# A-fib/Atrial Fibrillation



## jimPacNW (Feb 26, 2013)

I don't see another thread on here, this is probably worth discussing. As I understand it, A-fib is a general description of irregular heartbeat (not necessarily a fast rate), and is not uncommon, more common the older we get.
I had an A-fib 'event' about a week ago, I got to go to the ER and had a 'cardioversion' (where they paddle shock your heart back to a proper pumping sequence etc). I'm quite fit and not overweight. After meeting with a cardiologist yesterday, it seems the right combination of stress, being overtired, and a bottle of white wine (more than I usually drink, drinking even less/none now) was the right combo. I got off with just a follow up echo cardiogram, so hopefully I won't have a recurrence. 
Oddly enough, per my wife, I have not snored since the cardioversion.


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## leaguerider (Sep 6, 2010)

There has been lots of discussion about endurance athletes having more heart issues. I have also been wondering about increased risk due to use of NSAIDS (advil....)

Did the doc put you on an anti coagulant? Asprin at a minimum??? The risks of ischemic stroke go way up with a-fib....


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## jimPacNW (Feb 26, 2013)

I got away clean, - no meds just the follow up I mentioned. I'm just 51, and I do regular 'stress tests' (mountain bike racing), so the doc seems pretty unconcerned unless I have another one. I had done a hard bike workout (felt fine) about 36 hrs prior to the Afib and cardioversion, so it seemed it hadn't been 'off' for very long, and risk of stroke would be minimal at that point, so we did the cardioversion immediately. 
From what I've read (within the past week, I'm no expert), it's more the guys that do 10+ hours a week or a lot more hours, that develop the more regular Afib issues.


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## Crankyone (Dec 8, 2014)

Jim, if it was the white whine (according to my wife) I would be dead ten times over! Relax, I think you are gonna be fine! 

I had a Navy physical when I was 24 that indicated I had some abnormal valve rhythms. I was running 6 minute miles! and raised over 10K feet in Colorado. I am still very active at 66, actively whining, several marathons and a lot of riding under my belt and it hasn't been a problem. Reduce your stress! what ever that means to you. Mountain biking isn't your problem! it's your salvation.


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## eri (Sep 4, 2012)

I read a book published by velonews called 'the haywire heart', lots about heart issues in older athletes, about the general assumptions that are wrong and lead to misdiagnosis. Probably worth a read.


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## Fairbanks007 (Sep 5, 2009)

Atrial fibrillation is *not* a general term for an irregular heart beat, it is a very specific type of irregular heart beat. In atrial fibrillation, the signal for the heart to contract (beat) is not originating in the normal place which is the sino-atrial node. Instead, erratic electrical impulses from irritable myocardial cells on the upper part of the heart (atria) are randomly getting into the heart's normal conduction pathway. Some of these impulses cause the bottom part of the heart (ventricles) to contract whether they've had a chance to completely fill with blood or not. The end result of all this is a random heart rate, irregularly irregular, that may not be efficiently pumping blood out to the rest of the body. It's a lot like having the timing be out on your car's engine; it might run, but it's not running as designed.









Since the top part of the heart is not contracting uniformly, blood is not flowing smoothly and there's a chance that eddies and pools of blood may form in the atria. Anytime blood slows down it wants to clot. Clots forming inside your heart is usually considered a bad thing as they raise the risk of ischemic stroke, as was mentioned earlier. That's why people in chronic atrial fibrillation are usually on an anticoagulant. Generally speaking, aspirin is not the treatment of choice - Coumadin, Eliquis or Pradaxa are.

Anytime anticoagulants are used, there's an increased risk of bleeding. A certain amount of caution would be prudent in a sport like mountain biking where scrapes and cuts are likely. For sure I'd want a supply of bandages available, and any blow to the head (even if wearing a helmet) should be regarded as serious until proven otherwise.


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## MattMay (Dec 24, 2013)

^this. As a survivor of a massive heart attack while riding (see my signature) I am super vigilant with respect to my heart rhythms. Anything irregular is cause for concern. Atrial fibrillation is quite serious, according to my cardiologist and surgeon. I thought I was experiencing it not long ago because I felt like my heart was skipping a beat. He wanted me in the ER ASAP. Turned out to be PVCs...pre ventricular contractions, which aren’t actually skipped beats but premature beats, and benign. He was relieved and told me to lay off caffeine and take extra potassium. Atrial fibrillation though would have been a real concern. A friend of mine had it so bad he recently underwent a surgical procedure to correct it. True AFib can be life threatening if it persists.


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## mbcracken (Aug 12, 2006)

Highly recommend picking up the book "Haywire Heart". Great summary of the plumbing and electrical functionality of our wonderfully complex heart. Also goes into some of the possible problems that occur for both the plumbing and electrical.

Being from around here...there is great studies being done at UW Sports Cardiology in regards to athletes. Great place to go for a 2nd opinion for you.
https://www.uwmedicine.org/services/sports-medicine/sports-cardiology

My history is a bit different from most...I am now 50 years old but started pushing endurance (2-15 hours) sports starting around mid-20's. At age 30, I started having syncope (fainting) episodes with some odd deja vu symptoms. This lead to me being diagnosed as having seizures which was a mistake. Fast forward 20 years...I would have the rare break thru events and in discussion with neurologists, they seemed open to the idea it was not seizures. Not all the symptoms lined up for that. Long story made short, my cardiologist decided to implant a ILR loop recorder. It insert just under the skin and captures all cardiac activity. Data can be marked then downloaded at home. This worked well for me as I had two syncope episodes that were fully captured on the loop recorder. My heart had 3 beats in 30 seconds, then no activity for 15 seconds...then magically came back to life. Dec 28th, I had a dual chamber pacemaker installed. The docs don't know exactly why my heart did that as causes can be contributed to vasovagal problem, could be SA Node problem...could be something else. But, I now have a pacemaker to properly handle these problems.
If you've read this far, your cardiac solution will be different then mine but I am back to riding. I had to go 6 weeks without riding and 4 or 5 pacemaker tuning appointments but am back in the saddle. I have no cardiac limitations and regularly hit +170bpm which is fully approved by my cardiologist. I ride with a bit more caution now as I don't want to do a hard crash and damage the pacemaker.

