Scottish Triathlete with new afib diagnosis

[tridye]

I've just been told that by A&E that my ECG picked up afib & flutter. I'm a fit 53-year-old triathlete. I am waiting for a cardiology referral which could take months. My GP wants to put me on anticoagulants. I've refused just now. I feel like I've been hit with a life-changing bombshell and don't know where to turn for advice. I eat well, sleep well, don't drink, smoke etc. I'm not overweight. I train hard with swimming, cycling, running and gym work and now I don't know what to do for the best. is there anyone else who's a similar age and could share advice or experience? Also, can anyone recommend the best person to see in Scotland?

[BobD Volunteer]

Sadly for you it is highly likely that your life style is responsible for you developing AF. There is ample evidence that particularly with older amateur athletes this happens. Professionals who "retire" in their 40s and de -train suffer far less in this respect. It may interest you to know that fast jet pilots have a similar pre-disposition for AF as a result no doubt of the effort their hearts have to make to combat G forces.

Just be glad that AF is life changing rather than life threatening although of course it would be unwise to attempt triathon events whilst in AF. There are others like you on this forum so no doubt you will get some advice from them.

[pusillanimous in reply to BobD]

Yes, I live in South Africa, where extreme sports are popular. My cardiologist tells me that after older people, his second largest group of Afib patients are canoeists and triathletes.

[davebakerpurton in reply to pusillanimous]

Unfortunately, extreme athletes are 5 times more likely to develop AF, there's a difference between being fit and over stressing the body

[Hidden]

We can understand just how you are feeling at the moment. About anticoagulation, this is generally determined by what is known as the CHADsVASc score (worth a google) and males under the age of 60, with no other health issues, would normally score 0 which implies anticoagulation is not necessary. If I were you, I would check with your Doctor his reasoning because if he had good reasons for his recommendations, you could be putting yourself at the very real risk of having a life changing stroke.

Also, take the time to read all the information available on the AF Association website, link below. No doubt you will need to make some changes, but very often, folk with AF lead relatively normal lives but that probably does not include triathletes!

If the waiting list to see a specialist is long, think about a private consultation which would cost less than £300 but be careful about tests as they can be very expensive......no knowledge about Scotland.

heartrhythmalliance.org/afa...

[Hidden in reply to Hidden]

If you are female, your score may be 1, but still needs to be properly checked......

[Finvola]

Hello tridye and welcome to our group. Diagnosis of AF when we think we are doing fine is an awful kick in the teeth but, thankfully, it can be lived with.

The first weeks and months after diagnosis are the worst and as Flapjack advises, read up on the condition, the treatments and the way forward for you. Your athletic life is the likely culprit in causing AF to start but we need to have a predisposition to the condition to be afflicted with it in the first place, so don’t beat yourself over the head with reasons.

Depending where you are in Scotland, you may have to travel to see an electrophysiologist (EP) who is a cardiologist specialising in heart rhythm disorders. It is usual to have chest x-rays, echocardiogram and perhaps a stress test to determine the structural efficiency of your heart and I had those done on the NHS, then saw an EP privately to by-pass the enormous waiting lists where I live.

You, like all of us here, have been hit with a bombshell but how life-changing it may be depends on our outlook. Your lifestyle sounds really good, except for the athleticism, so you start with advantages there. The main thing now is to inform yourself - about the condition, your local cardiology facilities and keep posting here for practical and moral support. We have many members from Scotland who post regularly so that may help with finding the best cardiologist or EP in your area. Best wishes.

[higgy52]

I know mate i was in same boat as you 5 year ago at 58 years old fit as a fiddle Cycling weight lifting, and running.

I like you found out the hard way. it dont pay you to push yourself as you get older ,You have to Slow down a bit

[Barny12]

Hi Tridye. There are plenty of athletes on here who have AF. It does seem to strike us in our fifties, unfortunately.

I was a 55 year old fellrunner happily running 10 - 12 miles over mountains in the Lakes until AF struck in 2018. As per my cardiologist's advice I carried on running for another few months, until it became abundantly clear that the exercise would trigger the afib every time.

