Those with Afib/SVT: Could use some advice

Triathlon Forum
1

Hey everyone,
Recently it appears I may have had some kind of cardiac event, possibly afib or an SVT episode. I had finished a short lunch run, was sitting at my desk, and suddenly felt flushed. Looked at my watch, my HR read out as 198bpm. It stayed above 190 for over 45 minutes, hitting a peak of 210. Went to a cardiologist in the SF area here, and was told it could have been Afib or SVT, but the only way they would know for sure is if they caught an event on record with an EKG. Here’s a link to the Garmin file for reference: http://connect.garmin.com/activity/441864817
Keep in mind that is me sitting at my desk, not running.

So yesterday I went for a trail run/hike and felt pretty damn awful. I just now upload the data and see I hit 209bpm at some point: http://connect.garmin.com/activity/450565359
That seems to suggest another heart event given my normal max is 198bpm.

Had an EKG, echocardiogram and echo stress test that showed no issues. I was told that it very well could have been a random event and not to change my exercise behavior.

This feels like a somewhat unsatisfactory place to be in. I train 12+ hours a week and just waiting for the next event to occur seems dangerous given all the talk of heart health in triathlons these days. What if that next cardiac event happens during the swim of my next IM? Or when I’m alone on a ride… These are questions I have to answer for myself, but also to my wife. The safe route would be to just put training on hold till its diagnosed, but that seems drastic(or is it?).

So ST athletes with heart conditions: Thoughts? Suggestions?

2

You could to a stress test on the trainer attended by cardiologist to play safe. Just trying to provoke the situation.
Something same would be running with long term EKG , but not as safe as the other as long as you are alone.
Right here my garmin data clearly to see when afib hits:
http://connect.garmin.com/activity/87063301

I had to get electro shock 2 days after to get my heart in the right beat again BUT I could not provoke the situation on the trainer, it just happend in random.

It’s not easy to get a right advice via net in that cases, be really careful with what you are doing!

3

Sorry to hear you are going through this but until they tell you something can/should be done about this, I would say stay aerobic in your workouts. I have a similar issue which has since been diagnosed as SVT with normal rhythm. I have had all the tests done (stress, ECG, event monitor, halter, blood panels etc) and have been dx’d with a fairly benign condition. I have on a few occasions gone into SVT without being able to bring it down without a trip to the MD. My cardiologists have green lighted all activity but have recommended an ablation procedure if ever this progresses beyond what it is. Seek out an EP specialist, wear the event monitor for whatever period of time recommended. Workout with it and hope that you get an episode that can be analyzed. It is scary when it happens but the only way you can have peace of mind is when you can re-produce this for the specialist to let you know what can be done about it(if anything). After my last episode, my EP specialist told me it would take about 2 weeks of being stuck in SVT before CHF would occur. Like you, 45 minutes is the longest I’ve been stuck in the 180 to 200 bpm range.

4

I have a sneaky suspicion that many of the cardiac deaths caused during events are caused by an underlying cardiac event (SVT, Afib, etc). I have had a few friends pass away during events with seemingly no evidence leading to a cause. Logic would state that when you are really pushing yourself and using great amounts of O2, and you put your heart at risk for decreased perfusion (read: SVT, Afib), you will cause massive tissue death very quickly. Again, I am ER, not Cardiology and certainly have not put in any time related to proper data collection and testing, but this is my biased suspicion. Be careful, if you feel “off” just STOP.

5

That can certainly be unnerving. I had some bouts w/ SVT about 30 years ago when in grad school. The actually caught it in full action while they were doing an Echo Cardiogram - they thought it was cool and called in all the residents to see. Chief of cardiology gave me a clean bill of health. They basically said I was fine, watch the caffeine, and try to chill out a bit. It basically just faded away. I do throw a beat every now and then, but I think I am fine.

6

Sorry to hear about your bout with arrhythmias. If you have not done so I’d begin some research into a solid EP in your area. Electrophysiologists are specifically trained to work on conduction defects like this and to go a step further do a little research into Cryo Ablation. In my former life my main competitor in the pacer/defib market, Medtronic, bought a company about ten years ago that treats these arrhythmias without the side effects of ‘churn and burn’ EP work of old. In short it allows them to test the suspected tissue for results b/f ablating the area to disrupt the circuit causing the arrthythmia.

Not saying this is the route you will end up going, but the more you know the better the decision you can make if that scenario is thrust upon you. Really research your EP. I know you have heard this, but ‘what do they call the person who graduates last in their class in med school?’. ‘Doctor’. I probably worked with 50 different EP’s in my years in the pacing industry and there were probably 4 I’d let work on me. YMMV.

Best of luck and hope to see you posting about success.

7

This is really helpful, thanks! My doc had suggested that while the success rate typically published for Afib ablations is quite high, that doesn’t account for the many attempts it could take to actually isolate the tissue and witness the event. I’ll look into this and hunt down an EP specialist. For now I’m going to be setup with a 3 week ECG monitor.