Cheers,
Mike


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## Osco (Apr 4, 2013)

Books and Internet advice on my heart ?

I'd lean to finding a good cardiologist that knows the athletic side of this In aging adults..

170 bpm,, sounds good to me


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## mbcracken (Aug 12, 2006)

Osco said:


> Books and Internet advice on my heart ?


Reading up and educating yourself on cardiac concerns helps have very thorough conversations with cardiologist/ electrophysiologist. I also pointed him to the best in the nation right now in Athletic Cardiologists that are local. The work with all ages of athletes with cardiac concerns.

The book was also co-written by Lennard Zinn. Highly recommend it all my aging riding friends.
The Haywire Heart

Cheers,
Mike


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## Crankout (Jun 16, 2010)

eri said:


> I read a book published by velonews called 'the haywire heart', lots about heart issues in older athletes, about the general assumptions that are wrong and lead to misdiagnosis. Probably worth a read.


Thanks; I read over the link someone posted. Every now and again, though very infrequently, I get a flutter sensation that tends to pass quickly. I feel my pulse at the same time and nothing changes with it. It could be an anxiety thing....


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## WHALENARD (Feb 21, 2010)

https://www.eurekalert.org/pub_releases/2018-04/b-rni041318.php


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## MSU Alum (Aug 8, 2009)

Crankyone said:


> Jim, if it was the white whine (according to my wife) I would be dead ten times over! Relax, I think you are gonna be fine!
> 
> I had a Navy physical when I was 24 that indicated I had some abnormal valve rhythms.  I was running 6 minute miles! and raised over 10K feet in Colorado. I am still very active at 66, actively whining, several marathons and a lot of riding under my belt and it hasn't been a problem. Reduce your stress! what ever that means to you. Mountain biking isn't your problem! it's your salvation.


I also am actively whining!


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## owtdorz (Apr 26, 2012)

Get a second opinion is a good idea. My wife HAD issues until last year. She could feel her heartbeat was not always right. She forced her Dr to send her to a cardio. The first one said no problems. Still she didn't think it was right. Went to another and the diagnosed a problem. It was aortic stenosis, probably from birth or a viral event in her early years. She had the valve replaced with a tissue one last October. Now she's riding our tandem MTB for long distances as well as her own bike. She has always been fit. BTW she is 62 and can outhike and bike most younger ones. Don't read internet and do get it double checked. Also if you do have to go under the knife make sure they check you for heparin allergy beforehand. Heparin reaction IS DEADLY if you have a reaction to it. My wife was and died twice in the hospital a week after surgery.


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## PlutonicPlague (Jan 19, 2014)

mbcracken, thanks for your input. I also have AFIB, diagnosed in 2014. I suffered a syncope episode where I broke my neck when my head hit the ground (2016). I had a cardioversion, as well as other procedures. 
Just a couple of weeks after my cardiologist upped the level of my prescription drugs last year at this time, making me feel a little more "light-headed," I crashed my road bike (last June), breaking 6 ribs and smashing my shoulder (Its all finally healed to where I'm feeling no pain).
Coincidentally, when I suffered the "syncope" episode and broke my neck, my cardiologist had upped those same meds only 3 or 4 weeks prior.
My AFIB is my only real medical concern now, besides needing to see my dentist. My heart pumps only 90% - 92% of the blood moved by a normal heart. That's in the doctor's office, not exerting myself. Hill climbing shuts me down on big hills, and I'm pushing the rest of the way to the top. Small hills like 25' -30' tall sand dunes and rolling hills in the countryside are not so mucha problem. I may be getting a pacemaker next year, and that should make me feel stronger again.


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## PlutonicPlague (Jan 19, 2014)

Hey mbcracken, have you ever had your cardiology nurse call you up first thing in the morning and ask you what you'd been doing the previous afternoon, based on the reading from your loop recorder? I rode hard one late afternoon for nearly two hours, barely taking the time to let my heart rate recover between climbs...sort of testing myself. Well, when my nurse read the data from my loop recorder on her computer (my "patient monitor" reads my loop recorder every night at around 2:30am and sends it directly to her computer), she nearly freaked out and thought I had been having some sort of "episode." After I explained what I had been doing, she cautioned me to "Take it easy from now on!"


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## mbcracken (Aug 12, 2006)

PlutonicPlague said:


> Hey mbcracken, have you ever had your cardiology nurse call you up first thing in the morning and ask you what you'd been doing the previous afternoon, based on the reading from your loop recorder? I rode hard one late afternoon for nearly two hours, barely taking the time to let my heart rate recover between climbs...sort of testing myself. Well, when my nurse read the data from my loop recorder on her computer (my "patient monitor" reads my loop recorder every night at around 2:30am and sends it directly to her computer), she nearly freaked out and thought I had been having some sort of "episode." After I explained what I had been doing, she cautioned me to "Take it easy from now on!"