I stopped running altogether last May, but maintain a certain level of fitness through walking two or three miles every day at the moment - and while I still have the occasional episode of AF it's a lot better than previously. I'm hoping to start adding in some gentle jogging again this Spring and just see how it goes.

So, my heart goes out to you, I and many others on this forum know exactly how you feel.

It's not what you want to hear, but maybe try taking the cautious route and tone down the training for a while; keep an AF diary re foods and training, and note down whether/which exercise may have triggered the AF episode or whether it was a certain food etc.

Good luck with it, and remember, you're not on your own.

[sharonrc]

Where about in Scotland are you? There's an excellent ep at Edinburgh Royal Infirmary called Dr Grubb, would definitely recommend him.

[Hidden]

Hi same age as you and used to do alot of high intensity exercise, my advice is to take the drugs offered, see how you go and cut down your regime . Also have a look at a book called the haywire heart by dr Mandrola! Its treatable but at your age you need to slow it down ! I replaced my high intensity stuff with yoga and a more moderate regime and now pretty stable, there is a reason most professional sportsmen are done at 35, upping the intensity is not the way to go !

Andy

[etheral]

At least ask your doctor for an anticoagulant to help prevent a debilitating stroke. Your cardiologist can take it from there. Don't know how the health system works in the U K, but you should be seeing a cardiologist immediately even if you have to pay for it. Best wishes...

[mikeharrymac]

Running probably has your BP and pulse very low. Please be very wary of beta-blockers.

They will lower heart output, and combined with your low BP and pulse, can make blood vessels tortuous from the lowered volume.

[chrisfellrunner]

Hi Trydye and welcome (if that's the right phrase) to the forum from another endurance athlete (fellrunning, cycling, triathlons etc) who started with exercise induced AF + Flutter when I was 53yrs old. I've since had an ablation and am waiting to see if it has been successful. The above people have posted excellent advice, and I would caution not taking the anti-coagulants, I've been on them since first diagnosis (20mg Rivaroxaban) and they really don't impact your lifestyle too much.

I'd also strongly recommend ordering and reading the book 'The Haywire Heart' by Chris Case, John Mandrola & Lennard Zinn. It's written for sports people who develop heart rhythm problems and as well as understanding the condition more you will realise that you are not alone, and in fact share this condition with many of us who have exercised a lot throughout our lives. My sport of fell-running is littered with them!

Good luck on your journey.

Chris

[Ianc2 in reply to chrisfellrunner]

I agree. This book should be required reading for all triathletes of a certain age. Each Roman Emporer used to have a slave to walk behind them who had to say "remember - you to are human". it wasn't a job with great prospects.

[Jajarunner]

I've had two Afib episodes and been cardioverted both times. Now waiting for ablation. I still run and cycle etc though I'm not at eyeballs-out type!

My cardiologist said it's high amounts of high intensity stuff which can trigger Afib in athletes not just general stuff. They like you to be fit so the heart is stronger to deal with the Afib.

I spent several months mentally beating myself up over 'causing' my own Afib because of careless comments from people that like to see you brought low when you are fit. Now it seems it is triggered by something unrelated.

Please do not lose hope. You will be able to train again with sensible precautions.

Good luck

[Bellaheart]

Hi. I would highly recommend you go and see Prof Derek Connelly at Glasgow Royal. (He has just performed my ablation at the Royal Jubilee Hospital, centre of excellence.) even if you don’t see him at your consultation the EP consultants are great. I am two weeks post ablation and fairly well back to normal (even did my 7 minute cardio workout this morning!). Whatever happens you will get good advice at how to progress. I had PAF, kept well in check with sotalol, for 15 years (now 67) and was put on anticoagulants at 66 (female). I was not happy as I am a very active person but they really aren’t as bad as you think. Good luck

[tridye in reply to Bellaheart]

Hi Bella, Thanks for your response. I'm struggling to find a Glasgow-based specialist EP via my internet searching.

[Bellaheart in reply to tridye]

I saw Dr Gillian Marshall at the arrhythmia clinic at the Royal first. She was great and very positive.

