after four days in the icu (for monitoring) they cleared him 100 percent. This was two weeks before our state meet. The first week was tough bc all of a sudden he can get his HR up to 190 plus and that was pretty painful. He winds up breaking one of our school records in the backstroke 13 days after being in the ICU.

He went thru an entire hs lacrosse season with no issues and is back in the pool.

He’s going to have an ablation on August to get rid of this thing. Flecanide has really been a saving grace.

They believe the original episode was a side of the Covid booster he had gotten about a week before.

13

So, I jokingly referred to getting this at Unbound but I now have questions related to other’s experiences

After the ER visit, in Kansas, I was placed on Elliquis and Toprol XL. The Toprol helped control the HR but I remained in Afib (Toprol is a cardioselective Beta blocker that helps to control rate). I have tried very easy runs but get winded if I try any effort.

One week after the ER visit, I got in to see my cardiologist and he tried pharmacological cardioversion…Flecainide 300mg taken in the office. He asked me to come back later in the day to see if I had converted back to NSR (normal sinus rhythm), but I had not. About two hours after I left his office, I did convert to NSR (I have a Kardia device at home and this is nice for a quick evaluation). I have stayed in NSR except when i try to exercise. I can run about 3 miles, very easy, and not feel any symptoms. Between miles 3 to 4, I can feel the “fluttering” in my chest, and back at the car, the Kardia confirms Afib. Within 1-3 hours, I convert back to NSR.

I told my doc about this and he suggested trying a daily dose of Flecainide to see if this could help keep me in NSR better. When I took the Flecainide 300mg, it gave me a very strange sensation when I was running. I would feel like my heart was not able to keep up enough for my breathing. It was actually a little bit scary to feel that way with such an easy effort, and I did not feel a similar sensation when I was on Toprol only. After I mentioned this, he had me set up to see an electrophysiologist about an ablation.

So, I’m curious about other’s experience with Flecainide? I’m worried I’m not giving it a chance and it may not be as bad on a much lower daily dose (50mg twice daily vs the one time 300mg dose I took). My cardiologist was, of course, not sure how I would respond to a lower daily dose. When I search for “Flecainide” on here, the most recent was from 2020, so I am hoping there are others here with more recent or long term experience.

I got afib at 29 and an ablation at 30 (currently 3 months post-op and no afib yet!). I asked for Dofetilide instead of Flecainide or other heart rate lowering drugs so I could keep training. The doctors agreed, as my heart rate gets really low at night 30’s so they were afraid Flecainide would drop it too much further. Downside with dofetilide is that you have to go inpatient in the hospital for 3 days for them to monitor your heart’s response to it.

14

First off, hope you and the others you have posted with this diagnosis get it resolved or under control quickly. Second, is there anything proven that brings this condition on? I’m sure I’m a likely candidate for it based upon what I have read in these threads, and I would like to avoid it if at all possible.
Good question. My cardiologist said out of 10 men my age, 4 would have it. Mine was Presistant Afib, meaning I had it all the time, posing a risk of stroke.

15

First off, hope you and the others you have posted with this diagnosis get it resolved or under control quickly. Second, is there anything proven that brings this condition on? I’m sure I’m a likely candidate for it based upon what I have read in these threads, and I would like to avoid it if at all possible.

Clarifying that there are two separate conditions here. A fib and a flutter. Sometimes they overlap. I only had typical a flutter.

In my case my doc pretty confidently linked it to a virus I got in February. Run the weeks and even day before I got sick HR was normal. All runs since that date abnormal for me. Pretty clear connection. And he said their arrhythmia practice took off after Covid.

So, don’t get a virus. You know what that means and personally I will be masking in crowded environments again. I had gotten lax but I don’t want to lose another 3 months. And it’s not even a covid thing as three RATS came back negative

Otherwise we are generally at higher risk as endurance athletes and other than stopping don’t think there’s any change in behaviour that would help. Read Dan’s article by searching the home page for a fib. It’s enlightening

16

Have you changed your coffee or caffeine intake because of this? I still have to have that one cup in the morning.

I also have the afternoon fatigue problem, but I am old at 77 years, so who knows?

Before this started, I had already started cutting back on my coffee consumption (I don’t really know why I was doing that as I LOVE my coffee). I’ve read that coffee does not have much impact on a person already in Afib……or maybe I’m only reading what I want to read :slight_smile:

But, with my one cup of coffee, each morning, I’ve not noticed any worsening, so I’ll continue for now

17

First off, hope you and the others you have posted with this diagnosis get it resolved or under control quickly. Second, is there anything proven that brings this condition on? I’m sure I’m a likely candidate for it based upon what I have read in these threads, and I would like to avoid it if at all possible.

Biggest concern for the etiology of Afib is making sure you don’t have some type of underlying cardiac pathology, if you have new onset Afib. If there’s nothing bad going on then it may be related to our endurance lifestyles, dehydration, genetics, stress, etc….

For me, I imagine it’s a combo of me being an endurance athlete, chronic poor sleep (4-5 hours per night), and/or dehydration while racing Unbound.

18

Wow your poor son having to deal with so much. But, also the perseverance is amazing too, to be able to continue to compete like he has. I hope all goes well and thank you for sharing!

19

Thx!! And let’s not discuss his celiac challenges. Lol.

He’s got big goals…now if I could just get him mildly interested in triathlons 😀

21

Limit caffeine intake, avoid any or all alcohol, switch sexes(males are more prone), lose weight if obese, treat sleep apnea, avoid precipitating factors which are unique to each of us. Cold water, air, dehydration, electrolyte imbalances others…did I say stop any alcohol intake…
Antiarrhythmics can work sometimes, side effects especially beta blockers are annoying for endurance junkies. Ablations work however the tradeoff is further interventions or possible pacemaker.
I’m just waiting for mine to reoccur having been an endurance athlete for 40 years…

You had me at “limit caffeine intake”:slight_smile: I usually drink a pot a day, my gels have caffeine, and I take caffeine pills during long rides/races. I wasn’t plan on transitioning, but I’m pretty good with the rest of your list.