8

So you continue to train and race?
I guess the anxiety I’m having here is that often my measure of a “good” set, be it riding, swimming or running, is that I feel somewhat terrible at some point and pull through to finish. That run I linked to just seemed like an off day, but I wouldn’t have even guessed my HR was that high until I saw the file now.
I’m wondering how I can distinguish between just “challenged” and an actual cardiac event.

9

Back in September I had an episode of PSVT. I would be sitting at a desk, or get up to walk across the room, and my pulse would jump from 60 to 160, for 20 or 30 seconds or so. Heart rate would change like flipping a switch, one beat at the 60 bpm, next beat at 160 bpm. This would happen numerous times throughout the day, many times for no apparent cause, sometimes when raising my arms above my head or standing up. Happened in my doctor’s office, he checked my pulse, noted that it was steady, just extremely high. Had the echo-cardiogram, Holter monitor, etc.

My GF’s brother had something like this happen to him, and his recommendation was to take a product called Slow-Mag, a magnesium chloride supplement, and a 2500mcg B12 sublingual lozenge. When I did this, the symptoms receded and ended after a couple of days. Haven’t stopped this treatment to see if the symptoms come back, but it was certainly better than ablation or beta blockers. My family doctor was going to prescribe beta blockers, and I also talked to an electro-cardiologist (?) about the ablation therapy. The cardiologist poo-pooed my magnesium therapy, but said if it works go ahead and do it.

I don’t know where the GF’s brother found this treatment, on the internet somewhere, but I would be interested in hearing if it works for anyone else.

10

I had ablation surgery in September for a-fib. It is VERY easy to tell the difference between a-fib and just pushing hard, it feels really weird and your output(watts/speed) is usually not right as less blood is being pumped. A normal HRM will not catch it every time but your holter will.
Sounds like you got an EP already, that is what you need to do. If you have to get an ablation it is not so bad, Bobby Julich, Stuart O’Grady, some NFL’ers all made it back to then top post ablation but it takes a while.

I got a stress test and did not go into a-fib, but had the ablation anyway. I had one 20 second event since then which allegedly is normal.

11

Wednesday is my 4 week anniversary of having catheter ablation to address SVT so I thought I’d chime in. Long rambling post alert…

I’m not really offering advice as I’m pretty ignorant of medical details, I just wanted to describe my experience which may help you in figuring out what you want to do. I’ve experienced arrhythmias since I was young… like in the 5th grade. When I was little, my HR would skyrocket to the high 200s. My chest would just pound like crazy and it was visible to people from across the room. (I used to get a kick out of freaking out my Mom.) It also made me a little out of breath and the heartbeats definitely had a distinct feel to them. The only way I could ever describe it was “inefficient.” If felt like the heart was doing a lot of work but not pumping much blood.

When I was younger the events usually happened when I would quickly exert myself after being in a resting state for some time. Like if I was sitting out the couch watching TV, then would sprint upstairs to get a snack… bam! But I was very active and athletic and very rarely had an episode while playing sports. I actually only recall it happening once when I was younger while playing soccer.

I’m now 39. Throughout my life the frequency, duration, and HR of these episodes changed quite a bit. Recent episodes would have my HR spike around 170. I would have periods where I didn’t have an episode for over a year to the point over the past couple years where I’d have them daily. But again, for me, the episodes rarely occurred during exercise, though it has happened.

I’ve seen many cardiologists over the years and have had quite a few stress tests. I’ve lost count of the number of holter monitors I’ve worn. It seemed that the one way to guarantee that I wouldn’t have an event was to hook me up to a monitor. I had many of the simple recommendations such as no caffeine and no alcohol. But there were often times where I acted like an invincible ass; during college and the years after I pursued drinking to excess like it was possible to win a world title. Oddly I don’t recall having many heart issues during that period (then again I don’t remember much) and only really noticed them again when I started getting into shape/triathlon/cycling.

So it was back to the cardiologists and the holder monitors with no results. Last year I was finally able to capture an episode while wired up. In recent years it got to the point that laying on my left side would trigger an event, so I’d experience them almost nightly while laying with my kids at bedtime. My doctor determined I had SVT and considered my particular case to be low risk. His biggest concern was that I would pass out during an episode. He was unwilling to give medication as my heart rate is low (Low 30s while sleeping) and the medication tends to suppress HR. He recommended that I get the ablation procedure.

I was very happy to have a diagnosis, happy that what I had wasn’t considered life threatening by my doc, and happy that I had a possible course of action to pursue. However I wasn’t thrilled with the prospect of somebody messing around with my heart so I didn’t get the procedure right away. After a year passed, I felt it was time. I just got sick of it, I was comfortable with the level of risk associated with the procedure, and was comfortable with my doc and his track record. Most of all I was sick of lying next to my kids and pondering my own mortality due to an erratically thumping reminder sitting inside my chest.

So on Jan 29th I had the ablation done. My doc was very pleased with the procedure and was able to trigger the SVT “right away.” He was quite confident that it was a success. The first night I slept on my left side with no issues. Over the past 4 weeks I have not been symptom free. I have had a few other events, but they’re not as reliable/easily triggered/intense as before. My understanding is that this is common during recovery. I have noticed that the past week has been really, really good. I don’t know if I’m out of the woods yet or not. Time will tell. (I know that many people have several ablations) But I am happy that I took some proactive steps to address the SVT.