[chenstone18]

Great comments above and i echo them all. Couple of things that may help as i have found them too myself. I have found that a slower than normal warm up essential as i have found if i go out quick and hard on the bike or on a run it trips into af within the first ten mins. It takes the heart longer to adjust. Second look at your diet and eat foods high in Magnesium or take supplements as advised on here and get a blood test for vitamin and mineral deficiency. It could be that there is a route cause that triggers it like inflammation particularly gut related or an over sensitive vagus nerve. There is hope but it is devastating to have something you love and that has given you such good health to be taken away from you. One last thing try decreasing your max heart rate by 10 to 15% and not allowing yourself to go past that. I know that will be really hard as it is for me but over exertion is a major cause and i have found its not necessarily during exertion but can be 24 hours later. Get informed, stay positive, dont give up exercise, stay fit.

[Morzine]

Awe yes we all felt like you,I’d get a private consultation....you wil feel more positive if you’re in the way to a solution,

Everything sajd below is correct,,,,,anticoagulants are no big deal,you won’t bleed uncontrollably,they are much more modern these days......it’s only a tablets d helps prevent the stroke risk......

Chin up! Yes a huge blow as the word heart freaks us all, but as time goes along you will see it’s not the mountain it seems now......it becomes a molehill.

Sue

[Moazz]

Hi, There is a well written book "The Haywire Heart

" How too much exercise can kill you, and what you can do to protect your heart

By Chris Case, Dr. John Mandrola, Lennard Zinn

It was recommended by Dr Ford Brewer on his youtube channel Who developed Afib and he gives some good information in his videos. In the book it recommends to reduce the intensity and volume especially intensity. Keep max heart rate below your max heart rate for your age . I am following this advice and have continued to train a few times a week for the past year and haven't had a recurrence of the flutter. I experienced heart flutters when running on elliptical machine for over an hour in gym at over max heart rate for over an hour for several consecutive days. I diagnosed I had "pvc" (premature ventricular contractions) but they have diminished in occurrence over the past year. Initially I suspected Afib but it was a "pvc" but keeping intensity low and not overdoing volume has allowed me to continue training without a recurrence of any flutters whilst training so far. I would recommend reading the above book.

[MaxfieldP in reply to Moazz]

Hi Moazz, thank you for suggesting the book ("The Haywire Heart..."). I bought it at Amazon US, Kindle format and audiobook for US$ 10. You are right: every hard training person and athletes should read it.

[Jajarunner]

Also the meditalk podcast on afib was brilliant and took away most of my fear. Just search for it on google or a podcast provider.

[flecathletics]

In brief - I'm now 68 years old, diagnosed with AFib and flutter just over two years ago by two cardiologists, went to an EP and had an ablation just for the flutter. This worked well for around 6 months when the flutter returned. After 3 months wait had another ablation in March last year and things are OK so far. Was fell running and lots of XC and road running (range of just under 20 minutes for 5K to around 1:35/1:40 for half marathon.) Have been through a slow steady process of regaining fitness, looking at heart monitor, reducing alcohol intake, taking magnesium and resetting my goals, plenty of rest is important to me. In particular I've avoided hilly runs so no more fell racing for now. Nevertheless I've surprised myself with recent times of 20:28 for 5K and 1:46 for half marathon despite not pushing it, i.e. turning on the afterburners. My private theory is that low level flutter had been there unnoticed for a long time and had been inhibiting my running - with that out of the way I can now enjoy competition again at a reasonable level for my age. Oh and I do take the anti-coagulant twice a day (apixiban).

[jondeanp]

I was diagnosed at age 45. I had lots of concerns and questions like yourself. After a couple of cardioversions i had an ablation which has been a success.

The couple of things i try and keep on top of is taking Magnesium Taurate regularly and ensuring i stay hydrated using electrolyte tablets, particularly after exercise.

Seriously consider the anticoagulants though, especially while you are in arrhythmia. Since my ablation i am not on any meds.

