37 year old, diagnosed 18 months ago.

Long time lurker! Thanks for the collective support and insights. I am a 37 year old male, who has spent much time in their 20's and 30's doing 12-22 hours+ of endurance training (all cycling). 18 months ago I was hospitalized with flu and pneumonia, as well as Afib. It was my first time going into AF, and a scary experience. The hope was it was triggered by the Pneumonia (common from what I have come to understand). I went about 3 weeks with nothing, then boom, another episode. Since then I have gone up to 5 months without symptoms and unmedicated. More recently, the burden has increased. I started Flec. 100/mg 2x daily one week ago, and have still had 2 break throughs.

In the last 18 months, I have seen numerous cardiologists (EPs and general cardio), and have been fortunate to work with someone who specializes in athletes with arrhythmia.
I have been on a few meds (a total of 3 months in the last year and a half. Propafanone raised my alk phos to 2700, and was curtailed) for the arrhythmia, with varying degrees of success. Additionally, I have been seeing a functional MD, hoping this might provide the 'silver bullet'. None so far!!

I want to do everything I can to prevent this from becoming a bigger problem. I competed as a pro cyclist for a number of years, which I feel may along with diet and stress contributed. I certainly had eating issues...6'5'' and weighing almost 150 at times. I am convinced the lack of sleep, poor nutrition/anorexia and low testosterone, etc. helped get me here. No family history of AF, only tachachardia with my mom and her dad had a pacemaker, yet lived to 103.

I have ridden my bike maybe 5 times since the diagnosis, but run and lift weights now. My weight is better, 170-175, but I struggle to gain mass, despite my best attempt.

Sleep is definitely a weakness as is work stress. My labs reveal low T (350), higher TSH (3.0), low Vit. B, Copper 48, Thiamine (b1) 60, Zink 60, Parathyroid 100, Alk Phos is still 175, after being off Propafanone for 12 months. Ferritin is 19.2, t3 Free 2.5, T4 .9, Mag. 1.7 (despite 600mg of Mag Glycinate daily for last year), Dihydrotestosterone is 244.

I do not eat dairy or mammalian meat, and generally eat a very clean diet with lots of fruit/veg/fiber. I have tried Tuarine, as well as fish oil with no success.

All feedback suggestions are welcome. Ablation was not something I considered until recently, given my age and decrease in cardiac output. However, I am starting to think this might be something to reconsider. I continue to hope there is a dietary component I am missing, or something with my labs. I also understand sleep and stress are the low hanging fruit!

What am I missing? Thank you, Greg

Quote
GregH
Ablation was not something I considered until recently, given my age and decrease in cardiac output.

What do you mean by decrease in cardiac output and what does that have to do with an ablation?

Post ablation, there is a risk of 20% reduction in cardiac output (call it reduction of VO2). This is being studied and evaluated by a few cardiologists I have worked with who have good data to support the theory.

Quote
GregH
Post ablation, there is a risk of 20% reduction in cardiac output (call it reduction of VO2). This is being studied and evaluated by a few cardiologists I have worked with who have good data to support the theory.

I'd love to see the data on that because a 20% reduction in cardiac output from an ablation sounds like a seriously botched ablation. No such reduction should occur and has never occurred to anyone I know about, which is quite a few.

Greg,

Do you eat fish? The low ferritin may be from your diet. Taking Vitamin C along with your greens may help absorb more iron form them. Ferritin is a "Goldilocks" measurement, not too much, not too little. 19 is on the low end. 40 or 50 would be better. I'm not a high protein fan, but your diet may be a bit low. I'd run your diet through a calculator like <[cronometer.com] to see how much protein you are getting from all sources. 0.37 g/pound of body weight/day is kind of a rock bottom minimum. In your case this would be 175x0.37=65g/day. Also the veg protein is usually less bioavailable than meat/fish, so maybe adding some fish would help.

Chronic fitness is the path of ~15% of all afibbers. They are generally younger when diagnosed. (<50).

This was my path. Turns out the product of duration and intensity is a trigger for me. So I can do very intense exercise for short duration (Tabatas) or long duration, but modest intensity. Magnesium (and detraining from endurance) is what has kept me mostly in remission for 14 years after an initial 2.5 month episode at age 49. I also use a loading dose of flec (300 mg for those over 154 pounds, 200 mg for those under) when I do go out of rhythm (infrequently now), otherwise no other meds. Magnesium to bowel tolerance was my ticket. Right now that is 2.5 to 3 g/day and that is not bowel tolerance for me. While I maintain good fitness (bodyweigt trainingt: TRX Military Fitness, Convict Conditioning also super slow to failure strength training, plus Tabatas), I do not train any endurance activity at all and will avoid activities that look like endurance. For example, I can alpine ski all day, but will not do cross country because of the endurance aspect. If I do long hikes, it is not pushing myself at high heart rate.

I concur with Carey that I've not heard of the 20% reduction in cardiac output from ablations, at least from the top centers like Natale.

George

I think maybe I know where the 20% number comes from. It's not cardiac output. It's the "atrial kick." That's the blood pumped into the ventricle when the atria contract, which adds about 20%.

It's true that an ablation can lower that number, but afib lowers it to zero so it's not exactly the trade it might appear at first. Loss of the atrial kick would matter for a pro cyclist but not much for non-pros.

Quote
Carey
I think maybe I know where the 20% number comes from. It's not cardiac output. It's the "atrial kick." That's the blood pumped into the ventricle when the atria contract, which adds about 20%.

It's true that an ablation can lower that number, but afib lowers it to zero so it's not exactly the trade it might appear at first. Loss of the atrial kick would matter for a pro cyclist but not much for non-pros.