LOL...close...I've had pretty in depth chats with my cardiologist & nurse about my endurance riding. I was curious if there was any concerns about pushing high heart rate and both said not a problem. My cardiologist said the only concern would be my heart valves wearing out the leads before their 30 year life span is up. Kind of interesting concept that a heart valve can wear out pretty robust pacemaker leads but he likened it concrete steps wearing a groove over time from just pure use. The heart valve is also really good at rebuilding itself. My cardiac nurse asked me pretty early on to do a hard workout prior to seeing him to verify pacemaker was working at both ends of the extremes. He took a look at my workout and confirmed with a good chuckle that it appears all the plumbing is working great. I think that workout I had a 157bpm average for 2 hours with bumping into the high 170's. The cardiac nurse also enjoys seeing me as I am an interesting patient that wants to do more then figure out how to get from home to grocery store and back.

Cheers,
Mike


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## Fairbanks007 (Sep 5, 2009)

PlutonicPlague said:


> Well, when my nurse read the data from my loop recorder on her computer (my "patient monitor" reads my loop recorder every night at around 2:30am and sends it directly to her computer), she nearly freaked out and thought I had been having some sort of "episode." After I explained what I had been doing, she cautioned me to "Take it easy from now on!"


The amount of information that the *average* nurse or physician (even cardiologists) doesn't know about exercise is simply staggering. And I'm not talking about the latest fads or trends either, just basic exercise physiology. Not a knock against them, it's just not their thing.



mbcracken said:


> LOL...close...I've had pretty in depth chats with my cardiologist & nurse about my endurance riding. I was curious if there was any concerns about pushing high heart rate and both said not a problem. My cardiologist said the only concern would be my heart valves wearing out the leads before their 30 year life span is up. Kind of interesting concept that a heart valve can wear out pretty robust pacemaker leads but he likened it concrete steps wearing a groove over time from just pure use. The heart valve is also really good at rebuilding itself. My cardiac nurse asked me pretty early on to do a hard workout prior to seeing him to verify pacemaker was working at both ends of the extremes. He took a look at my workout and confirmed with a good chuckle that it appears all the plumbing is working great. I think that workout I had a 157bpm average for 2 hours with bumping into the high 170's. The cardiac nurse also enjoys seeing me as I am an interesting patient that wants to do more then figure out how to get from home to grocery store and back.
> 
> Cheers,
> Mike


Sounds like you've found a physician and nurse that's actually listening to you. Those people are out there, but they're unfortunately too few and too far apart making them worth their weight in gold.

Oh, and those of us in healthcare that work with varying populations definitely appreciate patients that make us question what we think we know, and re-evaluate our approach to meet the needs of the patient.


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## mbcracken (Aug 12, 2006)

Fairbanks007 said:


> Sounds like you've found a physician and nurse that's actually listening to you. Those people are out there, but they're unfortunately too few and too far apart making them worth their weight in gold.
> 
> Oh, and those of us in healthcare that work with varying populations definitely appreciate patients that make us question what we think we know, and re-evaluate our approach to meet the needs of the patient.


Yup, I also do my research to seek out healthcare providers that know athletic concerns. I also grew up in a healthcare family(pediatric nurse & veterinarian) plus I was on ski patrol for about 7 years...this helps me know how to talk the talk and make the most of quick appointments. Docs, nurses and I seem to get along as we have exchanged personal phone numbers to try and ride together. 

Cheers,
Mike


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## Spec44 (Aug 17, 2013)

Fairbanks007 said:


> The amount of information that the *average* nurse or physician (even cardiologists) doesn't know about exercise is simply staggering. And I'm not talking about the latest fads or trends either, just basic exercise physiology. Not a knock against them, it's just not their thing.
> 
> Sounds like you've found a physician and nurse that's actually listening to you. Those people are out there, but they're unfortunately too few and too far apart making them worth their weight in gold.
> 
> Oh, and those of us in healthcare that work with varying populations definitely appreciate patients that make us question what we think we know, and re-evaluate our approach to meet the needs of the patient.


No doubt. At both last years EP and Cardiologist appts, I asked them if there is any issue with me doing some HIIT work because my endurance is doing great, but my legs just die climbing hills. Both of them gave me a generic "you don't need to do that. Just ride your own ride, you don't have to keep up with faster people." Would have been nice to get a proper evaluation of the situation.

(I rode 1700 miles last year, have no problem riding for 3 hours averaging just below LTHR, live in north Florida so have hills but not "real hills"...I can spin em, but calves go into burn and get super winded)


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## RooHarris (May 11, 2011)

*Check out this thread...*



jimPacNW said:


> I don't see another thread on here, this is probably worth discussing. As I understand it, A-fib is a general description of irregular heartbeat (not necessarily a fast rate), and is not uncommon, more common the older we get.
> I had an A-fib 'event' about a week ago, I got to go to the ER and had a 'cardioversion' (where they paddle shock your heart back to a proper pumping sequence etc). I'm quite fit and not overweight. After meeting with a cardiologist yesterday, it seems the right combination of stress, being overtired, and a bottle of white wine (more than I usually drink, drinking even less/none now) was the right combo. I got off with just a follow up echo cardiogram, so hopefully I won't have a recurrence.
> Oddly enough, per my wife, I have not snored since the cardioversion.


