Has anyone out there gone thru the maze of drugs to get to a point where they can control AFib and keep training and racing? What is your “cocktail” that works for you?
Over the years I’ve been on Digitalis, metoprolol, flecanide and rhythmol eventually failing all those drugs. I quit drinking alcohol 5 years ago. I cannot drink iced beverages without immediately going into a-fib. I must get adequate sleep. Post race I continue walking 15 minutes to allow pulse rate to come down gradually. I’ve been cardioverted around 15 times in the past nine years. Caffiene is not a trigger for me.
Despite all this I continue to train and race. I did Ironman Hawaii the last two years, 9th in my age group this year! I did a 2:02 Olympic at St. Anthonys (age 50).
I finally decided to have an ablation done because episodes were occurring more frequently. I’m now 2 1/2 weeks post procedure and have started training again. Swimming daily, riding the trainer. Hope to start some easy running next week. I’ll be on Coumadin for 6 more weeks. Then I can resume riding on the road.
I’d suggest looking at www.afibbers.com. Some of the advice is good but some of it is “out there”.
Figure out what your triggers are and optimize them to buy more time.
That’s an amazing medical history. Did you ever have symptoms while racing/training? What types of advice did your MD’s have for you regarding you active lifestyle?
Wow- not to sound blase, but as someone studying medicine, that’s fascinating. I’m glad it didn’t stop you, and hope the ablation works out well- sounds like it’s off to a good start. Good luck!
Congrates on keeping up the training and racing–and the placing 9th in Hawaii! Hopefully this ablation will give you years of worry free training. I also placed 9th in my division in Hawaii in 2001 (age 50-54)!
After 15 years of AFib occuring for about 36 hours every four to six weeks (and doing triathlons and marathons since 1985), I decided to try and find a drug to control it.I know a triathlete that took 50 MG 2X/day of flecainide and he said it worked great for him-he could train hard and did well racing with no AFib. My cardiologist has prescribed flecainide but also metropolol @ 50 MG/day. The metropolol is a beta blocker and my HR goes only to about 82 BPM on the computrainer vs about 115 normally! No way that will work for training. Does anyone Tknow if that metropolol is that important with such a small dose of flecainide? The doc says the metropolol caps your heartrate in case another form of arithmea sets in, but it just doesn’t allow training or racing. I may end up doing the ablation as well but thought I should give the drug route a try. All the best and would like to stay in touch to see how you go with the ablation. Win Thomas
Maybe send a note to Monty. I know he has a pacemaker and would assume that he is also on meds. Cant think of a better source than someone who was top in the game and then had heart issues (and is still in the game).
Beta blockers like metoprolol (atenolol, propranolol) are not useful for preventing a-fib. Some people with adrenergic type a-fib may experience more episodes of a-fib on beta-blockers.
Beta-blockers are likely to worsen vagal type a-fib.
Beta-blockers are prescribed to slow the rapid heart rate resulting from an episode of a-fib.
I was on metoprolol for a couple years. I trained well on 25mg per day. I weaned off and discontinued it for races.
I tend to go into a-fib post-exercise, especially with a rapid decrease in heart rate. I’ll have runs of PAC’s during races but if I throttle back the effort they usually stop.
There are some studies (European) indicating intense exercise may pre-dispose to development of a-fib. These were done in mountainiers so a-fib could also be related to altitude for example.
Every cardiologist and electrophysiologist I’ve talked to has said “keep exercising, the benefits outweigh the risks”. This disease is also common in totally sedentary individuals. It may be more related to “Type A” personalities and stressful environments.
Thanks for this information. I very much agree the benefits outweigh the risks as far as exercise is concerned. The older I and my relationships get,the greater the difference I see in those that don’t keep fit and those that do. I think my cardialogist is worried that I will go into some form of arithmia (SP) while on the flecainide and thus wants me to take the metoprolol. Although I have never tried it at 25 mg/day, I sure know 50 mg/day doesn’t work. I will discuss this more with him. Also, a very important note I recall you mentioning is to identify your triggers. I am working on that as well. All the best for a speedy recovery back to enjoyable training!
How’s the training and your overall feeling since the ablation? I am still trying to find the triggers. No alcohal for 10 weeks and two cups of decaf per day but still getting Afib every three weeks or so for about 2 1/2 days then self corrects. Drugs seem to screw up the works. Last time took PIP and everything went to normal, of course couldn’t exercise cause of the beta blocker, then when the drugs wore off Afib popped right up again for a couple days then self converted. It is like it just had to run it’s course.
I’m 12 weeks out from ablation and couldn’t be happier. I’m taking a baby aspirin, that’s it. I’m training, racing and worried about other problems now. I can do really hard sets in the pool again with a regular heart beat post exercise, I can drink ice cold beverages. I even tried a beer with no ill effect. I had a couple short runs of a-fib but they converted spontaneously within seconds. For me, ablation has worked perfectly so far.
WOW! Good for you! Hopefully this will continue for you and would be interested to keep in touch with you to see how it goes.
