You don't need to be an 'investor' to invest in Singletrack: 6 days left: 95% of target - Find out more
To cut a long story shortish... I was out for my usual 2.5km open water swim this lunch time, here in NZ. Autumn, so the water temp was probably around 15c or so, and I was in a swimming wetsuit. Midway through, I noticed my heart wasn't beating quite right, so had to swim the return leg with a weird fluttering in my chest all the way.
Back to work, had a shower, had lunch, no difference, still weird fluttering going on. Sat down at my desk and still feeling weird and a bit dizzy, so it was off to A&E (or ED as they call it here).
ECG confirmed atrial fibrillations, which was initially treated with IV saline and magnesium. Several hours later and the IV magnesium hasn't worked - the ECG is still bouncing all over the place, so they wheeled me in to the actual frikkin' 'Resus' room (eek!) to have a cardioversion (electric shock treatment).
A few mg's of fentanyl and an injection of some weird pure white anesthetic in a syringe later - and they shocked me with a good few joules of Faraday's finest, which actually made me do the whole chest jolting thing you see in the movies. Apparently I was supposed to be out of it for this part, but I don't think they gave me quite enough anesthetic so I was conversant and fully aware throughout - quite an experience.
The procedure worked perfectly first time (hooray!), which was such a relief 'cause several hours of AF is really not much fun (er, actually quite terrifying).
Clearly, this episode was probably something to do with my exercise focused lifestyle. In this particular instance it might also be to do with high-intensity exercise in cold water. I've had intermittent short (less than a minute) and self-resolving boughts of AF of and on over the last 10 years or so, especially when running or cycling very hard, so I'm probably in the 'at risk' camp for this sort of thing, especially given there's a history of heart disease in my family.
So, what now? TBH I'm actually terrified of doing anything vaguely strenuous now, because I have no wish whatsoever to put myself in that state again. Apparently form the peer-reviewed papers I've read 'moderate exercise' is the ideal, rather than the high intensity, endurance exercise that I seem to have perhaps been somewhat addicted to over the last 15 years or so (I'm 45, by the way).
This is my normal week's routine:
Monday: Rest day
Tuesday: 2.5km open water swim
Weds: 1hr20 minute high-intensity forest run, with about 1000ft climbing
Thursday: 2 hour MTB ride moderate-high intensity with about 2000ft climbing
Friday: 1hr20 minute high-intensity forest run, with about 1000ft climbing
Saturday: Surfing for a few hours, or 10-20km walk
Sunday: 3-4 hour high-intensity MTB or road ride, with about 4000ft climbing
I'm not even training for anything whatsoever, I just like doing this sort of stuff and with living out here, it's very easy to go off and thrash yourself on the hills, lake or ocean for a few hours.
The doc's at A&E were a bit vague about what I should or shouldn't be doing now (I guess their specialty is more about patching people up and sending them home alive, rather than giving cardiological health advice). I have been referred to a cardiologist though, so I expect they will give some useful advice when I eventually get to see them.
In the meantime though, does anyone from the STW hive-mind have experience of this sort of thing and what is likely to sensible exercise wise immediately afterward? I'm kind of of a mind to just go for light walks now, or very gentle flat 5k runs, but I'm sure it will rapidly drive me completely mad with frustration.
Apologies again if I don't reply immediately. Time is upside down over here.
p.s. I gave up coffee 2 years ago and haven't drunk alcohol now for 9 months.
Sensible thing is to take it relatively easy until you've seen cardiology. Mum has AF, also has a stroke a few years ago. Turns out AF can increase your chances of a stroke 5 fold.
Sorry not being a doom monger, just wanted to flag it up.
Edit: https://www.stroke.org.uk/what-is-stroke/are-you-at-risk-of-stroke/atrial-fibrillation
Are we still not allowed to page other users? I guess Ton would be the best person to talk to here?
Are we still not allowed to page other users? I guess Ton would be the best person to talk to here?
Well personally I would be seeking out an Electrocardiologist myself (not that hard as I ride with two of them from Papworth every Saturday).
Yeah, Ton is one of us (AF sufferers), but there are a fair number of us that have had free electricity at the hands of a professional. FWIW, I have have had three jolts, two of which were in A&E following self admission and one during an EPS mapping session.
@no_eyed_dear First up, try really, REALLY hard not to think the worst. I know for a fact how shot that feeling is when you are in AF and waiting for your heart to feel normal again. I've no idea what causes it, or what caused it in me, but I do know that the fear I felt at the time made me depressed for a good long while. It was only when I started coming to terms with it that I started coming out of it.