Several years ago, I started a thread regarding cardiac concerns for older riders. It was my hope to bring attention to these issues especially regarding A-Fib and other athletic/rider cardiac concerns. Many bikers responded with similar situations which I feel are relevant here. Hope this helps:
http://forums.mtbr.com/california-norcal/cardiac-concerns-later-life-983825-2.html#post12849659


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## Fairbanks007 (Sep 5, 2009)

Spec44 said:


> No doubt. At both last years EP and Cardiologist appts, I asked them if there is any issue with me doing some HIIT work because my endurance is doing great, but my legs just die climbing hills. Both of them gave me a generic "you don't need to do that. Just ride your own ride, you don't have to keep up with faster people." Would have been nice to get a proper evaluation of the situation.
> 
> (I rode 1700 miles last year, have no problem riding for 3 hours averaging just below LTHR, live in north Florida so have hills but not "real hills"...I can spin em, but calves go into burn and get super winded)


I'd recommend trying to get in touch with a local university that has a graduate level clinical exercise physiology program and see if they have a program for testing athletes. If not, maybe they can connect you with one. We have a Human Performance Lab where I work, but Michigan isn't all that convenient for you.


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## Spec44 (Aug 17, 2013)

I live about 10 miles from FSU, so I could probably start there . Between 2 universities and a community college, we have 50,000+ students in town. But that's part of the mystery of these local doctors not being too tuned in to young active people.

I'm also usually the youngest patient in their waiting room... got a stent at 42 almost 8 years ago, and was diagnosed with Brugada Type 1 pattern at the same time, so not exactly A-fib but certainly arrythmic.


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## jrsbike (Jul 24, 2004)

I just dropped into the forum after a long time away and glad I did. This is extremely important information and I hope that people become fluent with these issues.


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## YogiKudo (May 12, 2013)

Check out afibbers.org. It has pretty exhaustive information on Afib. It is very important to keep your electrolytes on the high side of the scale. Magnesium aids in potassium absorption and is extremely difficult to find in foods. I supplement with magnesium chelate. I think Afib is a symptom with many different sources which, still to this day, are poorly understood. The best medicine can do today is to scar over the pulminary veins (PVI abation) to intercept the erratic signal or use chemical agents to keep you in rythm (Rythmol/Flecanide). They both have their drawbacks. As far as PVI ablation is concerned, EP experience (ie: how many has he/she done successfully) is a major factor in success. Secondly, even if the ablation is successful scars heal over time and future breakthroughs can happen. As for chemical control, these agents cap your max heart rate which for athletes is a bummer.They also can lower your heart rate some. My 24 hour Holter monitor showed 29 beats/min during REM sleep so I am not a great candidate for constant chemical intervention. I would opt for a PVI ablation because of this. I have been dealing with Afib for 25 years. I am 57. I have had 8 cardioversions during this time. I now use a Pill in Pocket (PIP) strategy. I carry Rythmol with me and use it only when I feel my heart get angry. Over 25 years, I became super sensitive and know where my heart is at all times. There are some large genetic studies going on now trying to isolate potential genes for Afib. The good news is I am still going to the gym daily and riding around 250 days every year. Cheers J


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## jimPacNW (Feb 26, 2013)

Short follow up for me; I had experienced consistent light headedness when standing from a crouching position, and even getting up from the couch, for 2 months (apparently some short term light-headed feeling is common?, but eventually fades?). I had also been avoiding beer. My light headed-ness has fairly abruptly disappeared, coincidentally when I started having 2 beers every other night... 
I'm pretty much in the clear, and my health insurance even covered the super expensive ambulance ride. - yay!


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## RooHarris (May 11, 2011)

YogiKudo said:


> Check out afibbers.org. I have been dealing with Afib for 25 years. I am 57. I have had 8 cardioversions during this time. I now use a Pill in Pocket (PIP) strategy. I carry Rythmol with me and use it only when I feel my heart get angry. Over 25 years, I became super sensitive and know where my heart is at all times. There are some large genetic studies going on now trying to isolate potential genes for Afib. The good news is I am still going to the gym daily and riding around 250 days every year. Cheers J


Leonard Zinn's most recent article on afib and the use of an e-bike in such a circumstance. I personally feel that this is a situation that warrants the use of an e-bike. Otherwise, I do not favor them. I am 71 and still riding my Ripley 4 days/week throughout the year. I have never been an ultra-racing type. Just someone who has always incorporated exercise on a daily basis. The ultra folks seem driven to the point where cardiac concerns should be seriously considered earlier in life.

Zinn: An e-bike can be life-changing for a lifelong cyclist | VeloNews.com


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## Fairbanks007 (Sep 5, 2009)

YogiKudo said:


> Check out afibbers.org. It has pretty exhaustive information on Afib. It is very important to keep your electrolytes on the high side of the scale. Magnesium aids in potassium absorption and is extremely difficult to find in foods. I supplement with magnesium chelate. I think Afib is a symptom with many different sources which, still to this day, are poorly understood. The best medicine can do today is to scar over the pulminary veins (PVI abation) to intercept the erratic signal or use chemical agents to keep you in rythm (Rythmol/Flecanide). They both have their drawbacks. As far as PVI ablation is concerned, EP experience (ie: how many has he/she done successfully) is a major factor in success. Secondly, even if the ablation is successful scars heal over time and future breakthroughs can happen. As for chemical control, these agents cap your max heart rate which for athletes is a bummer.They also can lower your heart rate some. My 24 hour Holter monitor showed 29 beats/min during REM sleep so I am not a great candidate for constant chemical intervention. I would opt for a PVI ablation because of this. I have been dealing with Afib for 25 years. I am 57. I have had 8 cardioversions during this time. I now use a Pill in Pocket (PIP) strategy. I carry Rythmol with me and use it only when I feel my heart get angry. Over 25 years, I became super sensitive and know where my heart is at all times. There are some large genetic studies going on now trying to isolate potential genes for Afib. The good news is I am still going to the gym daily and riding around 250 days every year. Cheers J


Fact: the longer you've been in atrial fibrillation, the harder it is to get you out of it. If keeping your electrolytes on the high side has worked for you and some others, great. More power to you. I think it's awesome you're maintaining a very active lifestyle despite persistent/recurrent atrial fibrillation. However, what's worked for you may not work for everyone. Consultation with competent EP or cardiologist with experience dealing with active individuals is paramount.