I am contemplating ablation. I have thought the best way to arrive at that point was first try to find my trigger(s); if this was not possible try drugs; and if that didn’t work go for the ablation, all at the same time keeping my fittness level up. I started with the medication but it actually screwed things up as far as I can see. Before I tried drugs I was having a Fib every four to six weeks for about 36 hours then it would self convert. After trying the drugs I went to having Afib about every two weeks and it would last up to 3 1/2 days! The drugs would bring me into NSR but then when they wore off I would go right back inot Afib. Like my body just had to go thru this process. I have concluded I have to try to find the triggers and forget the drugs. So…I quit coffee cold. Still had Afib now about every two weeks. After a month of no caffeine I started having two cups of de caf./day and I quit alcohol (10 weeks now with no alcohol) and still get Afib about every tow weeks! My doc says I should probably give up the alcohol for six months so I am going for that getting very frustrated. I had Afib about a week ago and have a half ironman in St. Croix in one week. Just hoping I will make it thru without waking up race morning with Afib. My thinking at this point is if this off alcohol/two cups of decaf/day does not work I may try 50 mg/flecanide twice a day as a small dose instead of PIP which doesn’t seem to work for me. If that doesn’t work then ablation. If you have any thoughts I would appreciate hearing from you. Good training!
A friend just turned me on to this website. This is very useful and helpful information. I am 53 and have been an avid mountain biker for over 10 years, and recently a road biker. Not a regular endurance athlete like you guys, but I keep up with the pack ! Last year in June was diagnosed at my physical to be in a-fib, and I did not even know it, I was pretty much asymptomatic at that point. In fact, I apparently had taken some mongo rides while in a-fib without knowing it. Have had a series of cardioversions, and been on tikosyn and toprolol (also warfarin so it really bleeds when I wreck !). But I would bounce back into a-fib about every 6 to 8 weeks. Didn’t really interrupt my riding and training except when I was in a-fib. But the symptoms of the a-fib have become progressive so I had an ablation done on 4-17-09 at Emory in Atlanta, 10 days ago. So far so good. Vtironman–how long did you keep taking the meds after your ablation ? And have there been any adverse side effects, after you recovered form the procedure?
You’re on the right track, find the triggers and eliminate. JIC it helps you ID yours, here are mine:
- Stress - emotional, physical, mental
- Lack of sleep, especially several days in a row
- High intensity workouts too closely spaced, v. bad if combined with 1 or 2 above.
- drinking very cold beverages too fast. Read somewhere (can’t recall source) that a “brain freeze” is related to heart, NOT head.
- Rum & cokes. I don’t drink much, and don’t drink coffee or many caffeinated drinks, but somehow this combination is bad (for heart)
FWIW, not on medications, no ablation, and no events, other than an occaissional skipped beat, for ~2+ years now.
Also, if I’ve been sleeping poorly, I skip, or reduce intensity of next morning workout, its just not worth the risk.
I am the same as you and others. 50 y/o male, had a-fib for about three to four years, episodes lasting up to 48 hours about every three months ( they got progressively worse). My resting was 110 and working HR was up to 190 to 220. Of course I could only sustain that for about a minute. Been doing tri’s since ’83. I finally went to a cardiologist, also an accomplished cyclist, and have been on the flec 50 and metrop 25 for about a year; Coumadin also. The day after I started the meds I felt GREAT. Although I only had one or two breakthroughs of a-fib (caused by forgetting the medicine and/or too much caffeine or alcohol) he has kept me on the meds. Now while I don’t want to stroke out from a bad bout of fib, I think I can control it w/o the beta blocker and since there is no fib, no Coumadin is needed.
My HR also maxed out at about 148 instead of 160. I cruise in the swim at about 120 and cycle at about 112 to 130. Running maxes out now at about 135 to 145 for tempos and races. As I start a workout I feel the HR slowly increase and then after about 10 to 15 minutes later, the HR goes into cruise control; very steady never wavering at all. Been a medic for 28+ years so I have some knowledge of meds and cardiology, My questions would be: Does the Coumadin thin out my O2 carrying capability since it thins out my blood and does the metrop’ limit my overall stroke volume hence less cardiac output? Also, to cut back on the triggers of exercise, coffee, chocolate or wine is probably not an option. Yep, I want my cake and everything that goes with it.; can I have that? Any thoughts?
Mine has been controlled since last August (cut my 2008 season in half) w/100mg Flecainide. Baby aspirin for stroke prevention.
My HR ranges are pretty much where they used to be, but a few (4-6) beats lower (bike and run).
I haven’t had noticeable episodes since I’ve been on the meds, but they’re usually related to drinking too much, then training too hard the next day, particularly in the heat.
I haven’t raced since being on it. I’ve got a 1/2 marathon in mid-May, then a sprint and oly in June.
Good luck.
I haven’t had an ablation yet. Ablation to me is the last step after I go this routine of trying to find the trigger and if that doesn’t yield any results then try to figure out the right drug cocktails. A frustrating process!
Add me to the list of 50+ guys who tried the drugs (amiodarone and flecainide) while continuing to train and race with no AFib control. Finally had the ablation (x2) and am completely free of AFib and I can eat and drink what I want and go all out in a race or workout. It used to be a burst of effort might send me into fib. The ablation was well worth it.