All the best

[Mjlarson11]

I am 63 years old cyclist and just got diagnosed in December. I am in persistent AFIB but do not have any symptoms (shortness of breadth, fatigue etc) other then the high heart-rate. My cardiologist put me on a blood thinner and a rate control drug. Like others have said, the blood thinner is critical to preventing strokes...this is not something I would ignore. The Cardilogist also recommended that I limit (for now) my exercise to (4) hours week at an average HR of 140. Unfortunately even with the rate control drug, my HR still gets to 140 bpm quickly so my bike speed/power output is 35% less then it used to be. I will see the cardiologist again next month when we will discuss next steps and other options like ablation.

iI also would not beat yourself up about what you may have done to cause this. I have been riding with a large group of age 60+ cyclists and none of them have AFIB and most of them train harder then me. There are a number of possible reasons for AFIB - for me it may be a family thing.

One more note....if you do end up taking a blood thinner and continue to run/bike, read up on falls and internal bleeding risks and the need to follow up with a doctor if this happens to you.

[cuore in reply to Mjlarson11]

You say you are in "persistent" which means you have AF all day every day. December to early February is two months plus February to March to see your cardiologist is another two months. And, you do not know how many months you have been persistent before that. "AF begets AF." The more you are persistent the more AF you will get. While in persistent , time is of the essence.

Since you mention ablation, you might want to read a paper by Dr. M. Haissaguerre (inventor of the modern ablation technique) who describes how the rogue signals travel beyond the pulmonary veins resulting in AF spreading to targeted areas of up to 4 targeted areas at the six month stage persistent, and more beyond that. The longer you remain in persistent, the less your chance of success. At the 12 month stage, you are in long-standing persistent resulting for ablation, your heart having extensive ablation (burning for scars to form).

afsymposium.com/library/201...

So, if you want to return to sinus, get a referral to an electrologist as soon as possible. Cardiologists are NOT the experts in persistent AF, and they are NOT trained to perform ablations.

In my case, the "system" promoted me to get into persistent and was keeping me in persistent. You appear to be following the same route. Consequently, I took matters into my own hands, but I had to have three ablations so far. But most importantly, had I not had the first ablation at the 6 month persistent, I never would have been able to return to sinus. (I seem to have a very uncooperative body.) Your time right now in persistent is precious. If you want to return to sinus, I strongly suggest you not waste it. Good luck!

[Mjlarson11 in reply to cuore]

Thanks Cuore - I should have said my electrologist - not cardiologist. Good to point this out to others re the difference!

[cuore in reply to Mjlarson11]

Hmm. I do now wonder if you interchanged paroxysmal AF with persistent AF. If you are in paroxysmal AF, time is not of the essence, hardly as much. If you are in persistent AF, it is surprising that your electrophysiologist did not try to chemically convert you ( he prescribed a rate control drug and not an anti-arrhythmic drug), or set up an appointment for an electrical cardioversion. It is surprising that your electrophysiologist is letting you remain in persistent for so long (4 months+) if "options like ablation" is one of the target goals being considered.

Since you just got diagnosed in December, a mere two months ago, you may not have had the time to grasp fully this condition. It would be beneficial for you to read up on what is going on in your body, or even consult another electrophysiologist who might have a different angle on the problem. Do keep in mind "AF begets AF."

[thumpthump]

Hi, welcome.

Firstly, I felt exactly how you did. I’m 38 and and in excellent health, eat well, train hard, zero alcohol or smoking.

From what I’ve learnt very quickly, AFib is not always an unhealthy person’s condition and sadly can also be the result of intense cardio training (something I’ve probably done too much of). The irony eh?

I’ve also learnt it’s unlikely to go away now it’s been diagnosed so you must accept this and be practical in how you chose to handle it. I chose to ignore for a while in hope but it starts to interfere.

For me I went straight for an ablation as I was fortunate enough to be a suitable candidate and have private medical insurance (Vitality). Currently in recovery 2 weeks post operation....so far so good.

Ive not needed to take any heart meds regularly (although I am prescribed some in case I need them) but am taking an anticoagulant (Rivaroxaban 20mg) without any side effects. It’s important you consider taking something like this until you decide what to do as it will help protect against stroke risks.