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## YogiKudo (May 12, 2013)

I'd love to hear your experience in this field. What are you doing for your Afib?


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## Cuyuna (May 14, 2017)

This winter, out on the local MTB trails in the snow, my HRM was showing heart rates on exertion upwards of 175. I mentioned it to a cardiologist friend because I'm 67 and that's higher than one would expect and he wondered about atrial fibrillation. He suggested a Holter monitor might be a good idea. Instead, I bought a Kardia device. It takes a lead II rhythm strip whenever you need it, shows it on your phone. I think it can get sent somewhere to be read by someone to diagnose a-fib but I just read it myself. I've never had a-fib, but this is a great device for answering that question, even on the trail. There's also a version (band) for Apple Watch. If a person ever had a question about whether or not he/she was in a-fib, or what the ventricular response was, this would be a very valuable device to keep in your pocket, especially when exercising. It's really remarkable technology and provides an excellent quality EKG recording. It's a medical grade EKG and is FDA-approved to detect atrial fibrillation.

Not trying to sell anything here, I have no connection, but this is remarkable technology and if I was the OP or had ever been diagnosed with a-fib, I'd have one of these things for sure.

https://www.amazon.com/Alivecor®-Ka...pID=41G-Scz4JvL&preST=_SY300_QL70_&dpSrc=srch


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## Fairbanks007 (Sep 5, 2009)

YogiKudo said:


> I'd love to hear your experience in this field. What are you doing for your Afib?


I don't have atrial fibrillation. I do have more than 20 years experience as a clinical exercise physiologist, and have worked with thousands of patients with atrial fibrillation. Granted, most of my patients aren't in the gym daily or riding ~ 250 days/year, but I've seen my share of Master's athletes with atrial fibrillation as well.

The etiology of any one person's atrial fibrillation might not be clear, but at the end of the day it's nearly always going to come down to cardiac myocyte excitability/irritability as the proximal cause. The unanswered question is what's causing that excitability? Electrolyte imbalances could easily contribute to that.

If maintaining high levels of electrolytes is helping *you* to control *your* atrial fibrillation, that's great. Keep doing what you're doing, it's working for *you*. What I got out of your post was a blanket recommendation that everyone do the same, and that's disingenuous to say the least. Sorry if I misread your intent.

Losing weight, avoiding tobacco, excessive alcohol and caffeine are general recommendations for patients with atrial fibrillation. Once you get past these, it's best to get a specialist involved.


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## Cuyuna (May 14, 2017)

Fairbanks007 said:


> I don't have atrial fibrillation. I do have more than 20 years experience as a clinical exercise physiologist, and have worked with thousands of patients with atrial fibrillation. Granted, most of my patients aren't in the gym daily or riding ~ 250 days/year, but I've seen my share of Master's athletes with atrial fibrillation as well.
> 
> The etiology of any one person's atrial fibrillation might not be clear, *but at the end of the day it's nearly always going to come down to cardiac myocyte excitability/irritability as the proximal cause*. The unanswered question is what's causing that excitability? Electrolyte imbalances could easily contribute to that.
> 
> ...


It's usually abnormal conduction in the heart's nerve pathways and influence from the autonomic nervous system, not myocyte excitability/irritability. The management recommendations you cite are indeed correct however...aimed at decreasing the excitability/irritability of that nerve network.


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## Fairbanks007 (Sep 5, 2009)

Cuyuna said:


> It's usually abnormal conduction in the heart's nerve pathways and influence from the autonomic nervous system, not myocyte excitability/irritability. The management recommendations you cite are indeed correct however...aimed at decreasing the excitability/irritability of that nerve network.


I guess that depends on the population you're looking at.

For the vast majority of the population with atrial fibrillation, I have to disagree. What is making the conduction abnormal in these folks is the fact that the depolarization is originating *outside *the heart's normal SA node to AV node electrical pathway. One of the characteristics of cardiac myocytes is automaticity, they can depolarize on their own, without stimulation from the nervous system. Neighboring myocytes may also depolarize creating a wave of depolarization that propagates across the surface of the myocardium. *Some* of these signals *do* get into the AV node pathway generating the irregularly irregular rhythm that is the hallmark of atrial fibrillation. This mechanism is the basis for common treatments for persistent atrial fibrillation such as catheter ablation (burns out the irritable ectopic foci) or the surgical Maze procedure (intentional creation of scar tissue on the myocardium's surface to block most of the ectopic signals.)

Specifically for male high intensity endurance athletes (very small subset of the general population) there is an ever increasing body of evidence on their increased risk for atrial fibrillation, though the mechanism for this is not known. Here's an excerpt from a September 2017 ACC story on the subject:

"While there are multiple knowledge gaps regarding pathophysiologic mechanisms underlying the development of AFib in athletes, proposed mechanisms include *alterations of autonomic tone*, *left atrial enlargement and fibrosis, electrical remodeling and increased inflammation*." Emphasis added.

Also not known is the threshold for the volume of high intensity endurance exercise that influences the development of atrial fibrillation, though I suspect that's pretty individual. What you might tolerate with no problem might cause me a lot of problems.

Link to full story: Is Endurance Exercise Safe in AFib? - American College of Cardiology


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## UpTheAnte (Mar 7, 2018)

#1) Heart desease 
#2) Cancer
#3) https://www.usnews.com/news/article...rs-are-third-leading-cause-of-death-in-the-us
Feeling the vertigo, 1+2+3= ?
You are a commodity... at our age, its just a horse race, and your horse is not going to win.
Be careful out there.