I really want to suggest that you get a specialist opinion of what could cause it. Exercise _might_ be a trigger, but then it might not be, or it could be one of many things, so getting an expert on the case is a good plan. I had triggers that were and were not dehydration, needing to pee, lack of sleep, anger and being cold, so it really could be anything.
I also want to say that this is possible to fix. Mine took a good few years before it could be fixed (because the treatments were young and underdeveloped at the time), but they did a decent job of it and after the op I did nine years in the Army Reserve with a full fitness rating, coached Crossfit and did triathlons before I resigned and went to Sweden to skydive.
Have hope and try not to fall into the same trap I did. Talk to someone if you need to, or if you just want to, but do talk about it.
i will make this short.
2010 went in AF
2010-2014 2 x cardioversion failed. 2 x ablations failed
2014 open heart surgical ablation worked.
october 2021 reverted to AF
april 2022 cardioversion worked
may 2022 reverted to AF
consultant feels now my heart likes being in AF. cant do anymore ablations because heart is to scarred for previous ones.
wont prescribe amiodarone as it is not good if you want to remain active.
wont fit a pacemaker as he feels i am too young.
going for rate control rather than rhythm control as i can still ride when rate is controlled.
one thing every consultant as told me........... once you start with AF chances are you will revert back eventually.
good luck with your outcome.
Blimey Ton, you've been thru the mill with it. I've had 4 cardioversions, 2002, 2006, 2009, 2016 and an ablation in Sept 2019 which has proved successful so far......
OP...I'd stick with the advice above, gentle exercise until you see the cardiologist....and by gentle, for me it would not be a 5k run but a 10k walk would be fine. Do what 'feels right'
I’d wait until you’ve soon the cardiologist but depending of the extent you may find you can carry on as normal.
@colournoise you can tag people in a post.
I had an ablation in 2016 following a number of AF episodes. Mine worked first time (tho I came close to having a pacemaker fitted while as was under as things "got bit exciting" to quote my surgeon). So far, I've had no further episodes. My surgeon told me I could go back to doing whatever I was doing before, and I have since trained for, and completed, the TransRockies.
My surgeon said that he'd seen an increase in AF over the years, and a good proportion of them were endurance atheletes, in particular cyclists. His theory was that cyclists stress their hearts for far longer than, say, runners - because there aren't really many people who run for hours on end - but cyclists "commonly" do 4, 5, 6 hours or more.
My wife went into AF after completing an ultra a few years ago. Not fun and took ages to get it back into rhythm. Had various tests but never did find a cause. They think it might have been low salts (long run on a hot day) but that’s just a theory. She was super nervous for a while but has had no further episode despite having done a few longer and tougher ultras since. So, certainly get it checked out but don’t stress about it too much as it may just be a one off thing. I hope so.
Thanks all!
So it sounds like it's bad news, that could turn out to be not so bad maybe, or possibly get worse long-term. It really helps to hear other similar A&E experiences, glad I'm not alone here in feeling scared shitless. Taking it easy will have to be my plan for now until I see a specialist. Trouble is, I'm so bloody competitive (with myself mainly!). But walks with my camera it is for now then.
Fingers crossed!
Not a great deal of help (my heart issues have been that it just stops for no apparent reason) but a mate has had several ablations that haven't really worked for long. However, most recently he had a cryoablation and it has lasted considerably longer.
This is a problem that plagues arrhythmia clinics. I am a doctor working in this field. I'm not your doctor. Not medical advice.
The first thing to say is don't panic. It's almost certainly not a dangerous condition for someone in their 40s (your cardiologist will be able to advise you on this directly), but it certainly has the capacity to be very frustrating and, at times, limiting.
It does appear that AF itself is more common in endurance-type athletes, though what constitutes endurance / how much exercise is 'too much' is unknown really. Probably the best evidence comes from registries of Nordic skiers, and they found an increase in AF depending on the duration/intensity or training and the number of ski events entered over a lifetime. But these are really at the very extreme end of the endurance athletic spectrum, and it's not clear how much training is 'safe'. Certainly, being inactive is also a risk factor for AF. It appears there's a U-shaped curve and no one really knows where the inflection points are.
In addition to that, it's probably disproportionately common (at least where I work) for cyclists or endurance runners to come to the AF clinic. Partly I suspect that's because this group is far more likely to have an awareness of their heart rate and athletic performance. They're also more likely to suffer as a consequence of AF, because it impacts their lifestyle so directly. So I suspect these people are more likely to seek medical attention, which skews the referral stats.
