Another Newbie

Greetings from a "new" afibber. A little background:
66 year old male. 6'5", 225 lbs., 10% body fat. No significant medical history. No meds. Social drinker.

My first experience was one year ago on a century bike ride. At 60 miles I could feel my heart racing and thumping in an unusual fashion. Almost abandoned the ride. Ten miles later, no issue. I rode 50 miles the next day without incident. Six months later I awakened in the middle of the night with same feeling. Irregular heart rhythm for three days. Reoccured three months later and never abated. MD sent me to an EP at Barnes-Jewish in STL. You know the diagnosis.

Sleep study negative. Mild hypertension only at EP office. No history before that. Losartin 50 mg. prescribed, tolerated poorly. Cut back to 25. And of course, Eliquis.
First cardio version lasted for five hours.

A month later, Tikosyn started in hospital. Cardioversion has lasted for six weeks. Periodic palpitations. Karidia usually reads "Unclassified" during these sessions that last about an hour, although it did read "Possible A-fib" on one occasion. Otherwise it reads "Normal".

For a former endurance athlete who just a year ago was biking centuries and lifting regularly, this has been shocking. I doubt I could comfortably do ten miles on the bike and any time in the heat "wipes me out". Since my first cardio version there has been no lifting, no riding and no alcohol.

I'll admit it. I am freaked out.

I'm sure there will be more to follow. Glad I found this forum.

As an endurance cyclist myself ( who has done his fair share of century rides ) I totally feel for what you are going through. I just went through this myself.

My suggestion to you is if you want your old lifestyle back, find out if you are a candidate for an ablation and if you are, have it done. If successful, and most are, you will be back on the bike, drug free in no time.

I had an ablation 7.5 years ago and was afib free until very recently. I went through a bout of afib and was put on beta blockers and then Flecanide. I absolutely hated my life! Was miserable for months ( albeit, afib free ) and decided to have another ablation. It is scheduled in 7 weeks from now.

I actually made a deal with my wife that I try the pill in the pocket method ( as it worked to convert me and I’ve stayed afib free ever since ) and go completely off the drugs. I couldn’t be happier! My life is back to normal, lost 10 lbs, cycling a ton and if I keep this up, will take a rain check on the ablation. I do take a bunch of supplements ( you can read about them on this forum ), eat a banana a day, drink low sodium v 8 juice daily and drink tons of water.

You may want to try this method first and see if you convert on your own. For me it was 200mg of Flecanide and 50mg of Metropolol. Worked in 2 hours.

But again, if it were me, I’d persue the ablation road as well.

Good luck to you!!!

docboss,

There are kind of two categories of afibbers. The largest group are older and have many comorbidities. The second is generally younger (you are a bit of an exception - took you longer to get to afib - I started 14 years ago at 49) and are chronically fit. The latter group makes up 10-15% of afibbers in general. Many have shown up here over the years shocked that they could have heart issues when they are so fit. Bottom line is what may be good for the plumbing is not good for the electrical system, at least in your (and other chronically fit afbbers) case.

In my case, detraining from endurance activity plus magnesium to bowel tolerance has enabled me to remain in remission most of the time with a very small AF burden (<0.01%). I started with a 2.5 month episode in my first four months, so the first four months of my afib career was not auspicious to be able to do what I've done since. I also use on-demand flecainide to terminate any episode I do get as soon as possible (300 mg loading dose for those over 70 kg (154 #'s), 200 mg for those under). It usually works in an hour or two.

I remain very physically fit, but now look at training as minimum effective dose. For me, the product of intensity times duration is the issue. So very high intensity (think 8x30:10 Tabatas) are OK as are long duration low intensity activity. I typically train with a lot of bodyweight exercises. I can rock climb for 7-8 hours in the sun at 7,000' or ski hard off piste' for 7 hours at 12-13,000' without issue. I cannot add hiking to each lap skiing for extra vertical without it being a trigger. I don't join my 32 year old friend who skins up and skis down at the beginning of the day as the skinning up would be a delayed (vagal) trigger. I can carry a 50-60 pound climbing pack up a steep rough trail for 45 minutes, but I don't push my speed in doing so.

You get the picture. I'm 63.

If you decide for an ablation. Most here will suggest you go to a very high volume center with a doc who does many hundreds of afib ablations a year. I would suggest that Andrea Natale in Austin is the premier choice and would be my first choice if I ever needed one.

Good luck!

George



Edited 2 time(s). Last edit at 09/14/2018 01:29PM by GeorgeN.

Welcome to the forum. Sorry you found the need to join us, but here you are. You can stop being freaked out now. :-)

I'll go with SocalSteve's advice but I would add two things:

1) Don't just go find the local electrophysiologist (EP) and sign up for an ablation. You need someone who's done at least many hundreds -- preferably thousands -- of ablations. Do not just go with whoever your doc recommends and definitely not somebody at a small center. Do your homework to find the best there is and we can help with that.