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## stuffshredman (Jan 23, 2007)

I was diagnosed w AFIB two years ago. 
I had a stress test and full workup, which showed no heart disease, great cardiac flow, etc.

I did have an ablation 15 years ago for another arrhythmia called supra ventricular tachycardia (SVT), where my heartrate would sometimes get stuck at a whopping 240bpm (not supposed to happen)

My original cardiologist put me on a blood thinner (xarelto) and wanted me to try an anti-arrhythmic drug (metoprolol), but it lowers your heart rate. My resting was already low (around 40) and dropped to 25bpm when on the drug, so he took me off. He suggested I get a pacemaker. I told him to eff-off, and I went to my original EP who did my ablation 15 yrs ago. 

Since I don't have any other risk factor for stroke (not overweight, no diabetes, don't drink or smoke, no heart disease, etc), my EP took me off Xarelto saying the risk of bleeding to death, for me, is much higher than stroke risk.

Anyway, the thing that is interesting about my AFIB is that it is closely tied to how my stomach is feeling, and what I put into it. 

I had GERD (acid reflux) which could trigger the AFIB. I'm on protonix for the acid reflux, so that mechanism has been defeated.

Another issue is with anything that causes bloating (stomach gas). I've been experimenting with a type of diet called "low FODMAP", which basically cuts out foods which cause bloating (onions, garlic, broccoli, etc). It sucks, but has had amazing results.

My type of AFIB is called "vagally mediated", which means the vagus nerve has something to do with it. It's not a very well understood type of AFIB.

If you have afib that's tied to eating/ drinking/ etc ... reach out, I'd like to hear more.

My electrophysiologist is recommending an ablation, which I might do .. but I'm trying to see if I can stave it off with natural methods for now. So far, a few months in, I've been having very good results.


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## Lawrence_S (Nov 15, 2018)

Thanks for this really interesting and enlightening post, stuffshredman. I had a mild heart attack at age 55. I developed panic disorder about 6 months after the incident. Went back to the ER three times in 2 years before it was clear that the panic attack symptoms (which can mimic certain cardiac events) were responsible - not anything related to my heart. 

Consequently I came to realize that the Vagus nerve played a major role in my attacks. Bloating and gas stimulated the nerve and brought about physical reactions and sensations that in turn would trigger the panic attacks. Since making this connection (and other cognitive behavioral therapies) I rarely have the panic attacks anymore and if I do they are manageable. 

I find the FODMAP hypothesis and therapy very intriguing and am going to do more research.


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## NordieBoy (Sep 26, 2004)

A couple of years ago I had AFib whilst taking antacids for indigestion.

Never taken antacids since


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## Earthpig (Jan 23, 2004)

Good thread. I was diagnosed with a-fib earlier this year and am going in for ablation #2 this week. I've been riding regularly (usually around 1500-2000 miles per year) for about 20+ years and used to XC race. Skate ski and snowboard regularly in the offseason. Used to run some too before a knee injury (from too much biking - go figure) ended that. Close to 50 and with that much regular and sustained stress on the heart muscle, it was only after diagnosis that I realized that my risk for a-fib was above normal. (I've read the Haywire Heart, Zinn's stuff and pretty much anything not super-clinical I can find about athletes and a-fib.) I started feeling abnormally tired during and after rides beginning about 18 - 24 months ago - climbs that used to be easy, even on a SS, because really hard and tiring. I just chalked it up to age, stress, and the extra 30 lbs or so I've gained since my racing days. It wasn't until a routine checkup this past February that I was diagnosed. I've been going to the doc for a yearly physical for decades, always was asked about and discussed my level of activity and exercise, and was never once told that too much sustained cardio over the years creates a higher than usual risk factor for a-fib. It would be great if health care professionals would maybe provide a little bit of warning about the risk. Now, I have had some other health/lifestyle factors (excessive and sustained stress for one) in the last couple of years that likely contributed to developing permanent/persistent a-fib, but in retrospect, it seems a little frustrating that not once until after I was diagnosed did any health professional bother to mention that running/skiing/riding increases the risk of a-fib. I'd advise anyone in their late 40's to early 50's who has been riding for a long time and starts to experience unusual fatigue while riding be checked for a-fib. It's more easily corrected before it becomes persistent/permanent. (And reduce/eliminate your post-ride beer intake. That's another big risk factor.)


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## jtc1 (Apr 13, 2004)

is alcohol (the post ride beer - not chronic drinking) in fact a known contributor to A-fib?? Antidotal - but seems i know a bunch of guys that have a post ride beer and MTB all th time that do not have A-fib. Just curious. 
I have not A-fib, but one of my brothers does so its in the family. I have had a few bouts of syncope - but it seems dehydration related. But maybe I need to think more about this.


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## Sanchofula (Dec 30, 2007)

@ Earthpig:

I find it curious that someone would blame their health care provider for not telling them all the risks associated with every aspect of their lives.

It does not take a rocket scientist to figure out that repetitive stress over time will increase the risk of stress related health issues.

Did ya think there was a free lunch?

What really drives me nuts is when I do tell clients the risks and they don’t change what they’re doing ... which I suspect would have been the case if your provider had told you the risks of a fib increase with age and can be aggravated by high intensity exercise.

.. and you’re overweight, but it’s the health provider who screwed up, not you, oh no, not you.