My impression from all my previous reading here and elsewhere over the years is that the 20% that the atria contribute to cardiac output can be diminished by ablation. That said, any such diminution should be negligible for one or two ablations carried out by a top EP but could become measurably significant after say half a dozen ablations by less experienced EPs at lower volume centres. As always, happy to be corrected and educated! As Carey says, a 1 or 2% reduction in ablation-caused atrial output is a helluva lot better than no atrial output at all.

Here is an old paper on dogs that is on the cardiac output topic, <[www.ncbi.nlm.nih.gov]

Atrial function was measured before and 30 +/- 24 days after a biatrial ablation procedure designed to cure atrial fibrillation in eight dogs and after a sham procedure in three dogs. Atrial mechanical function was assessed using Doppler diastolic blood flow velocities, atrial systolic pressure wave amplitude, and assessment of atrial contribution to cardiac output estimated by comparison of AV sequential pacing to ventricular pacing at the same heart rate. The mitral Doppler A/E velocity ratio was 1.03 +/- 0.45 before and 0.72 +/- 0.43 after ablation (P = 0.048). The tricuspid A/E ratio was 0.88 +/- 0.17 before and 0.71 +/- 0.12 after ablation (P = 0.04). The estimated atrial contribution to cardiac output was 18% +/- 9% before and 5% +/- 4% after ablation (P < 0.01). The left atrial systolic pressure wave amplitude was 2.8 +/- 1.5 mmHg before and 1.7 +/- 1.0 mmHg after ablation (P = 0.1). These changes were not observed in control dogs. Lesions covered 25% +/- 6% of the atrial endocardial surface.

A competent ablationist will only ablate the minimum necessary to accomplish the task, so the extent of the reduction will depend on the severity of the case and the skill of the operator.. In any case, in afib you lose 100% of the atrial kick, so you'd be better off with the ablation than in afib.

Quote
GeorgeN
Here is an old paper on dogs that is on the cardiac output topic, <[www.ncbi.nlm.nih.gov]

I feel fortunate that I don't have to chase squirrels.

You are most likely magnesium deficient or have an imbalance of calcium and magnesium.
GeorgeN is the expert when it comes to athletes who push their bodies so hard.
Take hIs advise about traIning and take magnesium, it will also help you sleep better.

I think the fear here may be overblown. I can’t tell any difference in running between pre-ablation and post-ablation. Sure, in the immediate aftermath of the procedure there is a lessening of tolerance but you can train right back out of that. I did.

Of the reasons to forgo ablation, this one’s something like seven hundred and fifty five.

My two cents, anyway.

Quote
wolfpack
My two cents, anyway.

I'll throw in two more.

After 6 ablations I haven't noticed any significant performance reduction. But while I was on meds? Oh hell yes. All of them had profound effects on me. Beta blockers were like tying lead weights to my arms and legs. Sotalol was the worst. Flecainide capped my HR at 105 no matter what I did. Tikosyn made my heart rate drop suddenly from 120 to 30 at random times during exercise, making cycling too dangerous for me to continue.

If I've lost a few percentage points of cardiac output to ablations, I'll take it over meds any day.

Quote
wolfpack

Of the reasons to forgo ablation, this one’s something like seven hundred and fifty five.

My two cents, anyway.

Wow, how long have you been working on that list?

Quote
jpeters
Wow, how long have you been working on that list?

You forgot the smilie on the end of that! (I hope... )

Quote
Carey

My two cents, anyway.

I'll throw in two more.

After 6 ablations I haven't noticed any significant performance reduction. But while I was on meds? Oh hell yes. All of them had profound effects on me. Beta blockers were like tying lead weights to my arms and legs. Sotalol was the worst. Flecainide capped my HR at 105 no matter what I did. Tikosyn made my heart rate drop suddenly from 120 to 30 at random times during exercise, making cycling too dangerous for me to continue.

If I've lost a few percentage points of cardiac output to ablations, I'll take it over meds any day.

I fully agree.
As long as I don't take meds (betablocker or AA drug), I'm OK. I've never been a great performer (no competition), but I rode 5000 to 7000 km a year on my bicycle, which means I was physically fit.
The problem now is I'm not afib free, nor meds free, after ablation. So, most of the times, I'm taking a betablocker (2.5 mg bisoprolol) in the evening, just in case I've to take my PIP flecainide. I've already tried not taking meds during some days, and the sensations are good. If I'm slower than before, it's not because of the ablation, but because I don't practice as much as before.
Nevertheless, afib is the worst condition. I can't ride at all. I'm better taking meds than having afib. Now I'm slower, but I enjoy the landscape a lot more.

Greg
I am 36 and was diagnosed about the same time you were. I am healthy and work out quite a bit (10-15 hours/week), but sounds like I’m nowhere near the shape your in.

Looking back I can remember at least a few times in the last 15 years or so that I was most likely out of rhythm.

When I was first diagnosed I didn’t even know there was anything wrong, I was having and ekg done for a police physical. At that time I ended up being out of rhythm for at least 5 weeks. I eventually converted on my own and with supplements and diet tweaks I am in a much better place. I prefer not to take any pharmaceuticals so currently I am in rhythm about 60% of the time, usually 4 days out of a week. These numbers aren’t great, but I’m still working on it. The most frustrating part for me has been the randomness as I’ll pop out of rhythm for what appears to be no reason.

I don’t really have any advice to offer that isn’t already on the forum, I really just wanted to let you know that there are other younger people out there going through this too. I read something the other day that said of those with afib people under 40 account for 0.004% of the population. Just something to keep in mind when the doctors are handing out treatment plans. Make sure you trust your doctors and do your dodilligence regarding any research.