2) In the meantime, dehydration and electrolyte imbalances are your mortal enemy. I'm sure you think you hydrate adequately. Well, you're wrong. You don't. Whatever it is you're doing now, double it. Yeah, really -- double the water you're consuming on rides. And you need to add a bit of salt and potassium to go with it. Forget sports drinks. They're better than nothing but mostly they're just sugar-laden crap. Don't laugh, but honestly, you know what I think is the perfect sports "drink"? A ton of plain water and a small bag of potato chips. That's a near-perfect combination of water, salt, potassium, and some carbs for energy. There are, of course, healthier options, but for a cyclist on a long ride with a convenience store being the only option, that's an excellent solution.

Thanks for the input. I'm drinking two Virgin Mary cocktails with low sodium V8 every morning. Taking Potassium and Magnesium supplements daily, plus my new meds. Strange for someone who only took the occasional Motrin for low back pain. My appointment with my EP's nurse practitioner is next week. Probably to check vitals, EKG and some blood work to see how I'm doing with the Tikosyn.
Contacted Natale's office in Austin (great cycling town). Nice folks.
My local EP says he has done over a thousand ablations and is on the Cox Maze "team". That is a really scary procedure.
BTW, I guess some of this may be hereditary. My departed father had a history of arrhythmia. He was an amazing physical specimen well into his 70's.

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docboss
Thanks for the input. I'm drinking two Virgin Mary cocktails with low sodium V8 every morning. Taking Potassium and Magnesium supplements daily, plus my new meds. Strange for someone who only took the occasional Motrin for low back pain. My appointment with my EP's nurse practitioner is next week. Probably to check vitals, EKG and some blood work to see how I'm doing with the Tikosyn.
Contacted Natale's office in Austin (great cycling town). Nice folks.
My local EP says he has done over a thousand ablations and is on the Cox Maze "team". That is a really scary procedure.
BTW, I guess some of this may be hereditary. My departed father had a history of arrhythmia. He was an amazing physical specimen well into his 70's.

How are you doing with this drug? Supposedly it is one of the best drugs for athletes. I am a member of a cycling forum and we have a member who is an endurance athlete and a EP doc. He recommended this drug. But everyone reacts differently. If you are not able to ride or do the things you want to do, maybe this is not the right drug for you.

I am not a doctor, nor do I play one on TV, but only going from my own personal experience... I would hope you would be able to get back to your normal lifestyle. You may want to persue other avenues-drugs-procedures.

Again, best of luck to you!

Thanks. My EP is an avid cyclist. I have not ridden in three months. My last ride was before the Tikosyn (a really bad ride), so I have no experience on the bike with the drug. Depending on the information I get at my upcoming appointment, I may try to do a few miles and see how I feel.
It should be funny getting on my loaded Propel and puttering along with the folks on their vintage Schwinns. I really miss the lifting but, like my riding, I have a tendency to push the limit.
My EP told me the Eliquis is recommended for cyclists because there is a lessened risk of cerebral hemorrhage should there be a crash.
If there is a better than 50/50 chance that I will ultimately need an ablation, I am inclined to get it done. Most endurance cyclists I know are type A++ and won't just sit around hoping the drugs will work long term. I just hate to have anything "intrusive" done. Don't even ask about the cardiac cath I had done in 2004, other than the results were that my arteries looked like "garden hoses".

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docboss
Thanks. My EP is an avid cyclist. I have not ridden in three months. My last ride was before the Tikosyn (a really bad ride), so I have no experience on the bike with the drug. Depending on the information I get at my upcoming appointment, I may try to do a few miles and see how I feel.
It should be funny getting on my loaded Propel and puttering along with the folks on their vintage Schwinns. I really miss the lifting but, like my riding, I have a tendency to push the limit.
My EP told me the Eliquis is recommended for cyclists because there is a lessened risk of cerebral hemorrhage should there be a crash.
If there is a better than 50/50 chance that I will ultimately need an ablation, I am inclined to get it done. Most endurance cyclists I know are type A++ and won't just sit around hoping the drugs will work long term. I just hate to have anything "intrusive" done. Don't even ask about the cardiac cath I had done in 2004, other than the results were that my arteries looked like "garden hoses".

Smart decision! Being an athlete, arrhythmia drugs are absolutely the worst! 2 best decisions I’ve made in regards to my afib. 1. Having the ablation 7.5 years ago. 2. After it came back, going off the arrhythmia drugs so I can enjoy my life again, The pill in the pocket method seems to work for me. Maybe it can for you too. Not harm in asking-trying it out, especially if the drug you are on now limits your lifestyle.

