UK EP who specialises in endurance sports

Can anyone recommend an EP in the UK who specialises in working with endurance athletes — including the amateur variety like me! — with AF that's sports-related? Or failing that one in the US who might be able to connect me with one in the UK?

All suggestions most gratefully received.

Thanks

Eugenie

I would be surprised if there's an EP in either country who specializes so narrowly. There are sports medicine doctors, but they're typically not cardiologists and certainly not EPs. I don't know why experience treating patients who engage in endurance sports would be important for an EP since the treatments are going to be the same

Thanks, Carey.

You may well be right, but I ask because the research strongly suggests that there are significant differences between how endurance athletes and less active people respond to the various ablation options. Same applies to medication.

We may be a subset, but we're a pretty large subset and one with an AF challenge that is becoming increasingly widely recognised.

So I am interested in finding an EP or, failing that, a UK-based cardiologist who has some specialist knowledge in this area.

York Cardiology - Dr Gupta might know?

You can be encouraged by the statistics that show athletes with AF respond quite favorably to ablation. Like Carey said, it’s not going to change the treatment but it would be good to pair with an EP who is at least aware of that fact. Being in the UK, as I understand it, a first ablation is most likely to be done by cryoballoon. If possible, I’d suggest finding an RF operator but in any case do ensure that whomever you choose is highly experienced with more than 1,000 cases of complex, left atrial ablation under his or her belt.

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emv54
You may well be right, but I ask because the research strongly suggests that there are significant differences between how endurance athletes and less active people respond to the various ablation options. Same applies to medication.

I'm unfamiliar with this research. I'm having a hard time imagining how ablation results would differ other than the obvious fact that athletes are going to have fewer comorbidities and be in better health overall so they'll suffer fewer complications and recover faster.

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Carey

I'm unfamiliar with this research. I'm having a hard time imagining how ablation results would differ other than the obvious fact that athletes are going to have fewer comorbidities and be in better health overall so they'll suffer fewer complications and recover faster.

You're right that the bald success/failure stats are very similar, but it's to do with what happens when you start training again. I just want to find a specialist who understands where I'm coming from, I guess. Someone who gets that — while it may seem frivolous to many — being able to train and compete remains important to me despite being in my 60s. I run, stand-up paddleboard, and open water swim.

I've managed my paroxysmal AF pretty well up to now without any intervention, but want to explore all the options and do so with someone who isn't going to dismiss my priorities as inconsequential — particularly 'at your age'.

Does that make sense?

Many thanks for all your responses — much appreciated.

I was not a professional athlete but very much into endurance sports for many years (20+), putting more than 13 hrs per week and participating in various IM 70.3 and lots of 21K and 10Ks. I started with paroxysmal and later on went into chronic afib, was in my mid 40's. Decided to go the ablation route with Dr. Natale.
I had many talks with Dr. Natale regarding my need of getting back to my training routine since I am a sports junkie. He said that as long as I am properly hydrated I can go back to whatever routine I decide to follow. He even send me to start with my activity 7 days after my ablation, I now can say that I have never been in such a good shape in my life, my running pace has improved tremendously as well as my bpm´s.

I suggest you find the best possible EP operator in the UK who works in a high demand ablation center, I have heard many positive comments in this forum and others regarding Dr. Sabine Ernst at Royal Brompton, also in case you can travel, there is a very good EP Lab in Bordeaux France lead by Dr. Haissaguerre and Dr. Pierre Jais (Bordeaux Group)

Cheers,



Edited 1 time(s). Last edit at 11/23/2018 10:31AM by fravi.

I think what you're going to hear from any EP, even ones who "get it," is you're going to need to back off the intensity a little. I and many others continued our athletic pursuits following ablations without problem. I've done 50+ mile bike rides in hilly terrain days after an ablation with the EP's full blessing. But I don't compete, so I'm sure my intensity is lower than yours. The duration of exercise and intensity is the problem. It leads to atrial enlargement, and atrial enlargement leads to afib. So I think almost any EP is going to recommend backing off a bit. That doesn't mean stopping your athletics at all. It just means running marathons instead of ultra-marathons.

Thank you all for your input — much appreciated. I'm blown away by the breadth and depth of knowledge here

Eugenie

I completely concur with Carey. While I maintain excellent fitness (I am not ablated), backing off endurance training (and no competition) has been an important part of my afib remission protocol. In my case it is the product of intensity times fitness that is the issue. I can do relatively low intensity activities for a long period of time. I can also do very intense activities for short periods of time (think HIIT Tabatas). Put them together and I have an an afib trigger.

George

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GeorgeN
Put them together and I have an afib trigger.

Yup — that sounds very familiar! After a rather challenging couple of weeks afib-wise, I am now embarking on a bit of recalibration. Going to test what happens with occasional short eyeballs-out SUP and run efforts interspersed with longer sessions at a significantly slower average pace than I'm accustomed to. And fewer of both, with more recovery time in between...

Not looking for miracles here, but hoping I can find a mix that keeps me on an even keel while I continue to consider whether to ablate or not.

I've also just taken delivery of a Kardia AliveCor so I can monitor with some degree of accuracy.

One thing I can't stress too strongly is hydration and maintaining proper electrolyte balance, especially potassium. I used to think I hydrated adequately on long bike rides, but afib taught me I was wrong. I literally doubled the amount of water I consumed before, during and after rides, and made sure I always added something salty and potasium-y. (In a pinch, a small bag of potato chips is a great source of salt, potassium and carbs.) I found that doing that significantly reduced my afib episodes. In fact, dehydration and low potassium levels are the only triggers I ever confirmed with testing. And I tested a million things that seemed like triggers, but every one of them was a false lead except dehydration and potassium.

In my case, potassium plays second fiddle to magnesium. If I get magnesium right, potassium falls into line. Afib came to me in July 2004, a product of a (several day) delayed vagal trigger after a training run on a 14,000' peak. Within two months I progressed to a 2.5 month episode that wouldn't convert. My EP agreed to prescribe flec on demand, to be used when my electrolyte repletion protocol failed. I've successfully done this for 14 years. The key components of the protocol are a) magnesium to bowel tolerance; b) detraining on endurance activity while maintaining fitness (I rock climbed for 5 hours at 7,500' today in 31 deg F temperature and wind in the tees with only shorts on); to a lessor extent c) taurine intake and d) potassium intake.