Recovery has been good. I was told that light activity was encouraged immediately following the procedure and was able to resume “normal” activity within a couple weeks. I did my first light trainer ride 3 days after the procedure. I tend to push things, I know that my doc probably wouldn’t be happy with my level of activity at some points. I asked the definition of “normal” and the response was somewhat ambiguous. I took it to mean “normal for me” vs “normal for the typical population.” So I’ve been riding quite a bit and was even skiing some bumps in Aspen Highlands last weekend. (For the geeks, my cycling TSS for the 7 days after the procedure was 338) I have been avoiding really hard stuff like sprint workouts on the bike and trying to be reasonable and back off when things don’t feel great. I really do feel good at this point though. My follow up with the doc is next week.

For me, the biggest thing was getting the diagnosis. I hated not knowing what I had. Once it was identified I felt I was in a position to assess my risks and evaluate options. If I was having events reliable while working out I would have had the procedure sooner. But having lived with this basically my whole life I was pretty jaded by it and didn’t feel a huge sense of urgency. That said, there are some really nasty conditions out there and I do think it’s best to get to the bottom of it and get a diagnosis as soon as possible.

A couple random thoughts… if you haven’t already, cutting caffeine and alcohol isn’t a bad idea. It may have a positive effect. I also had a nurse practitioner ask me about my hydration levels and suggest that there may be a correlation to being dehydrated and the frequency of the events I was experiencing. This resonated with me as I’m really bad with drinking enough water and there seemed to be some correlation to my level of fitness/how much I was working out and the frequency of the events.

A few more thoughts… I never felt bad after an episode, once it was done, it was done. No lingering effects. There was no “maybe I had another event” thoughts. My events had/have a very distinct feel to them and there was no mistaking the SVT events for the heart just beating fast. I could tell the precise beat when it would start and end.

It’s not drastic at all to put your training on hold to try to determine if you have a serious heart issue. A diagnosis, good or bad, will be a huge help in letting you evaluate next steps.

ETA: I keep referring to my “doc” or my cardiologist. To be clear, the doctor that made the diagnosis and performed the ablation is an Electrophysiologist.

12

I do continue to train and race. To my knowledge I have never had an episode in a race of any distance. The thing that seems to bring mine on is swimming sprint sets. The 2 times I have had to make ER trips came about during sprint swim sessions. For me, the events were 12 years apart, the last being a few weeks ago. I have since gone through testing for the second time and nothing was truly different in terms of dx or treatment options. PM me if you ever want to chat in detail.

13

I thought I might follow up here for those who may also have experienced similar symptoms.

I went ahead and did the 3 week monitoring and continued to train. No events were observed. Two days after returning the monitor I was preparing for a run and was quite literally putting on my HR strap when I all of a sudden felt very flushed. I looked down at my watch and it said 220BPM. I happen to work about 5 blocks away from my cardiologist so I jumped in a cab and made my way to the doctor’s office. I was still having the SVT episode when I arrived and we managed to capture it on an EKG.

So now it looks like I’m going to be having an ablation the day after Wildflower Long Course. I guess I’ll have to skip that race. I’m hoping the procedure doesn’t knock me too far off training for IMCanada. I’ve considered just avoiding the ablation all together but the meds dont seem ideal and the frequency of events seems to have become more predictable(coffee + stress or intense workouts).

Good luck to everyone out there in similar situations.

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Good luck with the procedure and after care training!

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Good Lucky and all the best for the next race.

16

This is really helpful, thanks! My doc had suggested that while the success rate typically published for Afib ablations is quite high, that doesn’t account for the many attempts it could take to actually isolate the tissue and witness the event. I’ll look into this and hunt down an EP specialist. For now I’m going to be setup with a 3 week ECG monitor.

Was diagnosed after an event monitor caught one. Mine is exercised induced and will typically go away in minutes with stopping the activity and doing vagal maneuvers. Went in for ablation a while back and it didn’t work as they couldn’t isolate the tissue. EP said it could take 3-4 trys and I said thanks, but no thanks. I think if i was having 40min episodes i would change my tune quickly though. Sucks it has kept me from a few podium spots here and there, but the EP said my case was mild and exercised induced so really nothing to worry about right now. Here’s a classic example of one from a race this past weekend: http://connect.garmin.com/activity/478679781

17

I had SVT as a kid and ended up having an ablation at age 14. My heart has been steady and treating me amazingly ever since.

I remember swimming through episodes during swim practices and having a heart rate of like 250-270 or something like that. I had all of the in hospital tests done and there was never something out of the ordinary.

The one way that they caught it was through a portable EKG that I kept in my swim bag during practice for about a week. During a set, it happened, I jumped out and was able to record a HR of 245. The episode lasted a few minutes.

I could have done beta blockers (say goodbye to swimming competitively) or the surgery. I did the ablation and am glad that I did. The docs said that it would have never really killed me, but that I needed to do something.

Get it checked out and catch an episode. I know that they have the tech to do it today if they had it around 16 years ago. GOOD LUCK!

18

Just read this - Best of luck with the surgery. Hope it works and you get healthy fast!