Docboss,

Like you I arrived at Afib via chronic endurance exercise - cycling for me as well. It's been four months since I was diagnosed and I'm having reasonable success with 200 mg Flecainide and 50 mg Metoprolol per day, all the supplements you mentioned and no alcohol, though my cycling is greatly limited. Psychologically it's been a real challenge to go from a self-perception as being very healthy to requiring meds twice a day and regularly meeting with specialized cardiologists. I also miss the camaraderie of riding with friends. Both have gotten better over time, however, thanks in no small part to the fine people on this forum who so generously share their knowledge and the hope that has provided.

Best of luck to you.

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Socalsteve
How are you doing with this drug? Supposedly it is one of the best drugs for athletes. I am a member of a cycling forum and we have a member who is an endurance athlete and a EP doc. He recommended this drug. But everyone reacts differently.

Interesting. I guess I'm one who reacts differently. I was on Tikosyn last year and had to quit riding my bike because of it. It would cause sudden drops in heart rate while I was riding. For example, if I was cruising along with a HR of 120, it would suddenly drop into the 30s for a few seconds. The result was near syncope, which I knew was going to become real syncope sooner or later so it was just too dangerous to keep riding.

You folks have given me quite a bit of information and created a host of questions for my EP. I will report on my visit next week. It appears this is not uncommon as my local bike shop knows of several serious riders who have developed afib, including one most accomplished semi-pros in the area. I stopped by the shop to ask about an e-bike.
Depending on my visit, I may "test the waters" on the bike or hit the weight machine next week, but the issue of possible syncope is unnerving.

Apparently there’s no safe level of biking!

Welcome to the club nobody wants to join. I, too, came to AF via fitness. Running 35+ miles/week. In my experience, drugs suck for vagal AFers and ablation works well. Certainly weigh your options and choose your path. We’re here to help.

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docboss
but the issue of possible syncope is unnerving.

Keep in mind that was an experience unique to me. I've never heard anyone else report it, so assume it won't affect you until it actually does. If you and your EP think Tikosyn might be the right choice, I'd give it a try. It does have advantages for athletes because it doesn't have rate limiting or BP lowering effects like most of the other antiarrhythmics do.

Here is what I learned at my appointment at the EP office.

I saw his PA's. Had an EKG and blood drawn.
1. I am in sinus rhythm. The charts of my times of palpitations as recorded by Kardia machine were PAC's and were not an indication of issues of going back in a-fib. She said it was normal in the first month but the tikosyn would actually work better as I stay on it.
2. No restrictions on "reasonable" lifting, bike riding or alcohol.
3. When I enquired about an ablation, her personal opinion was that I should seriously consider it as an alternative to life-long medication. Her reasoning is that I am in the best shape I will ever be in. She recommended I speak with EP at three month anniversary.
4. I am to cancel upcoming colonoscopy because I cannot go off Eliquis. The highest risk of stroke is in first 90 days of cardioversion.
5. Recommended that I get flu and shingles vaccination.
6. No adjustment of meds.
7. EKG and blood work again in three months.

So, based on this, I am feeling a little more comfortable. Bike goes on the wind trainer and light workouts on the universal weight machine. I am undecided about a martini tonight.
Thanks, Doc.

PA says my EP has done thousands of ablations. Success rate 70%, however they measure success.

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docboss
I am undecided about a martini tonight.

Good opportunity for making more healthy decisions.

Latest news from EP. I am still in normal rhythm taking my Tikosyn. He states this is the case with 60% of patients. He does not recommend ablation unless I choose it based on lifestyle decision. BP is under control with 25 mg.Losartin. I asked about resuming my "high mileage" cycling and weight lifting. He advised me to build up my cycling slowly but there are no limitations. He is more concerned about the possibility of trauma should I fall or crash (more on that later).
Powerlifting is not recommended. Sets of 12 reps are ok but maxing the weight and doing low reps is forbidden due to BP spikes.
With regard to the Eliquis I am taking twice a day. He says I may substitute 81 mg. of aspirin daily for the Eliquis. This stems from his concern about bleeding due to trauma.
This, IMHO, is all great news. I cannot wait to get out on the bike and get my aerobic fitness up and weight down. Since I have not been able to ride outside and only lifting, my weight has increased. Body fat has only gone up a bit as the lifting has put on mostly muscle, but I really feel the loss of endurance.
EKG was ok, BMP was ok. Follow up with EP in a year. BMP and PA every three months.
AND, a couple of martinis a week is ok.
Still taking my magnesium and potassium supplements and a glass of V8 spicy, low sodium each morning.
Any suggestions, comments, etc.?

You need this on a new post as few people look much beyond the first couple of pages.