Take care 👍

[Hidden]

I have found that once you find out what is triggering your afib, you can do any amount of exercise without a problem. Could be that dehydration is causing you problems - make sure you drink lots of water when exercising. Here is what I have found - you might want to give it a try:

------------------------------

After 9 years of trying different foods and logging EVERYTHING I ate, I found sugar (and to a lesser degree, salt – i.e. dehydration) was triggering my Afib. Doctors don't want to hear this - there is no money in telling patients to eat less sugar. Each person has a different sugar threshold - and it changes as you get older, so you need to count every gram of sugar you eat every day (including natural sugars in fruits, etc.). My tolerance level was 190 grams of sugar per day 8 years ago, 85 grams a year and a half ago, and 60 grams today, so AFIB episodes are more frequent and last longer (this is why all doctors agree that afib gets worse as you get older). If you keep your intake of sugar below your threshold level your AFIB will not happen again (easier said than done of course). It's not the food - it's the sugar (or salt - see below) IN the food that's causing your problems. Try it and you will see - should only take you 1 or 2 months of trial-and-error to find your threshold level. And for the record - ALL sugars are treated the same (honey, refined, agave, natural sugars in fruits, etc.). I successfully triggered AFIB by eating a bunch of plums and peaches one day just to test it out. In addition, I have noticed that moderate (afternoon) exercise (7-mile bike ride or 5-mile hike in the park) often puts my Afib heart back in to normal rhythm a couple hours later. Don’t know why – perhaps you burn off the excess sugars in your blood/muscles or sweat out excess salt?? I also found that strenuous exercise does no good – perhaps you make yourself dehydrated??

I'm pretty sure that Afib is caused by a gland(s) - like the Pancreas, Thyroid (sends signals to the heart to increase speed or strength of beat), Adrenal Gland (sends signals to increase heart rate), Sympathetic Nerve (increases heart rate) or Vagus Nerve (decreases heart rate), Hypothalamus Gland or others - or an organ that, in our old age, is not working well anymore and excess sugar or dehydration is causing them to send mixed signals to the heart - for example telling the heart to beat fast and slow at the same time - which causes it to skip beats, etc. I can't prove that (and neither can my doctors), but I have a very strong suspicion that that is the root cause of our Afib problems. I am working on this with a Nutritionist and hope to get some definitive proof in a few months.

Also, in addition to sugar, if you are dehydrated - this will trigger AFIB as well. It seems (but I have no proof of this) that a little uptick of salt in your blood is being treated the same as an uptick of sugar - both cause AFIB episodes. (I’m not a doctor – it may be the sugar in your muscles/organs and not in your blood, don’t know). In any case you have to keep hydrated, and not eat too much salt. The root problem is that our bodies are not processing sugar/salt properly and no doctor knows why, but the AFIB seems to be a symptom of this and not the primary problem, but medicine is not advanced enough to know the core reason that causes AFIB at this time. You can have a healthy heart and still have Afib – something inside us is triggering it when we eat too much sugar or get (even a little) dehydrated. Find out the core reason for this and you will be a millionaire and make the cover of Time Magazine! Good luck! - Rick Hyer

PS – there is a study backing up this data you can view at:

https//cardiab.biomedcentral.com/a...

[MaxfieldP]

Hi Trydye ! Be welcome. I am 73. I had my first AFIB episode during a mountain running competition, when I was 66. I ran 8 km uphill and had to walk slowly the downhill part. I was triathlete between 50 to 57, age group. I've been jogging and running since I was 30. Biking, mountain bike, all my adult life. During the last 4 years of my active outdoor life I did mountain running. And so, I had Paroxysmal AFIB. And, at the same time, my knees were worn out.

Thinking about AFIB, I am almost sure I really pushed my body and, specially, my heart, a little far from the safe limits. Curiously, as far as I can remember, the occasions that I was worried about pushing my heart to the limit was during some strenuous mountain bike weekend training with younger (better shape) friends.