At least that terrible health provider figured out the problem before you stroked out ... maybe thank them some day, it would be a nice gesture 🙄


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## Fairbanks007 (Sep 5, 2009)

Earthpig said:


> I've been going to the doc for a yearly physical for decades, always was asked about and discussed my level of activity and exercise, and was never once told that too much sustained cardio over the years creates a higher than usual risk factor for a-fib. It would be great if health care professionals would maybe provide a little bit of warning about the risk.


To be fair to your health care provider, the phenomena of increased risk of developing afib in male endurance athletes isn't anywhere near as well understood as the effects of other risk factors for heart health (e.g. diet, hypertension, tobacco use). There's a lot we don't know about it, probably the most frustrating being that we don't know the volume of training that increases an individual's risk for developing afib. You might be just fine spending 15 hours per week at or near 80% of your target heart rate range using the Karvonen formula, but I might get into trouble at half that training volume.

It's likely that the threshold is highly individual. Keeping in mind that the obesity epidemic is a legitimate public health crisis, and that more than half of the US adult population reports no leisure time physical activity (and bowling counts as physical activity, BTW. Bowling!), at what point should providers begin warning patients about the risk of afib?

Lastly, the risk of developing afib increases naturally with age. Current estimates of the prevalence of afib in those over 80 years old place it somewhere between 10-17% (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694766/). This is in a generation where high volume, high endurance exercise was unusual to say the least. These folks were going to develop afib without any influence from their physical activity patterns.

Practicing medicine is all about playing the odds. Odds are that any given provider will see a few dozen individuals over their career whose exercise places them at increased risk for afib. That same provider will see dozens of individuals PER WEEK whose physical activity is insufficient to prevent chronic disease.


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## bitflogger (Jan 12, 2004)

I'll suggest an Apple Watch 4 or later because it is an FDA approved ECG device but also point out that it's no replacement for a qualified health professional.

With some risk - dad died young of a heart attack, mother's had heart attack, my times with elevated cholesterol - I consider it a tool and so does my new physician. I've had health pros dismiss all the health data collected by my watch and phone and two who very much value and use it.

I've not yet had a-fib as a known problem but family members have. It was confidence inspiring to have a doctor who looked at and factored in my activity and Apple Health data with his own. Another advantage the watch has is notifying others if some problems occur.


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## Fairbanks007 (Sep 5, 2009)

bitflogger said:


> With some risk - dad died young of a heart attack, mother's had heart attack, my times with elevated cholesterol - I consider it a tool and so does my new physician. I've had health pros dismiss all the health data collected by my watch and phone and two who very much value and use it.
> 
> ...It was confidence inspiring to have a doctor who looked at and factored in my activity and Apple Health data with his own.


I'm glad you found providers that you can work with. That's kind of the trick, isn't it? Finding a physician that views the patient - provider relationship as a partnership where you work together towards optimal health is easier said than done.

Providers have a hard time trying to figure out what to make of all the data patients are able to provide these days from wearable devices. There's no end to the number of products and apps out there to generate this information, and all have various degrees of accuracy. It's a tall order to expect every provider to be familiar with the quality of the data from each device that they're receiving from patients. The best providers make an effort to stay on top of this, and if you find one that does you're fortunate indeed.

This problem will eventually solve itself, but right now it's a little bit like the wild west when it comes to patient provided health infomatics.


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## Sanchofula (Dec 30, 2007)

Seems like pork chop left the building...

Maybe he sent his doctor a holiday card?

I’ll admit, it freaks me out when I hear about a healthy person having a heart attack. I’m very low risk, no risk factors at all, but it still weighs on my brain when I think about it; so I
don’t think about it 🙄

If there’s one thing I wish everyone would do in the new year: lose weight and eat better.

You don’t have to die young, you have a choice.

... it also makes sense to pay attention to warning signs, especially if you have some risk factors.


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## bitflogger (Jan 12, 2004)

Fairbanks007 said:


> I'm glad you found providers that you can work with. That's kind of the trick, isn't it? Finding a physician that views the patient - provider relationship as a partnership where you work together towards optimal health is easier said than done.
> 
> Providers have a hard time trying to figure out what to make of all the data patients are able to provide these days from wearable devices. There's no end to the number of products and apps out there to generate this information, and all have various degrees of accuracy. It's a tall order to expect every provider to be familiar with the quality of the data from each device that they're receiving from patients. The best providers make an effort to stay on top of this, and if you find one that does you're fortunate indeed.
> 
> This problem will eventually solve itself, but right now it's a little bit like the wild west when it comes to patient provided health infomatics.


My luck here is a few years with primary care done by a co-op and specialty care the regional health care factory farm that's also a university. My PA now replaced with a young physician have paid attention. Both have been aware of the Apple Health stuff and knowing the newer watches are FDA approved devices.

They also saw close to 3 years of "closing the rings" regular activity and someone trying really hard to age as well as possible. In my mind age 60 has accompanied losing physical capability but they said in reality I have good shape for someone my age with some heart risk.

One of them said "there's gotta be 50 million of those Apple Watches now and that's more data than a lot of studies". Other physicians I know are very much different about it.



Nurse Ben said:


> Seems like pork chop left the building...
> 
> Maybe he sent his doctor a holiday card?
> 
> ...


I agree with the pay attention part. My dad died young in a different era but he was taking steps relative to the time such as quit smoking, diet and becoming physically active. My mother who just had a heart attack is almost 90. My assessment is some have more choice than others but I'm with you on generally making good decisions.

It probably works this way just illustrated by a large family group international travel vacation at a resort. Our two grandmas still with us who've made good life style choices clearly had more independence. The resort had other families and groups same ages and from all over. There was a division between those still walking on their own and swimming with those mostly in wheelchairs or not very mobile.