Unless, perhaps, if there's a repeated, specific, event that seems to trigger AF in an individual (like the ultramarathon example above), I am loathe to tell people to stop or reduce exercising, since there is no real data to say that doing so actually helps, and it can have a big impact on wellbeing. It's even possible that the left atrial fibrosis has already occurred and no amount of detraining will ever 'fix' that, though, again, this is unknown. Basically, there's so much we just don't really know so it's hard to be prescriptive about exercise. On the other hand, it does seem that endurance sport and cycling in particular is particularly high risk for AF, so some people like to try other sports which might be lower risk, or switch to shorter distances etc. If you can, try to speak to a cardiologist who understands the need of MAMILs to exercise.
I really feel for you though - I'm just waiting for that day when AF gets to me! Good luck.
.
I've got some heart arrhythmia issues, but they're exercise induced PCVs rather than AF. Apparently they're benign, but when I have a bad period they feel bloody awful and are a right mind-****. I'm going in for an ablation next week to try to get rid of it.
I have no idea what triggers them - they seem to come and go and Change in severity at random.
Its worth taking a look at the book 'the haywire heart' which covers many of the things @Superficial mentions.
@Ton really sorry to hear you are back in AF. Hope you find a way to manage it.
If you can, try to speak to a cardiologist who understands the need of MAMILs to exercise.
If you can get referred to Papworth, half their eltrocardiology department are very keen cyclists...
NB At least one of them is available to see privately...
https://www.nuffieldhealth.com/consultants/dr-claire-martin
Slightly ironic that the head of department normally causes me to hit max HR chasing him up hill - I often shout out my HR following him, 190, 195, 197....
I have had this for several weeks resulting in a trip to A&E yesterday by ambulance as I couldn't stand up. I have a resting HR of <40 but the paramedics machine was spiking from 80 to 157. May max HR is only around 170. I am 57 and have ran "competitively" for 40+ years. This does seem to have come on since I had Covid several weeks ago.
I have seen a consultant and a couple of specialist now and am undergoing more tests but other than the AF everything seems fine and my heart is extremely strong they tell me (as I would expect) I had big plans for racing in my age group but it dies appear that slightly harder runs trigger it so at the moment some rest, cut out coffee and alcohol then reintroduce some easy running until I have more information. Dr happy with the running just dial it back a bit.
It is constantly disconcerting feeling the constant out of rhythm beats and rapid flutters. At the moment I am glad that I feel better than I did yesterday but I can soon see myself getting depressed if it reduces my activity.
Stay active and speak to the Docs. Don't do what my BIL does and he's become an old man overnight. Wasn't into exercise but has really stopped doing much, even walking far. He's only 60. Got him self all worked up about the electric shocks, and hasn't had it yet. Still getting AF, but being controlled with meds. For someone that was ex. military, he isn't half a soft geezer.
MIL's AF is impressive - spikes from 40 to 160 in seconds. She's 85 and immobile - not much they can do, but she plods on. She forget's she's got it, and when she's in hospital they ask if she has AF, 'no' is the answer usually, but her warfarin card has 'AF' written in big letters on the front ! It's scary watching her heart on a machine - literally all over the place.
Many years ago I had a full check up via work, about 20 years ago. The doctor said 'just looking at your readout, if I didn't know you did alot of cycling, I'd be thinking you were about to have a heart attack'.
If you can get referred to Papworth, half their eltrocardiology department are very keen cyclists…
heck of a trip from New Zealand 😂
Totally worth it though. They have some really, REALLY good people working there. It's just a shame they moved from actual Papworth to Addenbrokes. It was nice having a hospital next door.
(I am serious though, the people that work at Papworth are really good. I got my RF ablation done there)
Thanks for the tip @el_boufador with the 'Haywire Heart' book. That really looks like a must read! 👍
The Haywire Heart: How too much exercise can kill you, and what you can do to protect your heart
I'll have to see what this book says, but for the moment, I'll stick to consensus advice I'm seeing on various heart health websites - which for my age - seems to suggest I shouldn't exceed 149 bpm (85% of maximum).
I've bought a HRM for the first time - and am trying to figure out how the bloody thing works! It will be good because I've only ever trained by feel up to now - and the 'feel' I have tended to go for more often than not for is 'completely smash myself to pieces', which is often probably far in excess of 149 bpm!
It looks like the cardiologist appointment will be a long wait here, so even if I could get to Papworth from NZ, it will be a while before I can get an expert opinion.
Nevertheless, my GP told me today that I 'shouldn't stop exercising', so I'll just have take things cautiously - with the HRM as my guide.