Back to AFIB, mine is (was, I hope...) paroxysmal. Episodes from 15 minutes to 2 hours.

Trying to understand my AFIB condition I bought a device for recording 30 seconds ECG (one channel) and I recorded about 200 AFIB 30 seconds events in the last 5 years. The device is a PC-80B Easy ECG Monitor. Excellent. I bought also some books on ECG. And saw some online courses on ECG.

I saw 6 physicians and had an indication for ablation, which I didn't because I chose to try medications first. The last cardiologist I saw (January, 2019) gave me anticoagulant (rivaroxaban), a betablocker and pills for cholesterol and high pressure. But the "doctors" generally don't have time or disposition to make a real follow-up case by case (I am talking about Brazilian conditions...I am Brazilian and I live in Fortaleza, Ceara). And AFIB is still not well understood. You need to monitor and understand the parameters of your own AFIB.

Betablockers (bisoprolol, the worst for me and nebivolol, a little better...) transformed my AFIB on a lot of ectopic beats (PVC). On betablockers my nights were difficult because I could not sleep on the left side. If I lay on the left, ectopic beats began in 2 or three minutes. Betablockers gave me bradycardia (pulse 46-48) and my pulse didn't rise enough during exercises. Even in very low doses.

At indoor biking at the gym, I tried to push myself to the limit and my pulse raised only to 85-90. Meantime, I think I discovered my AFIB trigger: it is something in the chemistry of the beer. It is not the alcohol. It is a chemical preservative in the (Brazilian's ??) beer. I drank only occasionally and just a little. Today I quit completely the beer. Since I needed desperately to make some aerobic exercise, I quit also the betablocker. Results: my heart is back to normal: without ectopic beats and without AFIB. The response to aerobic exercises is perfect. Today I am doing some spinning bike sessions, at gym, of 45 to 60 minutes, rising my pulse to the limit I feel safe. By "official" tables for my age, 73, the maximum is about 150. Today, without beta blockers, I am comfortable (vigorous but not maximum) with 140-145 bpm.

Today I take anticoagulant and pills for cholesterol and high pressure (which I am not sure I need). I take also ZMA, for magnesium. The anticoagulant makes outdoor cycling not recommended because of the risk of fall. Anyway, I am old and cant broke a bone or beat my head.

Now I am without AFIB or PVC for 60 days. I am beginning to think that my AFIB was gone. Why? I don't know exactly. But since I quit the beer and the betablocker, I am free from AFIB. I will wait more 60 or 90 days and, if nothing happens, I will quit the anticoagulant. I have a lot of documentation of my case: about 200 ECG - AFIB episodes (30 sec) recorded, treadmill testes, 24 hours Holter and blood pressure monitoring.

Sorry for the long post, but I think I have the responsibility to share my experience with others in same situation. And pardon for the bad English.

Think positive and go on.

[Duddles]

Hello - I think there is light at the end of the tunnel. I was playing regular football into my fifties, and also did racewalking - mostly training for long distance races, in particular a race over 85 miles non-stop. I developed AF in 2008 aged 62 and carried on with tablets until 2011. I then had an ablation operation at the excellent Heart Unit at Broadgreen in Liverpool and that seemed to do the trick. Now aged 73, I have this morning had a full game of 11-a-side football, am back racewalking and though I have not been able to finish the 85 mile race in recent years, I do get to about 70 miles before my back gives in.

I have also taken up running again - starting a few years ago with the Couch to 5k NHS app, and now run two or three times a week, and cycle a couple of times a month.

I have a Flecanide 'pill in the pocket' which I rarely need to use. The downsides are that I have occasionally gone out of synch if I start off too quickly, without warming up properly. I have learned to start slowly and build up speed. In a walking race last week I went 'out of synch' for that very reason and had to abandon the race. I always have a Garmin watch on to show my heartbeat, because you cannot always tell.

And I am about to get an electric bike to help with my road cycling, just to use on the extreme hills where I live (the Isle of Man) as I feel cycling on hills is sometimes an exertion too far.

So bottom line, if you can get the ablation procedure, your sporting life can return to near normal.

Never give up!