A large family I know where 1/2 left the farm illustrates the scenario too. At a gathering I noticed the ones who kept farming or active had more mobility. It is interesting to see knowing the same gene pool.


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## BrianMc (Jan 5, 2010)

I mostly hang in the commuting group. Did some in the DIY light, and Clydesdale groups years ago. Just found this group while looking for another. Would it be OK to discuss issues around CAD in this thread? I think my cardiologist is a bit clueless about exercise especialy cycling in the soon to be 68 patient (me). 

I learned I can get a crude reading on Blood O2 off my Samsung phone so the plan is to check that at the places I need to stop and recover on future rides. I am blowing well on the lung capacity device I got after the stents were placed which suggests the lungs are OK, and my BP is fine. I think it is just a matter of time, alternate days to recover, stopping when it feels like I need to, and otherwise, just keep on keepin' on.

Anyone worked their way through getting back to about where they were after bypass or stent surgery? Any tips? 

Some background: I was returning to more regular cycling 2 years ago when I got angina in my first warm-up laps in the neighborhood, and the old Garmin 500 said my pulse was 232 (likley miscounting erratics). That and no change with a nitro pill got my attention. That lead a month and a half later to 4 stents as the anterior descending was 99% blocked. I went through the cardio rehab, and cycled there and back after my second week. Was advised to keep the heart rate below 120. Found that a bit tricky with some grades. I picked up some cross training at the Y until the lockdown for COVID-19. I was riding fine during the lock down (no traffic to speak of), then the house renovations hit the point where we could move back in from the temporary apartment. So lots of exercise moving furniture and little time to ride and thunderstorms took out what riding I did plan. 

So back on the bike the last month and had some chest pain (though it feels different), and the stress test last week showed normal function of the heart (though I have a heart mumur). I was put on slow-release nitro to ease exercise induced chest pain on top of the other heart meds. My advised max heart rate is 152 by the 220 minus age calculation and my 70-80% best workout pulse range is 130-136. I have to rest after bigger climbs, and the sprint off the traffic light (left turn) to catch my breath. I exceeded my Max heart rate on one of those small but steep hills near the end of my second last ride Into the wind 10 lower the next day), which I think after 40 minutes, sets a new Max Heart Rate (still 20 below what it was 3 years ago).


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## BrianMc (Jan 5, 2010)

I dropped my warm up HR max to 105-115 range, and kept the ride in the 118-122 range for most of it until near the end. Was less winded at the top of the hills and after the light sprint. Blood O2 saturation after the climbs and light was 99 to 100 for three readings and 96% after a couple of miles approaching 130 HR. So I readjusted what I think as normal HR. No headacahe at the end of the ride which I took as either excess NO or low blood O2 or both.


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## Spec44 (Aug 17, 2013)

You'll get there. Any level of activity is better than no activity.

I have an electrophysiologist and a cardiologist, and while we discuss my 4-6 hours a week on the bike, when I asked each of them about if they have any concerns with me doing some HIIT a couple years ago they both said "you don't need that, just ride to have fun." They don't even understand the basic premise that I'm already pushing the intensity enough that I want to train my body to better handle the higher intensities. (I got a single stent about 8 years ago at 42, well I was diagnosed with Brugada syndrome, too, but that's more of a v-fib concern)


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## 274898 (Nov 29, 2005)

I had a few where it just felt like my heart was skipping a beat and it was after a heavy workout with elevated heart rates. Not for sure on this one, but in my experience it may have been caused by dehydration or electrolytes being off. Now it seems like I have to pre-hydrate well before intense rides and running. It does improve performance in workouts as well.


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## stuffshredman (Jan 23, 2007)

update to my 12/28/18 post:
after being diagnosed w AFib, I tried many many lifestyle changes to reduce the occurrences. There was definitely a connection to my stomach/ esophagus. Some of the diet changes helped for a while, but not for long.

I eventually caved and had an ablation. A year and a half now with zero issues. I've upped my ride volume and intensity with no problems at all. I was nervous about the risks of the procedure, but for me, it turned out to be the best decision.


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## nOOky (May 13, 2008)

Glad the ablation helped you!

I had two ablations way back in 2002, and a third in 2005. In 2005 I was 37, and still riding hard and doing some mountain bike racing. I remember riding with my gf at the time, and she was beating me up the hill, and I was out of breath and my HRM said 220 or 240 I don't remember exactly, but it said I was maxed out. Back then even I dismissed it as powerline interference or just a lack of good connectivity with the strap. I ignored it for a while, but eventually I kept pushing myself until I felt so horrible I went in, thinking I had bronchitis.

They found the a-fib right away, and that was the start of my journey. It turns out I had pushed so hard that I had a heart failure, and ended up in the cardiac care unit for two weeks. They tried every drug imaginable at the time of course, along with 7 cardioversions, and enough amiodarone to drown a pig. They talked of a pacemaker, and I was of the mind that I would not do that. I was just in a bad way, with an ejection fraction below 25%. When I was in a-fib I felt terrible, no energy at all, when I was in normal sinus rhythm I felt fine.

The ablation procedure has changed a lot in the past 20 years even. My first one was almost 12 hours long, and after they gave you a bunch of tests to make sure there was no stenosis of the pulmonary veins, lung perfusion scans, the works. My last one was only a "touch-up" ablation, maybe 4 hours long with cooling catheters and the recovery was much quicker.

I currently have no restrictions, nothing sets it off anymore. Sometimes I'll feel like there was a slight pause or an occasional skipped beat, but everyone has those.

I remember researching extensively about athletic performance and the heart in general so I could ask informed questions about it all. I can still take my pulse and be within 2 beats of the actual, but now my Garmin does that for me.


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